bluuebunny/crossref_metadata_2025 huggingface dataset:
General Gotovina
Authors: Meron Theodor
Published: May 2021

This chapter describes the controversial acquittal of General Ante Gotovina. The events giving rise to this case occurred between July and September 1995. During that time, Croatia initiated a military action called “Operation Storm” for the purpose of taking control of territory in the Krajina region of Croatia. Gotovina was a colonel-general in the HV (Croatian Army) during the Indictment period and was the operational commander of Operation Storm in the southern part of the Krajina region. The Trial Chamber found that Gotovina contributed to the joint criminal enterprise (JCE), the common purpose of which was to permanently remove the Serb civilian population from the Krajina region. The Trial Chamber consequently found Gotovina guilty under the first form of JCE of both persecution and deportation as crimes against humanity. It also found him guilty under the third form of JCE of murder and inhuman acts as crimes against humanity, plunder of public and private property and violations of the laws or customs of war. He was sentenced to a single term of 24 years’ imprisonment.
Speaking of Fake News
Authors: Jaster Romy , Lanius David
Published: May 2021

This chapter shows why defining “fake news” is worthwhile and what a suitable definition of “fake news” might look like. It begins by introducing the authors’ definition of “fake news” (§2) and employs it to set fake news apart from related phenomena that are often conflated with it (§3). It then extracts seven potential dimensions of the concept of fake news from the literature (§4) and compares the most representative definitions that have been proposed so far along those dimensions (§5). The chapter’s primary aims are (i) to enable a systematic evaluation of prevalent definitions with respect to their extensional scope, practical utility, and conceptual transparency, (ii) to demonstrate that there is more widespread agreement than one would think at the outset, and (iii) to show (in §6) that defining “fake news” is not only far from futile, but of vital importance to confront the epistemic threats posed by fake news.
Good News, Bad News, Fake News
Authors: Pritchard Duncan
Published: May 2021

An account is offered of the nature of fake news, and it is explained how this account differs from the main proposals in the contemporary philosophical literature in this regard. One key feature of the account is the idea that fake news is not a genuine form of news. In particular, fake news is to be distinguished from genuine news that is epistemically problematic. It is argued that this point is important because it entails that what is required to differentiate news with a sound epistemic pedigree from news that has a poor epistemic pedigree is distinct from what is required to differentiate genuine news from fake news. This has implications for how we should manage the challenge posed by fake news, at both the individual and the structural levels.
The Dissemination of Scientific Fake News
Authors: Genot Emmanuel J. , Olsson Erik J.
Published: May 2021

Fake news can originate from scientific fraud. An article can be retracted upon discovery of fraud. A case study shows, however, that such fake science can be visible in Google even after the article is retracted. Authors hypothesize that the explanation lies in the popularity-based logic governing Google’s foundational PageRank algorithm, in conjunction with the “law of retraction”: a retraction notice is typically taken to be less interesting and therefore less popular with internet users than the original content retracted. This chapter presents an empirical study drawing on records of articles retracted due to fraud (fabrication of data) in the Retraction Watch public database. It finds that both Google Search and Google Scholar more often than not rank a link to the original article higher than a link indicating that the article has been retracted. Thus, both Google Search and Google Scholar risk disseminating fake science through their ranking algorithms.
General Covariance
Authors: Emam Moataz H.
Published: May 2021

The general theory of relativity is introduced based on the principle of equivalence. Gravity is shown to arise dues to spacetime curvature. Specific examples of curved spacetimes are presented from the approximate but more intuitive to the complex: Uniform gravitational field (Galilean metric), the Newtonian weak field metric, Schwarzschild’s exterior and interior solutions, black holes, and cosmological spacetimes. A brief discussion on distances, areas and volumes in curved spaces is also given.
Differential Forms
Authors: Emam Moataz H.
Published: May 2021

In this chapter we present the modern theory of differential forms and see how it applies to the classical fields studied in the previous chapter. We apply the theory to Maxwell fields as well as to Cartan’s formulation of general relativity. A discussion of the generalized Stokes theorem is given.
Generalizing General Relativity
Authors: Emam Moataz H.
Published: May 2021

In this chapter we review 5 popular models of modifying and/or generalizing our current understanding of spacetime. These are: Brans-Dicke theory, f(R) theory, Gauss-Bonnet theory, Kaluza-Klein theory, and finally Cartan’s theory of gravity.
Introduction
Authors: Gosden Chris , Franconi Tyler , Harkel Letty ten
Published: May 2021

This chapter introduces the project, the history of work on the English landscape for all periods from the Bronze Age to the early medieval period, earlier attempts at long-term histories and our intellectual approach.
Scale
Authors: Cooper Anwen , Green Chris , Gosden Chris
Published: May 2021

A crucial consideration for any approach to landscape is that of scale. People in the past operated at a series of scales from the very local to long distance sets of connections, so that often most evidence is generated by life in the local area, structuring the nature of evidence. The balance between local, regional and long-distance action varies between periods, with longer distance connections most obvious in the Roman period, when Britain was connected to the empire. We start with a general consideration of questions of scale, before moving to consider the Roman period more specifically. We focus on the nature of villas as microcosms of the landscapes in which they sit, looking at where building materials come from, using good information from Isle of Wight villas as a case study. We play with the ideas that villas sit in landscapes, but also represent those landscapes in a condensed form.
How surface tension matters in polymer-free graphene transfer
Authors: Okmi Aisha , Li Ningxin , Gao Guanhui , Rublova Yelyzaveta , Jabegu Tara , Maraba Diren , Lei Sidong
Published: May 2021

The main goal of this work is to achieve a direct transfer of graphene and examine the exact effect of surface tension (ST) on graphene during this type of transfer. To reach this target, we designed a specific transfer container with two-sided ports to facilitate replacing liquids underneath graphene and monitor the effect of ST. We prepared liquids with various STs by mixing pure deionized-water with different ratios of isopropanol (IPA). Our results indicate that high ST does not break the graphene structure if graphene has good quality. Besides, a ST gap (STG) can be applied to graphene at a specific level without damaging the graphene monolayer. Comparing those results to the defective graphene features after applying high ST and varied STGs confirms that standing high ST and STG can be considered as a key feature of good quality graphene. Thus, good-quality graphene can be transferred at high ST (ST of water: 72 dyne/cm) with no sign of structural damage. In addition, this type of graphene can stand STG ≤ 40 dyne/cm. This new understanding of the ST effect on graphene could simplify the current direct transfer techniques and widen the graphene applications by expanding the choices of the target substrates and transfer liquids.
Polarization images of accretion flow around supermassive black holes: Imprints of toroidal field structure
Authors: Tsunetoe Yuh , Mineshige Shin , Ohsuga Ken , Kawashima Tomohisa , Akiyama Kazunori
Published: May 2021

With unprecedented angular resolution, the Event Horizon Telescope (EHT) has opened a new era of black hole studies. We have previously calculated the expected polarization images of M 87* with EHT observations in mind. There, we demonstrated that circular polarization (CP) images, as well as linear polarization (LP) maps, can convey quite useful information, such as the flow structure and magnetic field configuration around the black hole. In this paper, we make new predictions for the cases in which disk emission dominates over jet emission, bearing Sgr A* in mind. Here we set the proton-to-electron temperature ratio of the disk component to be Tp/Te ∼ 2 so as to suppress jet emission relative to emission from accretion flow. As a result, we obtain ring-like images and triple-forked images around the black hole for face-on and edge-on cases, respectively. We also find significant CP components in the images (≳10% in fraction), with both positive and negative signs, amplified through the Faraday conversion, not depending sensitively on the inclination angles. Furthermore, we find a “separatrix” in the CP images, across which the sign of CP is reversed and on which the LP flux is brightest, that can be attributed to the helical magnetic field structure in the disk. These results indicate that future full polarization EHT images are a quite useful tracer of the magnetic field structure. We also discuss to what extent we will be able to extract information regarding magnetic field configurations under the scattering in the interstellar plasma, in future EHT polarimetric observations of Sgr A*.
RsmD, a Chloroplast rRNA m2G Methyltransferase, Plays a Role in Cold Stress Tolerance by Possibly Affecting Chloroplast Translation in Arabidopsis
Authors: Ngoc Le Nguyen Tieu , Park Su Jung , Cai Jing , Huong Trinh Thi , Lee Kwanuk , Kang Hunseung
Published: May 2021

Ribosomal RNA (rRNA) methylation is a pivotal process in the assembly and activity of ribosomes, which in turn play vital roles in the growth, development and stress responses of plants. Although few methyltransferases responsible for rRNA methylation have been identified in plant chloroplasts, the nature and function of these enzymes in chloroplasts remain largely unknown. In this study, we characterized ArabidopsisRsmD (At3g28460), an ortholog of the methyltransferase responsible for N2-methylguanosine (m2G) modification of 16S rRNA in Escherichia coli. Confocal microscopic analysis of an RsmD– green fluorescent protein fusion protein revealed that RsmD is localized to chloroplasts. Primer extension analysis indicated that RsmD is responsible for m2G methylation at position 915 in the 16S rRNA of Arabidopsis chloroplasts. Under cold stress, rsmd mutant plants exhibited retarded growth, i.e. had shorter roots, lower fresh weight and pale-green leaves, compared with wild-type (WT) plants. However, these phenotypes were not detected in response to drought or salt stress. Notably, the rsmd mutant was hypersensitive to erythromycin or lincomycin and accumulated fewer chloroplast proteins compared with the WT, suggesting that RsmD influences translation in chloroplasts. Complementation lines expressing RsmD in the rsmd mutant background recovered WT phenotypes. Importantly, RsmD harbored RNA methyltransferase activity. Collectively, the findings of this study indicate that RsmD is a chloroplast 16S rRNA methyltransferase responsible for m2G915 modification that plays a role in the adaptation of Arabidopsisto cold stress.
A nanodomain-anchored scaffolding complex is required for the function and localization of phosphatidylinositol 4-kinase alpha in plants
Authors: Noack Lise C , Bayle Vincent , Armengot Laia , Rozier Frédérique , Mamode-Cassim Adiilah , Stevens Floris D , Caillaud Marie-Cécile , Munnik Teun , Mongrand Sébastien , Pleskot Roman , Jaillais Yvon
Published: May 2021

Phosphoinositides are low-abundant lipids that participate in the acquisition of membrane identity through their spatiotemporal enrichment in specific compartments. Phosphatidylinositol 4-phosphate (PI4P) accumulates at the plant plasma membrane driving its high electrostatic potential, and thereby facilitating interactions with polybasic regions of proteins. PI4Kα1 has been suggested to produce PI4P at the plasma membrane, but how it is recruited to this compartment is unknown. Here, we pin-point the mechanism that tethers Arabidopsis thaliana phosphatidylinositol 4-kinase alpha1 (PI4Kα1) to the plasma membrane via a nanodomain-anchored scaffolding complex. We established that PI4Kα1 is part of a complex composed of proteins from the NO-POLLEN-GERMINATION, EFR3-OF-PLANTS, and HYCCIN-CONTAINING families. Comprehensive knockout and knockdown strategies revealed that subunits of the PI4Kα1 complex are essential for pollen, embryonic, and post-embryonic development. We further found that the PI4Kα1 complex is immobilized in plasma membrane nanodomains. Using synthetic mis-targeting strategies, we demonstrate that a combination of lipid anchoring and scaffolding localizes PI4Kα1 to the plasma membrane, which is essential for its function. Together, this work opens perspectives on the mechanisms and function of plasma membrane nanopatterning by lipid kinases.
A Current and Future Challenge to Contemporary Policing: The Changing Profile of Crime and the Police Response. Examples of Policing Fraud in Two Police Jurisdictions: England and Wales and South Korea
Authors: Loveday Barry , Jung Jeyong
Published: May 2021

This article considers recent developments in the policing of fraud and provides an evaluation of the police response to the growing problem of fraud in England and Wales and South Korea. The size and nature of the fraud problem has most recently been recognized by HMIFRS in its 2019 Report which, drawing on data provided by the Office of National Statistics, notes that fraud now makes up almost one-third of total crime and was now the largest stand-alone crime type. In light of this changing profile of crime growing interest has been directed at the police response to this ever-increasing challenge. Drawing on data provided by a variety of sources the current role and status of the police response in England and Wales is identified and explored. The evidence suggests that a police organizational culture has proved reluctant to engage with this now major crime problem. The article then considers the police response to fraud in South Korea. As is argued although sharing some cultural features with the police service in England and Wales it would appear that inhibitions arising from these can be successfully challenged and overcome. It is also evident, however, that alternative enforcement structures may be needed to fully engage with the fraud problem but what form they should take remains uncertain and the subject of continuing debate.
Tocilizumab in the treatment of COVID-19—a meta-analysis
Authors: Avni T , Leibovici L , Cohen I , Atamna A , Guz D , Paul M , Gafter-Gvili A , Yahav D
Published: May 2021

Background

Interleukin-6 inhibitors showed promising results in observational trials of patients with coronavirus disease 2019 (COVID-19).

Aim

To evaluate whether interleukin-6 inhibitor tocilizumab (TCZ) reduces mortality among hospitalized COVID-19 patients.

Design

A systematic review and meta-analysis.

Methods

Systematic review and meta-analysis of randomized controlled trials (RCTs) comparing TCZ vs. placebo/control, for treatment of adults with COVID-19. Primary outcome was 28–30 days all-cause mortality. Search was conducted up to 1 April 2021. Two independent reviewers screened citations, extracted data and assessed risk of bias. Relative risk (RR) with 95% confidence intervals (CI) were pooled. We performed subgroup analysis for patients with critical illness and sensitivity analyses.

Results

Eight RCTs were included, assessing 6481 patients with mostly severe non-critical COVID-19 infection. TCZ was associated with a reduction in all-cause 28–30-day mortality compared to placebo/control (RR = 0.89, 95% CI 0.82–0.96). Among the subgroup of critically ill patients no reduced mortality was demonstrated (RR = 0.94, 95% CI 0.74–1.19). No mortality benefit with TCZ was demonstrated in trials that used steroids for >80% of patients. TCZ was associated with significantly reduced risk for mechanical ventilation (MV); for combined endpoint of death or MV and for intensive care unit (ICU) admission. No significant difference in adverse events was demonstrated. Risk of serious superinfection was significantly lower with TCZ (RR = 0.57, 95% CI 0.35–0.93).

Conclusion

The treatment with TCZ reduces 28–30 days all-cause mortality, ICU admission, superinfections, MV and the combined endpoint of death or MV. Among critically ill patients, and when steroids were used for most patients, no mortality benefit was demonstrated. Additional research should further define sub-groups that would benefit most and preferred timing of administration of TCZ in severe COVID-19.
Promoting fruit and vegetable consumption in rural China: Does off-farm work play a role?
Authors: Ma Wanglin , Zheng Hongyun
Published: May 2021

Although off-farm work plays a significant role in facilitating agricultural production and rural development and improving household welfare, little is known about whether off-farm work can promote fruit and vegetable consumption in rural areas of developing countries. This paper sheds new insights by estimating the impact of off-farm work on fruit and vegetable consumption, measured by purchasing frequencies and consumption expenditures. We employ a two-stage residual inclusion estimator to address the self-selection bias and analyze data collected from 558 rural households in China. The results show that household heads’ off-farm work promotes rural households’ fruit and vegetable consumption by significantly increasing purchasing frequencies and expenditures. Further analysis confirms that household heads' off-farm work participation, rather than all household members, plays a prominent role in promoting household fruit and vegetable consumption. We also find that farmers’ behaviours of growing fruits and vegetables appear to substitute their purchasing behaviours.
Blood PD-1+TFh and CTLA-4+CD4+ T cells predict remission after CTLA-4Ig treatment in early rheumatoid arthritis
Authors: Aldridge Jonathan , Andersson Kerstin , Gjertsson Inger , Hultgård Ekwall Anna-Karin , Hallström Magnus , van Vollenhoven Ronald , Lundell Anna-Carin , Rudin Anna
Published: May 2021

Objective

Treatment with CTLA-4Ig blocks T-cell activation and is clinically effective in RA. However, it is unknown if specific CD4+ T-cell subsets in blood at baseline predict remission after CTLA-4Ig, or other biological treatments with different modes of action, and how treatment affects CD4+ T cells in patients with untreated early RA (eRA).

Methods

This study included 60 patients with untreated eRA from a larger randomized trial. They were treated with methotrexate combined with CTLA-4Ig (abatacept, n = 17), anti-IL6 receptor (tocilizumab, n = 21) or anti-TNF (certolizumab-pegol, n = 22). Disease activity was assessed by clinical disease activity index (CDAI), DAS28, swollen joint counts, tender joint counts, CRP and ESR. The primary outcome was CDAI remission (CDAI ≤ 2.8) at week 24. Proportions of 12 CD4+ T-cell subsets were measured by flow cytometry at baseline and after 4, 12 and 24 weeks of treatment.

Results

In patients treated with CTLA-4Ig, the proportions of PD-1+TFh and CTLA-4+ conventional CD4+ T cells at baseline predicted CDAI remission at week 24. CD4+ T-cell subset proportions could not predict remission after treatment with anti-IL6R or anti-TNF. The percentage of regulatory T cells (Tregs) expressing CTLA-4 decreased in all treatment arms by 24 weeks, but only CTLA-4Ig treatment significantly reduced the proportions of Tregs and PD-1+T follicular helper (TFh) cells.

Conclusion

These findings indicate that circulating proportions PD-1+TFh and CTLA-4+ conventional CD4+ T cells at baseline may serve as predictive biomarkers for remission in early RA after CTLA-4Ig treatment.
DOSE EVALUATION AND PROPOSAL OF LOCAL DIAGNOSTIC REFERENCE LEVELS FOR PAEDIATRIC CARDIAC CATHETERIZATIONS PERFORMED ON A HIGH-SENSITIVITY ANGIOGRAPHIC SYSTEM ALLOWING LOW-DOSE IMAGING
Authors: Hultenmo Maria , Nygren Anders , Söderberg Björn , Wåhlander Håkan
Published: May 2021

Radiation doses from paediatric cardiac catheterizations were analysed based on procedure type and patient weight, and local diagnostic reference levels (LDRLs) were proposed. The procedures were performed on a Siemens Artis Q.zen biplane system with high-sensitivity detectors allowing low-dose imaging. Good radiological practice, e.g. adapting dose level and frame rate continuously and minimizing the x-ray field with collimators, was routine during procedures. The median total dose-area-product (DAP) value was 58 μGym2 for diagnostic catheterizations, 48 μGym2 for interventional catheterizations and 33 μGym2 for myocardial biopsies. The median DAP per body weight was 4.0 μGym2 kg−1. The median total fluoroscopy time varied from 6.0 min for myocardial biopsies, to 9.7 and 10.5 min, respectively, for diagnostic and interventional catheterizations. The third quartile of the DAP values in each weight group was proposed as LDRL. LDRLs for fluoroscopy time were determined solely based on procedure type, due to the absence of weight dependence.
Precision Medicine on the Fly: Using Drosophila to Decipher Gene-Environment Interactions in Parkinson’s Disease
Authors: Sarkar Souvarish , Feany Mel B
Published: May 2021

Big data approaches have profoundly influenced state-of-the-art in many fields of research, with toxicology being no exception. Here, we use Parkinson’s disease as a window through which to explore the challenges of a dual explosion of metabolomic data addressing the myriad environmental exposures individuals experience and genetic analyses implicating many different loci as risk factors for disease. We argue that new experimental approaches are needed to convert the growing body of omics data into molecular mechanisms of disease that can be therapeutically targeted in specific patients. We outline one attractive strategy, which capitalizes on the rapid generation time and advanced molecular tools available in the fruit fly, Drosophila, to provide a platform for mechanistic dissection and drug discovery.
Imaging-Based Resistance Assay Using Enhanced Luminescence-Tagged Pseudomonas syringae Reveals a Complex Epigenetic Network in Plant Defense Signaling Pathways
Authors: Pujara Dinesh S. , Kim Sung-Il , Nam Ji Chul , Mayorga José , Elmore Isabella , Kumar Manish , Koiwa Hisashi , Kang Hong-Gu
Published: May 2021

High-throughput resistance assays in plants have a limited selection of suitable pathogens. In this study, we developed a Pseudomonas syringae strain chromosomally tagged with the Nanoluc luciferase (NL) from the deep-sea shrimp Oplophorus gracilirostris, a bioluminescent marker significantly brighter than the conventional firefly luciferase. Our reporter strain tagged with NL was more than 100 times brighter than P. syringae tagged with the luxCDABE operon from Photorhabdus luminescens, one of the existing luciferase-based strains. In planta imaging was improved by using the surfactant Silwet L-77, particularly at a lower reporter concentration. Using this imaging system, more than 30 epigenetic mutants were analyzed for their resistance traits because the defense signaling pathway is known to be epigenetically regulated. SWC1, a defense-related chromatin remodeling complex, was found to be a positive defense regulator, which supported one of two earlier conflicting reports. Compromises in DNA methylation in the CG context led to enhanced resistance against virulent Pseudomonas syringae pv. tomato. Dicer-like and Argonaute proteins, important in the biogenesis and exerting the effector function of small RNAs, respectively, showed modest but distinct requirements for effector-triggered immunity and basal resistance to P. syringae pv. tomato. In addition, the transcriptional expression of an epigenetic component was found to be a significant predictor of its immunity contribution. In summary, this study showcased how a high-throughput resistance assay enabled by a pathogen strain with an improved luminescent reporter could provide insightful knowledge about complex defense signaling pathways.

[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Temperature-Responded Biological Fitness of Carbendazim-Resistance Fusarium graminearum Mutants Conferring the F167Y, E198K, and E198L Substitutions
Authors: Wang Yingfan , Hou Yiping , Mao Xuewei , Liu Fuyu , Zhou Mingguo
Published: May 2021

Understanding the effects of temperature on Fusarium graminearum infection can provide theoretical guidance for chemical control of Fusarium head blight (FHB). Here, we evaluated the effects of various temperatures on biological fitness development of wild-type sensitive strain 2021 and carbendazim-resistance mutants conferring β2-tubulin substitutions F167Y, E198K, and E198L. The results showed that mycelial growth and conidiation of four strains increased with the increase in temperature between 10 and 25°C. Conidia of F167Y displayed strong adaptability to low temperature. The virulence of the four strains was largely similar at the same temperature, showing an upward trend between 10 and 25°C. At 10°C, the hyphal growth of all strains was significantly inhibited, metabolism was slowed down, and the accumulation of secondary metabolites decreased. Subsequently, the production of deoxynivalenol (DON) and its intermediates pyruvate and aurofusarin decreased at low temperature, and the expression of DON biosynthesis-related genes Tri5, FgPK, and AUR decreased accordingly. At the same temperature, the aurofusarin production of the strains F167Y and E198K was higher than that of strains 2021 and E198L. The contents of DON and pyruvic acid in carbendazim-resistance mutants were higher than those in the wild-type strain 2021. The sensitivity of four strains to different fungicides changed at various temperatures. The sensitivity to most fungicides increased with decreasing temperature. The carbendazim-resistance mutants showed positive cross-resistance with other benzimidazoles. However, there was no cross-resistance to pyraclostrobin and azoles. These results would direct us to use fungicides preventing the infection of F. graminearum with changeable atmospheric temperature at the wheat flower stage.
Teaching Spiritual and Religious Competencies to Psychiatry Residents: A Scoping and Systematic Review
Authors: Hathaway David B. , de Oliveira e Oliveira Fabrício H. A. , Mirhom Mena , Moreira-Almeida Alexander , Fung Wai Lun Alan , Peteet John R.
Published: May 2021

Purpose

For many persons worldwide, mental health is inseparably linked with spirituality and religion (S&R), yet psychiatrists have repeatedly expressed doubts regarding their preparedness to address patients’ spirituality or religion appropriately. In recent decades, medical educators have developed and implemented curricula for teaching S&R-related competencies to psychiatry residents. The authors reviewed the literature to understand the scope and effectiveness of these educational initiatives.

Method

The authors searched 8 databases to identify studies for a scoping review and a systematic review. The scoping review explored educational approaches (topics, methods) used in psychiatry residency programs to teach S&R-related competencies. The systematic review examined changes in psychiatry trainees’ competencies and/or in patient outcomes following exposure to these educational interventions.

Results

Twelve studies met criteria for inclusion in the scoping review. All reported providing residents with both (1) a general overview of the intersections between mental health and S&R and (2) training in relevant interviewing and assessment skills. Seven of these studies—representing an estimated 218 postgraduate psychiatry trainees and at least 84 patients—were included in the systematic review. Residents generally rated themselves as being more competent in addressing patients’ S&R-related concerns following the trainings. One randomized controlled trial found that patients with severe mental illness who were treated by residents trained in S&R-related competencies attended more appointments than control patients.

Conclusions

S&R-related educational interventions appeared generally well tolerated and appreciated by psychiatry trainees and their patients; however, some topics (e.g., Alcoholics Anonymous) received infrequent emphasis, and some experiential teaching methodologies (e.g., attending chaplaincy rounds) were less frequently used for psychiatry residents than for medical students. The positive association between teaching S&R-related competencies to psychiatry residents and patient appointment attendance merits further study. Future trainings should supplement classroom learning with experiential approaches and incorporate objective measures of resident competence.
The Women Before Me: My Journey Painting Honor Wall Portraits of Women Physicians
Authors: Chen Pamela , Kasper Jennifer , Khoshbin Shahram
Published: May 2021

In this article, the authors briefly review the history and status of institutional honor wall portraits at medical schools, and they highlight the implications of a lack of diversity in these portraits for current medical students and the academic medicine pipeline. The authors then describe how contemporary portrait artists have used art as a tool for advocacy. They detail the first author’s empowering and intimate journey as a medical student as she identified, connected with, and painted a portrait gallery of some of her medical school’s prominent alumnae of color. This unique effort highlighted the unsung accomplishments of these women physicians and served to combat the visual disparity in honor wall portraits on campus.

The authors also outline the common barriers faced by the portrait subjects and the key validation they offered the first author, a fellow woman of color. The authors describe the historical and psychological significance of several artistic decisions made for these portraits in weighing the intersections of race, gender, and profession. They then emphasize the reciprocal nature of oil portraiture and how, through painting these women, the first author was able to better envision her community of mentors, deepen her commitment to diversity and inclusion, and strengthen her own career aspirations. These portraits will hang in the student center of Harvard Medical School and will serve as a lasting reminder to future trainees, especially women and people of color, that they belong in the halls of medicine.
Patient monitoring in the nonoperating room anesthesia (NORA) setting: current advances in technology
Authors: Routman Justin , Boggs Steven Dale
Published: May 2021

Purpose of review

Nonoperating room anesthesia (NORA) procedures continue to increase in type and complexity as procedural medicine makes technical advances. Patients presenting for NORA procedures are also older and sicker than ever. Commensurate with the requirements of procedural medicine, anesthetic monitoring must meet the American Society of Anesthesiologists standards for basic monitoring.

Recent findings

There have been improvements in the required monitors that are used for intraoperative patient care. Some of these changes have been with new technologies and others have occurred with software refinements. In addition, specialized monitoring devises have also been introduced into NORA locations (depth of hypnosis, respiratory monitoring, point-of care ultrasound). These additions to the monitoring tools available to the anesthesiologist working in the NORA-environment push the boundaries of procedures which may be accomplished in this setting.

NORA procedures constitute a growing percentage of total administered anesthetics. There is no difference in the monitoring standard between that of an anesthetic administered in an operating room and a NORA location. Anesthesiologists in the NORA setting must have the same compendium of monitors available as do their colleagues working in the operating suite.
Radial Head Replacement for Acute Radial Head Fractures: Outcome and Survival of Three Implant Designs With and Without Cement Fixation
Authors: Songy Chad E. , Kennon Justin C. , Barlow Jonathan D. , Sanchez-Sotelo Joaquin , O'Driscoll Shawn W. , Morrey Mark E.
Published: May 2021

Objectives:

To determine outcomes of radial head replacement (RHR) for acute fractures using 3 different implant designs with or without cement fixation.

Design:

Retrospective.

Setting:

Tertiary referral hospital.

Patients/Participants:

One hundred fourteen elbows underwent RHR for an acute radial head fracture using either (1) a nonanatomic design and smooth stem (n = 60), (2) a nonanatomic design with a grit-blasted, ingrowth, curved stem (n = 21), or (3) an anatomic design with a grit-blasted ingrowth straight stem (n = 33). Cemented (25%) or uncemented (75%) fixation was used at the discretion of the treating surgeon.

Intervention:

RHR.

Main Outcome Measurements:

The primary outcome was implant survivorship free of revision or removal for any reason. All elbows were evaluated clinically (the Mayo Elbow Performance Score and reoperations/complications) and radiographically.

Results:

Fourteen implants (12%) were revised. Of elbows with a minimum 2-year clinical follow-up, the average Mayo Elbow Performance Score was 88. The rate of survivorship free from revision was 92% [95% confidence interval (CI) = 87%–98%] at 2 years, 90% (CI = 84%–96%) at 5 years and 84% (CI = 75%–94%) at 10 years. The differences in survivorship between the 3 implants did not reach statistical significance, but the nonanatomic design with a grit-blasted ingrowth curved stem had a hazard ratio of 4.6 (95% CI = 0.9%–23%) for failure. There were no differences in survivorship between cemented versus uncemented stems. For those elbows with a minimum of 2 years of radiographic follow-up, implant tilt was observed in 10 (16%) elbows and loosening in 16 (26%) elbows. Stress shielding was present in 19 (42%) of well-fixed implants.

Conclusions:

RHR for acute trauma leads to survivorship greater than 80% at 10 years. Radiographic changes (loosening, stress shielding, and implant tilting) can be expected in a substantial portion of elbows at long-term follow-up.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Novel device for nonsurgical correction of rigid forefoot adduction in children
Authors: Freedman Daniel , Kotlarsky Pavel , Eidelman Mark
Published: May 2021

Forefoot adduction deformity (FAD) (commonly called metatarsus adductus) is reported as the most common congenital foot deformity in newborns. Early diagnosis and treatment are important in rigid cases, as better outcomes have been reported if treatment was initiated before 9 months of age. While casting and splinting is the current standard of care for nonsurgical management of rigid FAD (RFAD), several orthoses have demonstrated equal benefit. The Universal Neonatal Foot Orthotic (UNFO) brace is below ankle orthosis that provides continuous pressure, thereby correcting the deformity without casting. To the best of our knowledge, UNFO is the first brace that operates below the ankle. The aim of this study was to compare the effectiveness of UNFO shoe to standard serial casting in the treatment of RFAD in infants. Between the years 2012 and 2019 we treated 147 feet (94 patients): 52 using the UNFO shoes and 95 by standard casting and splinting protocol. The treatment groups were compared based on treatment duration, complications, and recurrence of deformity. Mean full-time treatment duration was significantly shorter in the UNFO group, while no significant difference in the total duration of treatment was observed. Similar complication and recurrence rates were demonstrated. In conclusion, treatment with UNFO is equally effective to serial casting. The use of UNFO increases convenience and diminishes social burden, thus providing a distinct advantage over other treatment modalities.
Opioid Prescriptions After Pediatric Orthopedic Surgery: Analyzing Rates of Unfilled Prescriptions
Authors: Cazzulino Alejandro , Meza Blake C. , Woodard Thaddeus , Swarup Ishaan , Shah Apurva S.
Published: May 2021

Background:

The prevalence of nonmedical use of prescription opioids among American teenagers is staggering. Reducing the quantity of postoperative opioid prescriptions can help address this epidemic by decreasing the availability of opioids. As the fourth most common opioid prescribers, orthopaedic surgeons are primed to lead efforts to reverse this crisis. The purpose of this study was to determine patient factors associated with filling opioid prescriptions after pediatric orthopaedic surgery and to recommend potential methods to limit excess opioid prescriptions.

Methods:

This retrospective cohort study included 1413 patients who were prescribed opioids upon discharge after an orthopaedic surgical procedure at a single urban children’s hospital from 2017 to 2018. The state’s Prescription Drug Monitoring Program was used to determine which patients filled their opioid prescriptions. Comparisons of demographic, clinical, and surgical factors were made between patients that filled their opioid prescription upon discharge and those that did not. Statistical analysis included λ2, Mann-Whitney U, and binary logistic regression for significant factors from bivariate analysis.

Results:

Nine percent (n=127) of patients did not fill their opioid prescriptions after discharge. Those who filled and did not fill prescriptions were similar in terms of sex, ethnicity, race, insurance type, and age at surgery (P>0.05). Patients who did not fill their opioid prescriptions received significantly fewer opioids during their postoperative hospital course (5.3 vs. 7.7 mg oxycodone, P=0.01). Not receiving oral oxycodone during postoperative hospitalization (odds ratio=2.16, 95% confidence interval: 1.49-3.14) and undergoing upper extremity surgery (odds ratio=2.00, 95% confidence interval: 1.37-2.91) were independently associated with not filling opioid prescriptions after surgery in the multivariate analysis.

Conclusions:

This study identified a subset of pediatric orthopaedic surgery patients who were prescribed opioids upon discharge but did not fill those prescriptions. Factors that increased the likelihood that patients did not fill their prescriptions upon discharge included fewer postoperative hospital course opioids, no oral oxycodone, and surgery on the upper extremity. Future studies must be performed to help decrease the number of opioids prescribed unnecessarily.

Level of Evidence:

Level III—prognostic cohort study.
Irreversible Electroporation (IRE) Combined With Chemotherapy Increases Survival in Locally Advanced Pancreatic Cancer (LAPC)
Authors: Oikonomou Dimitrios , Karamouzis Michalis V. , Moris Dimitrios , Dimitrokallis Nikolaos , Papamichael Demetris , Kountourakis Panteleimon , Astras Georgios , Davakis Spyridon , Papalampros Alexandros , Schizas Dimitrios , Petrou Athanasios S. , Felekouras Evangelos
Published: May 2021

Objectives:

Locally advanced pancreatic cancer (LAPC) is found in about 40% of patients with pancreatic cancer. Irreversible electroporation (IRE) is a nonthermal ablative technique that provides an alternative in patients with LAPC and can be safely combined with chemotherapy.

Materials and Methods:

From 2015 until October of 2019, we performed laparotomic IRE in a total of 40 patients with stage III LAPC. The median age of these patients was 65.2 years (range: 46 to 81 y), and the median tumor size was 3.8 cm (range: 2 to 5.2 cm). 33 of 40 patients were treated preoperatively with FOLFIRINOX or nab-paclitaxel plus gemcitabine and in case of disease control, IRE was performed, whereas in 7 patients, IRE was performed without previous chemotherapy.

Results:

All patients were treated successfully with IRE as the tumor evaluation showed no disease progression after the completion of induction chemotherapy. No IRE-related deaths occurred. Two major grade III complications were reported: pancreatic fistula grade A in 8 patients and 3 patients diagnosed with delayed gastric emptying. Up to October 31, 2019, the median overall survival (OS) of all patients was 24.2 months (range: 6 to 36 mo), and the median progression-free survival was 10.3 months (range: 3 to 24 mo). After the completion of IRE, 30 patients (75%) continued with adjuvant chemotherapy. Fifteen patients (37%) have >24 months OS and 3 patients (8%) have reached 36 months OS and are still alive.

Conclusion:

The combination of chemotherapy with IRE, which is a safe and effective procedure, may result in a survival benefit for patients with LAPC.
Association of endocannabinoids with pain in endometriosis
Authors: Andrieu Thomas , Chicca Andrea , Pellegata Daniele , Bersinger Nick A. , Imboden Sara , Nirgianakis Konstantinos , Gertsch Juerg , Mueller Michael D.
Published: May 2021

Endocannabinoid (eCB) levels fluctuate in inflammatory conditions and as such may take part in endometriosis-associated pain or even in endometriosis pathogenesis. In this case–control (23 cases and 19 controls) study, targeted lipids were measured in the serum and peritoneal fluid collected during laparoscopy. Endometriosis was confirmed histologically. Dysmenorrhea, abdominal pain, and dyspareunia were assessed using the Numeric Rating Scale for pain. Steroids, eCBs, and related lipids were quantified by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Tumor necrosis factor alpha, IL-8, PAPP-A, PP14, RANTES, OPG, MIDKINE, MCP-1, VEGF, leptin, and defensins were quantified by ELISA. We found that eCB levels were significantly influenced by both noncyclic and cyclic abdominal pain. Specifically, women suffering from noncyclic abdominal pain were characterized by a higher 2-AG level in the peritoneal fluid throughout the menstrual cycle, whereas women suffering from dysmenorrhea had higher 2-AG levels and lower AEA levels during the proliferative phase alone. In addition, 2-AG positively correlated with prostaglandin E2 (PGE2), and the ratio AEA/2-AG positively correlated with defensins, suggesting a possible link between endocannabinoids system and inflammatory pain. The results of the current study indicate that the eCB system may play a role in endometriosis-associated pain, but additional studies are needed to investigate the causal relationship.
Longitudinal, bidirectional relationships of insomnia symptoms and musculoskeletal pain across adolescence: the mediating role of mood
Authors: Arnison Tor , Schrooten Martien G.S. , Hesser Hugo , Jansson-Fröjmark Markus , Persson Jonas
Published: May 2021

Previous studies have established a bidirectional relationship between sleep and pain, and mood has been proposed as a mediator of this relationship. There are only a limited number of longitudinal studies examining the mediational role of mood, and the directionality of effects between sleep, pain, and mood is uncertain. In addition, despite the high prevalence of pain and sleep problems during adolescence, these relationships have rarely been examined in a longitudinal sample of adolescents. Here, longitudinal survey data with 5 yearly measurements were used to examine the bidirectional relationship between insomnia symptoms and pain across adolescence (Mbaseline age = 13.65 years, Nbaseline = 2767). We also explored if depressed mood, positive affect, and anxious mood are mediators in both directions of the sleep–pain relationship. Using latent variables for insomnia, pain, and mood at multiple time points, the data were analyzed with cross-lagged panel models for longitudinal data with structural equation modeling. Current results confirmed a bidirectional relationship between insomnia symptoms and pain, where the effect of insomnia symptoms on pain was stronger than vice versa. Depressed mood and anxious mood mediated the effect of insomnia symptoms on pain, but not the reverse effect of pain on insomnia symptoms. Positive affect did not serve as a mediator in either direction. These findings add novel insights into the temporal directionality of sleep, pain, and mood during adolescence, suggesting a temporal path from sleep to pain, through mood, rather than a reciprocal relationship between the constructs.
One-year outcome of single-stent crossover versus accurate ostial stenting for isolated left anterior descending ostial stenosis
Authors: Yang Zhen kun , Hu Jian , Ding Feng Hua , Ni Jing Wei , Zhang Rui Yan , Shen Wei Feng
Published: May 2021

Background

The optimal strategy of percutaneous coronary intervention (PCI) for isolated left anterior descending (LAD) ostial lesions remains debatable. This study aimed to compare clinical outcomes of patients with isolated LAD ostial stenosis treated by single-stent crossover versus accurate ostial stenting.

Methods

A total of 216 eligible consecutive patients with isolated de novo LAD ostial stenosis were enrolled, and were stratified according to the stenting techniques. Clinical follow-up was performed by review of medical charts or telephone contact with the patients, and repeat angiography was made at 9–12 months after the procedure. Major adverse cardiovascular events (MACE) including cardiac death, myocardial infarction, non-fatal stroke and target vessel revascularization (TVR) were recorded.

Results

Single-stent crossover and accurate ostial stenting were applied to 78 (36%) and 138 (64%) patients, respectively. During a mean of 13 ± 4.1 months of follow-up, the rate of composite MACE (19.6 vs. 8.9%; P = 0.040) was higher in LAD ostial stenosis patients treated with accurate ostial stenting than those treated with single-stent crossover technique, mainly driven by more frequent TVR (17.4 vs. 7.7%; P = 0.048). PCI strategy was an independent predictor of MACE (hazard ratio 2.561; 95% CI, 1.041–6.299; P = 0.021) in the multivariable Cox regression analysis.

Conclusions

Our retrospective study suggests that the single-stent crossover technique is associated with a better 1-year clinical outcome compared with accurate ostial stenting in patients with isolated LAD ostial stenosis.