bluuebunny/crossref_metadata_2025 huggingface dataset:
Palliative care in heart failure
Authors: Slawnych Michael
Published: January 2022

The landscape of heart failure has changed dramatically over the course of the last several decades, with patients now having access to medical and device treatment options not available in the past. As a result of these advances, heart failure patients are living longer. However, many patients will still face clinical decline. When this occurs, these patients generally do not have insight with respect to their overall poor prognosis. Importantly, patients with advanced heart failure are more likely to die in hospital than other groups such as cancer patients. Palliative care is infrequently involved in the care of heart failure patients. There are several contributing factors for this, including prognostication challenges. There is an opportunity for all physicians to embrace palliative care principles and to reach out for specialized palliative care services when needed.
Cirrhosis and diseases of the gastrointestinal tract
Authors: Hiebert Tim
Published: January 2022

Cirrhosis is the end result of a wide variety of chronic progressive liver diseases. Unless treated by liver transplant, end-stage liver disease (ESLD) is a life-limiting illness with greatly diminished life expectancy and is associated with a significant symptom burden, including pain, pruritus, and confusion, as well as social isolation, stigma, and diminished quality of life. Other gastrointestinal diseases, including chronic pancreatitis, bowel ischaemia, and gastroparesis, while chronic in nature, are life-threatening illnesses leading to significant patient suffering and warrant a palliative approach. This chapter will review the prognosis, most common complications, and symptoms associated with cirrhosis, pancreatitis, and other debilitating diseases of the gastrointestinal tract. In addition, the impact of stigmatization in ESLD, as well as of incorporating a palliative approach into the care of patients awaiting liver transplant, will be discussed.
Maps and Place
Authors: Eve Martin Paul
Published: January 2022

This chapter pertains to place and maps. The ‘spatial turn’ in the humanities—exemplified in the work of scholars as far apart as Jo Guldi and Robert Tally Jr—draws our attention to how literary texts structure their senses of place. From J. R. R. Tolkien to W. G. Sebald via the Hundred Acre Wood, literary works have often included maps within their pages. Yet such topoi sit distinct and apart from the extra-textual world, even when such places are represented therein. This chapter introduces the reader to the variety of approaches that have been undertaken in the Geographic Information Systems (GIS) space. It begins with a theoretical background to ideas of literary space before moving to a showcase of various projects and their accomplishments
Conclusion
Authors: Eve Martin Paul
Published: January 2022

This conclusion remarks on the future of digital literary studies and their place in the discipline of English. Covering subjects such as the ‘explainability turn’, this chapter also considers the pedagogical implications of using statistical methods in our discipline and the future training implications for students. Finally, as throughout the book, this chapter suggests that digital methods are no more alienating than any other form of critical approach. They can, instead, offer us a route by which to reappraise literary works in the light of new knowledge.
Telamonian Ajax
Authors: Bocksberger Sophie Marianne
Published: January 2022

This monograph provides a complete overview of the development of Telamonian Ajax’s myth in archaic and classical Greece. It is a systematic study of the representations of the hero in all kinds of media, such as literature, art, or cultic practice. It establishes how and why the constitutive elements of Ajax’s myth evolved by examining the way the literary works and visual representations in which he features were influenced by the historical, socio-cultural, and performative contexts of their receptions. The political valence and religious dimension of the hero as well as the audience for which each work was produced are consistently taken into account. The study focuses on three main loci of reception: (1) the Panhellenic figure of Ajax, through a study of early Greek hexameter poetry and archaic art, (2) archaic and classical Aegina, and (3) archaic and classical Athens. By following in the footsteps of Ajax, this study offers a journey across the archaic and classical history of the Saronic Gulf, and exemplifies the manner in which the respective priorities of art, cult, and politics could be negotiated through the re-configuration of mythological figures.
The Organic Intellectual
Authors: Abi-Saab Georges
Published: January 2022

The essay calls on the Gramscian concept of ‘organic intellectual’—who introduces new ideas or theories in society and transforms them into current social practice—to portray the lifelong struggle of Philip Alston for human rights and more particularly his efforts at buttressing and mainstreaming economic, social, and cultural (ESC) rights. These efforts follow what looks like a three-prong strategy aiming at: (a) heightening the efficiency of the institutional framework within which they are further elaborated, and their implementation monitored, through better communication, coordination, and harmonization of the work of diverse UN family organs that deal with them; (b) shedding light on their intrinsic legal characteristics and the legal means to effectuate and protect them, thus rendering these rights and corresponding obligations more palpable, hence operable and justiciable; and (c) exposing egregious violations and deprivation of ESC rights and their causes which can be traced back to certain current macroeconomic policies—together with a constant effort at dissemination and outreach, particularly through important press coverage, to public opinion at large.
A Duty to Negotiate in Good Faith as Part of the Duty to Cooperate to Establish ‘An International Legal Order in which Human Rights can be Fully Realized’
Authors: De Schutter Olivier
Published: January 2022

The Declaration on the Right to Development refers to the duty of states to ‘co-operate with each other in ensuring development and eliminating obstacles to development’, and the extraterritorial human rights duties of states have gained visibility in recent years. Such duties include the conclusion of conventions, which the International Covenant on Economic, Social and Cultural Rights explicitly refers to. This chapter explores whether such a duty is enforceable. It argues that, whereas states have a sovereign right to choose whether or not to conclude an international agreement, they may be obliged to negotiate in good faith with a view to reaching a satisfactory agreement, in circumstances where the realization of human rights requires international cooperation. Far from being purely rhetorical, such a duty requires that the state put forward proposals, with a view to strengthening international cooperation, that are both sufficiently concrete and ‘reasonable’. This means in particular that in the distribution of the burdens and benefits, such proposals should take into account the principle of common but differentiated responsibilities and respective capabilities.
Dilemmas Facing Commissions of Inquiry
Authors: Clapham Andrew
Published: January 2022

This contribution focuses on Philip Alston’s contribution to the world of commissions of inquiry. It considers a number of dilemmas faced by such Commissions related to determining when an armed conflict starts and ends, the particular human rights law to apply, distinguishing violations from abuses, considering whether to warn interlocutors that they may be incriminating themselves, weighing whether to issue a letter of cooperation, and determining who should have access to the information gathered by a commission. It is argued that scholars should heed Alston’s call to pay more attention to the new generation of fact-finding mechanisms which, in his words, have ‘been largely neglected as an area for sustained exploration, critique, and refinement’.
Should Human Rights Practice be Rights Based?
Authors: Knuckey Sarah , Satterthwaite Margaret
Published: January 2022

Human rights scholars and organizations often call on governments to adopt ‘human rights-based approaches’ (HRBAs) to many policy areas, from climate change to health policy. HRBAs identify rights and obligations, and advance the principles of participation, accountability, equality, and non-discrimination. This chapter argues that HRBAs have been exported to many fields without ever being sufficiently integrated within human rights advocacy. We find that NGOs often fail to adhere to foundational human rights principles in their own work, reproducing unjust power hierarchies, objectifying victims, and disempowering rights-holders. Were HRBAs adopted by more human rights organizations, the face of human rights advocacy would change—often dramatically. We conclude with questions that could guide human rights practitioners and scholars to advance reform.
Alston in Alabama
Authors: Mégret Frédéric
Published: January 2022

Starting from Alston’s visit in the United States as Special Rapporteur on Extreme Poverty and Human Rights, this chapter interrogates that moment as an illustration of what it means to engage in international human rights work in the world today. It thus foregrounds a notion of human rights praxis as distinct from human rights law or theory. That notion of a praxis is tested against well-known critiques of human rights, namely their tendency to engage in politics without saying so and, more specifically, of not having much to say of substance about fundamental economic inequality. The praxis of human rights, as illustrated by Alston’s own work, is both vulnerable to these critiques and an implicit response to them. The chapter shows how to engage in human rights is simultaneously to performatively construct one’s authority to do so whilst insisting on human rights’ relevance. This brings Alston dangerously close to taking on fundamental questions of political organization that under a liberal view of rights might be thought off-limits and render his own authority precarious. Yet the chapter suggests that in the best of cases a considered and strategically informed praxis of human rights can make the best of bad situations, elevate the debate, and recapture some of the original indignation about injustice that goes at the heart of human rights. It does so both thanks to and despite the contradictions of rights discourse.
From Aristotle to Cicero
Authors: Striker Gisela
Published: January 2022

This collection draws together a selection of Gisela Striker’ essays on ancient philosophy published over a period of forty years. There is first a series of papers on Aristotle’s logic, complementing her translation and commentary on Aristotle’s Analytics book I, two of them translated from German. These are followed by three essays on Aristotle’s ethics and moral psychology and a short paper on his metaphysics. The last five chapters include studies on Hellenistic philosophy, three on epistemology and two on ethics. Three of these essays have not been published before.
Mental Disorders Involve Limits on Control, Not Extreme Preferences
Authors: Sripada Chandra
Published: January 2022

According to a standard picture of agency, a person’s actions always reflect what they most desire, and many theorists extend this model to mental illness. In this chapter, I pin down exactly where this “volitional” view goes wrong. The key is to recognize that human motivational architecture involves a regulatory control structure: we have both spontaneous states (e.g., automatically-elicited thoughts and action tendencies, etc.) as well as regulatory mechanisms that allow us to suppress or modulate these spontaneous states. Our regulatory abilities, however, are bounded. Mental illnesses, I argue, arise precisely where these bounds are reached, thus allowing inappropriate spontaneous states to regularly manifest in thought and action. I conclude that the volitional view of mental illness is wrong: when a person with mental illness reaches the limits of control, what they do often does not reflect what they most prefer.
Immaterial
Authors: Irvin Sherri
Published: January 2022

Contemporary art can seem chaotic: it may be made of toilet paper, or candies you can eat, or meat that is thrown out after each exhibition. Some works fill a room with obsessively fabricated objects, while others purport to include only concepts, thoughts or language. I argue, through many examples, that disparate developments in installation art, conceptual art, time-based media art, and participatory art can be understood in terms of custom rules. Many artists articulate custom rules governing artwork display, preservation of material elements, and interactivity or audience participation. Rules are established through the artist’s sanction: the creative act of designating the material elements and rules that constitute the work’s structure. Rules serve as medium: they are part of the work’s structure and help to constitute its meanings. Rules are meaningful in themselves, and they help to activate the expressive potential of material objects. Museum practice should include providing information about the rules; otherwise, audiences can’t fully appreciate the work. Contemporary art conservation involves preserving information: loss of information about the rules, like loss of a chunk of marble, can seriously damage the work. Rules are trickier to pin down than material objects and are subject to violation, so we’ll examine the effects on the work’s integrity and authenticity when things go wrong in various ways. Is the emergence of custom rules a positive development? Some artists have used rules to powerful effect. But rules aren’t always used well: bad art can take any form.
Parmenides
Authors: Sorensen Roy
Published: January 2022

Despite isolation from China and India, the Greeks simultaneously switch attention from what is to what is not. This suggests that the switch from positive to negative philosophy is a scale phenomenon. When the Chinese and Indians achieved critical mass, they viewed the vista of nothingness as an opportunity. Extra room! The Greeks are instead horrified by the void. They look down at the abyss. The abyss looks back with the l'appel du vide. Parmenides inaugurates a twenty-five-hundred-year project to close our eyes to absences in all their chameleonic guises: shadows, motion, plurality. Logicians, mathematicians, and contemporary physicists continue their effort to prove that reality is entirely positive. ‘The pail has a hole’ is just a misleading way of describing the shape of the container. Or it expresses disappointment with the pail or conveys a warning. Once a metaphysician completes an inventory of all the positive things, he is done characterizing the nature of the universe.
Anaxagoras
Authors: Sorensen Roy
Published: January 2022

The hitch to Parmenides’s project is that people tend to believe their senses. This inspires compromises in which reality is permitted to change and have a population of more than one object. Anaxagoras asserts what Nagarjuna merely supposes: each object is composed of other objects without limit. Furthermore, each component contains every type of object as subcomponents. Since everything is in everything, there are no relative absences. The closest approximation to an absence is scarcity.
Leucippus
Authors: Sorensen Roy
Published: January 2022

Greek atomists originally picture the universe as a plenum, filled with atoms. Leucippus innovates by allowing atoms to move through empty space. Even dense objects contain empty space. The void is an arena for a vast number of entities that each resemble Parmenides’s One. These little ones change location, collect to form familiar objects. All of these composite objects are doomed to destruction. But their constituent atoms are immortal. Indeed, they are as beginningless as they are endless. In contrast with Buddhism, all the atoms are material objects. Mental phenomena are emergent properties from composite objects.
Intrinsic and Extrinsic Motivations for Music Performance
Authors: Evans Paul , Ryan Richard M.
Published: January 2022

Abstract: Performing music is both a joy and a discipline. In this chapter we review the basic tenets of Self-Determination Theory (SDT) as they apply to developing interest and expertise in music performance, and the growing evidence concerning how parents, educators, mentors, and professional pressures can facilitate or undermine musicians’ enjoyment, persistence, and performance. SDT provides a framework for understanding both the intrinsic and extrinsic motivations that underlie music performance, and their dynamics in educational and professional contexts. Applying the theory, we discuss the near-universal, intrinsically motivated nature of performing music, and why some individuals develop that interest into an identity or vocation. In addition, SDT provides a framework for understanding extrinsic motivation in performance contexts, including how performers internalize the motivation to persist at the less intrinsically enjoyable but nonetheless essential aspects of learning and practice. The theory argues that both intrinsic motivation and internalization are strongly affected by the fulfillment of basic psychological needs, which can be supported by teachers and mentors. We review evidence on this idea and discuss the implications of such research in the context of music education and music performance. Finally, we highlight some areas in need of more refined research and evidence-based interventions in this important domain.
Art, Music, and Literature: Do the Humanities Make Our Lives Richer, Happier, and More Meaningful?
Authors: Westgate Erin C. , Oishi Shigehiro
Published: January 2022

For many, there is little more rewarding than the feeling of curling up with a good book, wandering a famous art gallery, or listening to a favorite musician perform live in front of an audience. But do the arts, music, and literature actually make our lives happier, richer, and more meaningful? The authors suggest they do. In this chapter, they review empirical evidence for the psychological benefits of the humanities, including art, music, and literature, and find that across a wide variety of samples, exposure and engagement are consistently linked to greater well-being. In particular, they suggest that the humanities may increase well-being directly by providing people with enjoyable, rich, and meaningful experiences, as well as indirectly by fostering skills and abilities that contribute to psychological well-being in the long term. These approaches map onto two mechanisms: (1) direct affective benefits that create enjoyable, rich, and interesting experiences, and (2) indirect cognitive benefits, including social abilities and motivations that promote subjective well-being via interpersonal connection and self- and emotion-regulation. Art, music, and literature may not only provide temporary nourishment for a good life, but also teach people lasting skills they can capitalize on to increase long-term well-being.
Introduction: The Role of the Arts and Humanities in Human Flourishing
Authors: Tay Louis , Pawelski James O.
Published: January 2022

The Positive Humanities are an emerging new field of inquiry and practice concerned with the relationship between the arts and humanities and human flourishing. The first half of this chapter introduces the work of the Humanities and Human Flourishing Project (HHF), a growing international and multidisciplinary network of scholars, researchers, and creators that the editors of this volume have led since 2014 with the aim of establishing the Positive Humanities as a robust field. Among other endeavors, HHF has conducted literature reviews, developed and refined a conceptual model, created and validated a toolkit of measures, and identified five key psychological mechanisms connecting the arts and humanities to human flourishing: reflection, acquisition, immersion, socialization, and expression (RAISE). The second half of this chapter introduces the six parts of this Handbook: overview of the Positive Humanities, historical and current trends, flourishing outcomes, pathways from arts and humanities engagement to human flourishing, disciplinary considerations, and public engagement and policy. The aim of the various parts of this Handbook is to bring together theoretical, empirical, and applied work to advance the understanding of the range of effects that engagement in the arts and humanities can have on human flourishing. The editors hope this seminal volume will encourage continued cross-cultural and multidisciplinary work in the Positive Humanities.
Emotional Development Across Cultures
Authors: Broesch Tanya , Carpendale Jeremy
Published: January 2022

The biological characteristics of human infants set up a developmental trajectory toward forming emotional attachments with caregivers. The caregiver–infant system sets the stage for later development and learning through these early interactions in a bidirectional manner. This system is common across cultures and social contexts, and therefore we see similar emotion recognition, production, and communication across diverse contexts in the first few years of life. Yet, differences emerge in how caregivers respond to infants and shape their expressions. This can be seen in cultural display rules—that is, the expression of emotion based on social norms. The authors argue that emotions ground communication, specifically through a process of mutually shared enjoyment (species-specific), and also develop in complexity as children learn words to describe and then reflect on emotional experience. This chapter provides an overview of emotion development drawing on cross-cultural research.
Play and Games
Authors: Zaharia Alexandra , Dell'Angela Linda , Sander David , Samson Andrea C.
Published: January 2022

This chapter examines the mechanisms through which play may contribute to emotional development. First, the authors discuss different types of play that can be identified across developmental stages. Second, the chapter focuses on the emotional benefits of play and its potential role as a protective factor against the manifestation of psychopathologies. Next, it specifically refers to the experience of positive emotions and to emotion regulation, which are triggered in play, as key elements for adaptive emotional functioning. Furthermore, the authors characterize board games as a particular type of play that holds powerful learning value through their design and mechanics. Finally, the chapter briefly summarizes the first study to date to examine theory-driven board games that were explicitly designed to support emotional competences in school-age children.
Introduction
Authors: Maus Fred Everett
Published: January 2022

Academic study of LGBTQ issues in relation to music became prominent in the early 1990s, developing in close connection to and with support from initiatives in feminist music studies. At that time much of the research centered on Western art music (WAM); the research topics mostly concerned white people and researchers were mostly white. The scope of the field has expanded greatly since then, with ongoing research on WAM, extensive work on white popular music, a valuable and rapidly-growing literature on Black music, and past and present initiatives in ethnomusicology. The term “queer” has a welcome intention of inclusiveness, along with some complexity in its meanings. Individual authors for this Handbook chose whether and how to emphasize the word. The Handbook departs decisively from the older academic habit of treating WAM as central, instead including many different musics, understood from many perspectives. Sections of the book reflect several rhetorics of queer music studies: chapters address kinds of music, queer versions, queer voices and queer sounds, queer lives, queer music histories, and cross-cultural queerness.
Metal–insulator transition in the (2+1)-dimensional Hubbard model with the tensor renormalization group
Authors: Akiyama Shinichiro , Kuramashi Yoshinobu , Yamashita Takumi
Published: January 2022

We investigate the doping-driven metal–insulator transition of the (2+1)-dimensional Hubbard model in the path-integral formalism with the tensor renormalization group method. We calculate the electron density 〈n〉 as a function of the chemical potential μ, choosing three values of the Coulomb potential with U = 80, 8, and 2 as representative cases of the strong, intermediate, and weak couplings. We determine the critical chemical potential at each U, where the Hubbard model undergoes the metal–insulator transition from the half-filling plateau with 〈n〉 = 1 to the metallic state with 〈n〉 > 1. Our results indicate that the model exhibits the metal–insulator transition over a vast region of the finite coupling U.
Sleep in the time of COVID-19: findings from 17000 school-aged children and adolescents in the UK during the first national lockdown
Authors: Illingworth Gaby , Mansfield Karen L , Espie Colin A , Fazel Mina , Waite Felicity
Published: January 2022

Study Objectives

Sleep is essential to young people’s wellbeing, yet may be constricted by the adolescent delayed sleep phase coupled with school start times. COVID-19 restrictions caused major disruptions to everyday routines, including partial school closures. We set out to understand changes in students’ self-reported sleep quality, and associations with mental wellbeing and interpersonal functioning, during these restrictions.

Methods

The OxWell school survey—a cross-sectional online survey—collected data from 18 642 children and adolescents (aged 8–19 years, 60% female, school year 4–13) from 230 schools in southern England, in June–July 2020. Participants completed self-report measures of the impact of COVID-19 restrictions on sleep quality, happiness, and social relationships. Sleep timing was compared with data collected from 4222 young people in 2019.

Results

Females and older adolescents were more likely to report deteriorations in sleep during the national lockdown. Regression analysis revealed that changes in happiness (β = .34) and how well students were getting on with others in their household (β = .07) predicted change in sleep quality. Students’ bedtimes and wake times were later, and sleep duration was longer in 2020 compared to the 2019 survey. Secondary school students reported the greatest differences, especially later wake times.

Conclusions

During COVID-19 restrictions, sleep patterns consistent with adolescent delayed sleep phase were observed, with longer sleep times for secondary school students in particular. Perceived deteriorations in sleep quality were associated with reductions in happiness and interpersonal functioning, highlighting the importance of including sleep measures in adolescent wellbeing research.
The key to successful NP transition to practice
Authors: Cappiello Joyce D. , Boardman Maureen B.
Published: January 2022

This article explores the experiences of the new NP's onboarding process based on data from two qualitative studies. Interviews with 27 new graduates were used to inform the design, implementation, and experience of an onboarding program in a small healthcare setting without robust internal resources or a human resource department.
M1 Macrophage-Derived Interleukin-6 Promotes the Osteogenic Differentiation of Ligamentum Flavum Cells
Authors: Qu Xiaochen , Xu Gang , Hou Xiaofei , Chen Guanghui , Fan Tianqi , Yang Xiaoxi , Chen Zhongqiang
Published: January 2022

Study Design.

Basic experimental study.

Objective.

The aim of this study was to clarify the role of macrophages (Mφs) in the osteogenic differentiation of ligamentum flavum (LF) cells.

Summary of Background Data.

Mφs and secreted factors are involved in the regulation of cell osteogenic differentiation, and play an important role in the process of heterotopic ossification. Whether Mφs are involved in the development of ossification of the ligamentum flavum (OLF) have not been reported.

Methods.

The expression of CD68+ Mφs in ossified LF tissue was identified by immunohistochemical staining. THP-1 cells were polarized to M1 and M2, and identified by flow cytometry and immunofluorescence. The alkaline phosphatase activity and osteogenic differentiation-related gene expression in LF cells were evaluated following incubation with each Mφs conditioned medium (CM). Enzyme-linked immunosorbent assay was used to detect the pro-inflammatory cytokines in the supernatants, and qPCR was used to detect the expression of the corresponding receptors in the LF cells after incubation with the CM. LF cells were induced with CM-M1 in the presence of neutralizing antibodies to further test whether cytokines secreted by M1 Mφs impacted their osteogenic differentiation.

Results.

CD68+ Mφs were found on the OLF samples. THP-1 cells were polarized into M1 and M2, and both M1 and M2 Mφs promoted the osteogenic differentiation of LF cells. The concentrations of tumor necrosis factor (TNF)-α, interleukin (IL)-1 β, and IL-6 in M1 Mφ supernatants were greater than those in M2, and greater levels of these cytokine receptors were observed in LF cells induced with CM-M1 than those with CM-M2. Osteogenic differentiation of LF cells induced by CM-M1 decreased after IL-6 was neutralized; however, not after IL-1β and TNF-α were neutralized.

Conclusion.

M1 Mφ-derived IL-6 promotes the osteogenic differentiation of LF cells, which may be a pathway in which Mφs regulate the osteogenic differentiation of LF cells.
Progress in breast cancer surgical management
Authors: Magnoni Francesca , Corso Giovanni
Published: January 2022

Evolution in breast cancer surgery has been significant over these four decades. Many scientific changes have been reached, impacting daily clinical practise, thanks to scientific research and surgeons’ efforts, always tended to warrant oncological radicality as well improve women quality of life and cosmesis. Achievements in imaging, in breast cancer molecular signature characterization and patients’ genomic profile are progressively refining a sophisticated personalization of breast cancer prevention and treatment. Progress in surgery involves both primary breast site surgery and surgical axillary staging, revealing a strong propensity for a limited surgical approach and technical precision. Multimodal management and individualization are the axioms on which current research on breast cancer prevention and treatment is progressing.
Posterior Amorphous Corneal Dystrophy: New Chromosomal Breakpoints in the Small Leucine-Rich Proteoglycan-Coding Region
Authors: Basbus Federico José , Cremona Federico Andrés , Lucero Saá Francisco , Chiaradía Pablo Alberto , Francipane Liliana , Menazzi Sebastián
Published: January 2022

Purpose:

The purpose of this study was to report the clinical features and describe the results obtained by multimodal corneal imaging of a patient with novel chromosomal breakpoints of the 12q21.33 locus.

Methods:

This study was a case report and literature review.

Results:

A 12-year-old girl presented with visual loss whose examination revealed a best-corrected visual acuity of 20/50 in her right eye and 20/35 in her left eye and corneal flattening and gray sheet-like opacities deep in the stroma. Anterior segment optical coherence tomography and ultrabiomicroscopy showed an evenly distributed hyperreflective line in the posterior stroma. Confocal microscopy revealed enlarged keratocytes and the presence of small reflective deposits from the pre-Descemet line to the endothelium. In addition, a 447-kb deletion that included the small leucine-rich proteoglycan-coding region in locus 12q21.33 was found. She was, therefore, diagnosed with PACD.

Conclusions:

PACD is a rare genetic disorder of the cornea characterized by gray sheet-like opacification of the posterior stroma in combination with corneal flattening. Confocal microscopy provides histologic segmentation of each corneal layer and shows the degree to which they are affected. New chromosomal breakpoints of a deletion in the small leucine-rich proteoglycan-coding region are hereby reported. PACD may be a contiguous gene syndrome, and further tests are required to identify the exact position responsible for the phenotypic variation.
Bridging Didactic Learning and the Complexity of Practice Through Clinical Immersion
Authors: Moore Ginny , Lutenbacher Melanie , Waynick-Rogers Pamela , Wilbeck Jennifer , Raman Rameela , Schorn Mavis N.
Published: January 2022

In this article, we discuss the development and evaluation of the Vanderbilt Nursing Education Program for Sexual Assault Nurse Examiners (VEP-SANE), a 3-day clinical immersion (CI) program, including the lessons learned and the challenges experienced with the completion of two trainee cohorts. To bridge didactic learning and the complexity of practice, the VEP-SANE team designed an innovative, competency-based CI. Fifteen trainees from Cohort 1 and 19 trainees from Cohort 2 met requirements for CI participation. Trainees in Cohort 1 represented the advanced practice registered nurse specialties of emergency, women's health, and pediatrics. For Cohort 2 recruitment, enrollment was expanded to include family and midwifery advanced practice registered nurse specialties. Trainees were required to complete online training modules before CI participation. Online surveys assessed trainee perceptions about levels of knowledge and confidence related to sexual assault nurse examiner competencies (pre/post CI), each CI session, and the overall CI experience. Separate focused discussions were conducted with trainees and faculty after each CI. Both cohorts rated CI sessions as “excellent” or “very good” over 93% of the time. Perceived levels of knowledge and confidence increased from pre-CI to post-CI for both cohorts. Similar CI strengths were identified across trainees and faculty including speakers, high interactivity, safe environment, reality of cases, and surrogate practice. All trainees indicated readiness for preceptorships and interest in a virtual community of practice. Suggestions included more time for laboratory sessions, documenting photos, and interaction with individuals from the lesbian, gay, bisexual and transgender (LGBT) community and presenters. Future efforts focus on CI conversion to a virtual format because of the impact of COVID-19, increased VEP-SANE community of practice interaction, and expanded engagement with practicing sexual assault nurse examiners.
Challenges and Collaborations
Authors: Thomas Tami , Nobrega Juan Carlos , Britton-Susino Sherry
Published: January 2022

Challenges can often only be overcome with collaboration. In this case report of a Health Resources and Services Administration-funded program for Advancing Nurse Education – Sexual Assault Nurse Examiner, we describe the unique challenges and collaborations that have taken place in rural communities as we continued to train nurses during the COVID-19 pandemic. Geography and lack of availability of sexual assault nurse examiner (SANE) trainees brought many challenges as we prepared them to successfully pass the SANE certification examination and recruit new cohorts to expand SANE education.

During the implementation of this program, we found that our process model, community collaboration, and commitment to these rural counties were the keys to our success before and during the COVID-19 pandemic.

SANE trainee process and outcome measures were collected through quantitative and qualitative data collection. These data from the first cohort, along with the strategies implemented as all partners navigated the challenges of COVID-19, helped to strengthen our collaboration and expand the program. Details of these strategies and outcomes to date will be discussed.
Apparent mineralocorticoid excess: A diagnosis beyond classical causes of severe hypertension in a child
Authors: Gulhan Bora , Ünsal Yağmur , Baltu Demet , Çelik Ertaş Nur Berna , Özdemir Gülşah , Utine Eda , Ozcan H. Nursun , Duzova Ali , Gönç Nazli
Published: January 2022

A genetic defect of 11 β-hydroxysteroid dehydrogenase causes apparent mineralocorticoid excess syndrome. Since 50 days of life, our patient was hospitalized several times for various reasons including hypokalemia. At the age of 3.3 years, she was diagnosed with severe hypertension (160/120 mmHg). She also had left ventricular hypertrophy and hypertensive retinopathy and referred to our center. Her renal function and electrolytes were normal except for hypokalemia. She was on captopril treatment; nifedipine and propranolol were added. Plasma renin and aldosterone concentrations were 1.13 pg/ml (1–8.2 pg/ml) and 12.2 ng/dl (35–300 ng/dl), respectively. Severe hypertension, hypokalemia, low renin and aldosterone levels pointed to the diagnosis of apparent mineralocorticoid excess syndrome. Strict salt-restricted diet and potassium citrate were ordered. Genetic analysis of the HSD11B2 gene showed c.623G>A (p.Arg208His). Spironolactone was initiated. On follow-up, amiloride was added and her blood pressure was controlled. In patients with severe HSD11B2 mutation, combination therapy of spironolactone with amiloride could be effective in controlling blood pressure.
New targets for treating hypertriglyceridemia
Authors: Parhofer Klaus G.
Published: January 2022

Purpose of review

Elevated fasting and postprandial plasma triglyceride concentrations are associated with an increased risk for atherosclerotic cardiovascular disease in patients on and off low-density lipoprotein (LDL) lowering therapy.

Recent findings

This association is not mediated by triglycerides directly. Other components of triglyceride rich lipoproteins, such as cholesterol and apolipoproteins B and -CIII can directly induce and enhance atherosclerosis. In addition, an elevated concentration of triglyceride rich lipoproteins affects the concentration, composition, function, and metabolism of LDL and high-density lipoprotein (HDL), which contributes to the risk. Especially in patients with hypertriglyceridemia, apolipoprotein B and non-HDL-cholesterol (encompassing cholesterol of all atherogenic lipoproteins) predict risk better than LDL-cholesterol and/or triglycerides. Therefore, current guidelines have stated secondary goals relating to non-HDL-cholesterol and apolipoprotein B (in addition to the primary goal relating to LDL-cholesterol). These secondary goals can be achieved by further reducing LDL-cholesterol or by decreasing triglyceride rich lipoproteins. However, only further LDL reduction has so far proven to be beneficial in outcome trials. In addition, high dose eicosapentaenoic acid (EPA) can reduce atherosclerotic cardio-vascular disease risk in patients with hypertriglyceridemia, although benefit is not (or not only) related to apolipoprotein B or non-HDL-cholesterol reduction.

Non-HDL-cholesterol and apoB represent novel targets for patients with hypertriglyceridemia, but achieving LDL-cholesterol targets remains the first step for cardio-vascular risk reduction.
Development of neutron-activated samarium-153-loaded polystyrene microspheres as a potential theranostic agent for hepatic radioembolization
Authors: Tan Hun Yee , Wong Yin How , Kasbollah Azahari , Md Shah Mohammad Nazri , Abdullah Basri Johan Jeet , Perkins Alan Christopher , Yeong Chai Hong
Published: January 2022

Purpose

Hepatic radioembolization is an effective minimally invasive treatment for primary and metastatic liver cancers. Yttrium-90 [90Y]-labelled resin or glass beads are typically used as the radioembolic agent for this treatment; however, these are not readily available in many countries. In this study, novel samarium-153 oxide-loaded polystyrene ([153Sm]Sm2O3-PS) microspheres were developed as a potential alternative to 90Y microspheres for hepatic radioembolization.

Methods

The [152Sm]Sm2O3-PS microspheres were synthesized using solid-in-oil-in-water solvent evaporation. The microspheres underwent neutron activation using a 1 MW open-pool research reactor to produce radioactive [153Sm]Sm2O3-PS microspheres via 152Sm(n,γ)153Sm reaction. Physicochemical characterization, gamma spectroscopy and in-vitro radionuclide retention efficiency were carried out to evaluate the properties and stability of the microspheres before and after neutron activation.

Results

The [153Sm]Sm2O3-PS microspheres achieved specific activity of 5.04 ± 0.52 GBq·g−1 after a 6 h neutron activation. Scanning electron microscopy and particle size analysis showed that the microspheres remained spherical with an average diameter of ~33 μm before and after neutron activation. No long half-life radionuclide and elemental impurities were found in the samples. The radionuclide retention efficiencies of the [153Sm]Sm2O3-PS microspheres at 550 h were 99.64 ± 0.07 and 98.76 ± 1.10% when tested in saline solution and human blood plasma, respectively.

Conclusions

A neutron-activated [153Sm]Sm2O3-PS microsphere formulation was successfully developed for potential application as a theranostic agent for liver radioembolization. The microspheres achieved suitable physical properties for radioembolization and demonstrated high radionuclide retention efficiency in saline solution and human blood plasma.
Can nuclear imaging accurately detect scar in ischemic cardiac resynchronization therapy candidates?
Authors: Degtiarova Ganna , Claus Piet , Duchenne Jürgen , Schramm Georg , Nuyts Johan , Bogaert Jan , Vöros Gabor , Willems Rik , Verberne Hein J. , Voigt Jens-Uwe , Gheysens Olivier
Published: January 2022

Background

Accurate scar assessment is crucial in cardiac resynchronization therapy (CRT) candidates, since its presence is a negative predictor for CRT response. Therefore, we assessed the performance of different PET parameters to detect scar in CRT candidates.

Methods:

Twenty-nine CRT candidates underwent 18F-fluorodeoxyglucose (18F-FDG)-PET/computed tomography (CT), resting 13N-NH3-PET/CT and cardiac magnetic resonance (CMR) prior to CRT implantation. Segmental 18F-FDG uptake, late 13N-NH3 uptake and absolute myocardial blood flow (MBF) were evaluated for scar detection using late gadolinium enhancement (LGE) CMR as reference. A receiver operator characteristic (ROC) area under the curve (AUC) ≥0.8 indicated a good accuracy of the methods evaluated.

Results

Scar was present in 111 of 464 segments. None of the approaches could reliably identify segments with nontransmural scar, except for 18F-FDG uptake in the lateral wall (AUC 0.83). Segmental transmural scars could be detected with all methods (AUC ≥ 0.8), except for septal 18F-FDG uptake and MBF in the inferior wall (AUC < 0.8). Late 13N-NH3 uptake was the best parameter for transmural scar detection, independent of its location, with a sensitivity of 80% and specificity of 92% using a cutoff of 66% of the maximum tracer activity.

Conclusions

Late 13N-NH3 uptake is superior to 13N-NH3 MBF and 18F-FDG in detecting transmural scar, independently of its location. However, none of the tested PET parameters was able to accurately detect nontransmural scar.
Prediction of early biochemical response after 177Lu-PSMA radioligand therapy with 68Ga-PSMA PET, a different perspective with quantitative parameters
Authors: Aksu Ayşegül , Vural Topuz Özge , Yilmaz Burçak , Karahan Şen Nazli Pinar , Acar Emine , Çapa Kaya Gamze
Published: January 2022

Objective

In this study, our aim was to evaluate the relationship of the quantitative data obtained from pretreatment 68Ga prostate-specific membrane antigen (PSMA) PET-computerized tomography (PET/CT) with treatment response of the patients with the diagnosis of metastatic castrationresistant prostate cancer (mCRPC) who received 177Lu-PSMA radioligand therapy (RLT).

Methods

The patients who were given three or four cycles of 177Lu-PSMA RLT between January 2016 and June 2018 were evaluated retrospectively. Volumetric data; PSMA tumor volume (TV) and total lesion (TL) PSMA, were obtained from 68Ga-PSMA PET/CT for whole (PSMA-TVT and TL-PSMAT). The distance between the two furthest lesions (Dmax) was calculated. Posttreatment early prostate-specific antigen (PSA) values on the fourteenth day after treatment were obtained. According to the PSA responses, the patients were divided into two groups as progressed and nonprogressed. In univariate analysis, the relationship of PET quantitative data with biochemical response groups was evaluated with Mann–Whitney U test. Logistic regression was used in multivariate analysis.

Results

A total of 38 patients were included in the study. In univariate analysis, Dmax, PSMA-TVT and TL-PSMAT values were obtained at lower levels in the progressed group. In multivariate analysis, only Dmax was found to be a prognostic factor in predicting early biochemical response.

Conclusion

Dmax is the most prognostic parameter in predicting the early biochemical response in patients with mCRPC; high total tumor volume and burden are also parameters that give us an idea about the response to treatment. The success rate will be higher if 177Lu-PSMA RLT treatment is planned for patients with higher tumor volume and spread.
Perturbation-based training enhances anticipatory postural control in individuals with chronic stroke: a pilot study
Authors: Curuk Etem , Aruin Alexander S.
Published: January 2022

Individuals with stroke commonly have impaired balance control. The aim of this study was to investigate the effect of targeted intervention on anticipatory postural adjustments (APAs) and postural control in people with stroke. Six participants with unilateral hemiparesis due to a stroke (5.0–8.4 years post stroke) participated in a two-phase random crossover study. The participants received in counterbalanced order (a) 2 weeks of experimental, targeted intervention (pushing a medicine ball attached to the ceiling using their unaffected upper extremity) and (b) 2 weeks of control, self-guided general mobility exercise program with a 1-week washout period in between. All study participants were assessed with laboratory tests before and after each intervention. Lab tests included predictable external perturbations induced by a pendulum impact and clinical assessments of balance. Bilateral electromyographic activity of eight trunk and leg muscles and center of pressure (COP) displacements were recorded, and data during the anticipatory and compensatory phases of postural control were analyzed. After the experimental intervention, as compared to control intervention, the participants showed earlier APA onsets (P < 0.05), smaller COP displacements (P < 0.05), and improved [although not significantly (P >0.05)] scores of clinical tests of balance. The results of this feasibility study provide a foundation for developing balance rehabilitation protocols focused on improving APAs in individuals with neurological disorders.
When Management of Cancer-Related Pain Is Complicated by Coexisting Opioid Use Disorder
Authors: Lowry Sarah
Published: January 2022

Patients with cancer are living longer, and many experience pain secondary to tumor invasion or as a consequence of cancer-directed therapies. Opioid use disorders and associated morbidity and mortality have increased with dramatic rise during the SARS-CoV-2 pandemic. National and international stakeholders have developed clinical practice guidelines in an effort to curb opioid misuse and overdose-related death. However, to ensure that patients with cancer do not experience barriers to adequate pain management, most of these guidelines are not intended for patients with cancer-related pain or for those receiving palliative or hospice care. Oncology, palliative, and hospice care providers are increasingly tasked with the management of severe disease-related pain in the setting of coexisting opioid use disorder without research on the most effective risk and harm reduction strategies to guide care.

Clinicians should be familiar with addiction medicine and chronic pain literature and be able to incorporate some of these best practices. This case study reviews the management of severe cancer-related pain in a patient with co-occurring opioid use disorder, utilizing many of the best practices in available clinical practice guidelines for the management of chronic non–cancer-related pain.