bluuebunny/crossref_metadata_2025 huggingface dataset:
HPB SO12 - Comparison of outcomes between stapled closure and sutured closure of pancreatic stump following robotic distal pancreatectomy
Authors: Kho Jason , Hamady Zaed , Arshad Ali
Published: November 2024

Background

Postoperative pancreatic fistulas (POPFs) are associated with high patient mortality and morbidity. There are multiple approaches in managing pancreatic stumps following distal pancreatectomy. We compared the outcomes between sutured closure and stapled closure following robotic distal pancreatectomy and splenectomy, and the associated cost difference between the two techniques.

Method

We retrospectively analysed consecutive robotic distal pancreatectomy and splenectomy cases between October 2022 and January 2024 in a single United Kingdom tertiary hospital. Stapled closure was the initial standard approach. Sutured closure utilising 3/0 Prolene was regularly performed from July 2023. The study cohort was divided into these two groups and outcomes were compared. Primary outcome was POPF rates and secondary outcomes included postoperative length of stay (LOS), 30-day readmission rates and postoperative complications graded by Clavien-Dindo classification (CDC). Equipment costs for the respective procedures were obtained from hospital procurement team.

Results

36 patients were reviewed; 14 (38.9%) were stapled and 22 (61.1%) were sutured. Patient characteristics including mean age, gender and ASA grade were similar in both groups. 23/36 (63.9%) patients had confirmed malignancy on postoperative histopathology – similar distribution in both groups. 6/14 (42.9%) in the stapled group vs 4/22 (18.2%) in the sutured group developed POPF Grade B (p=0.14). LOS, 30-day readmission and CDC complication rates were similar in both groups. Median costs were £2236.40 and £1541.86 in the stapled and sutured groups respectively.

Conclusion

Sutured closure of pancreatic stump yielded similar outcomes to stapled closure following robotic distal pancreatectomy, associated with a significant cost saving in favour of sutured closure.
HPB SO17 - A rare case of Goblet cell adenocarcinoma of appendix presenting as primary ampullary tumour
Authors: Hamadalnile Albasheer , Mohammed Mustafa , Lykoudis Pavlos
Published: November 2024

Background

Goblet cell adenocarcinoma (GCA), formerly known as goblet cell carcinoid,is a rare appendiceal tumour with amphicrine differentiation that has distinct morphologic and clinical features compared to carcinomas seen elsewhere in the gastrointestinal tract. The tumour histologically resembles both carcinoids and adenocarcinomas. It is found in 0.3–0.9 % of appendectomy specimens; hence, ampullary GCAs are exceptionally uncommon.

Method

A 57-year-old Caucasian male presented with a two-month history of weight loss, pruritus, and dark urine. His blood tests revealed deranged liver enzymes. His past medical history was unremarkable. Abdominal CT identified a double duct sign, no detectable mass. Endoscopic ultrasound (EUS) revealed a dilated biliary system terminating in a slightly enlarged ampulla (15mm) without any obvious mass lesions. Endoscopic retrograde cholangiopancreatography (ERCP) was performed showing a distal common bile duct (CBD) stricture. Cytology samples were negative for malignancy, and stents were placed in the CBD and pancreatic duct (PD). Pancreaticoduodenectomy was advised given the high risk of malignancy.

Results

Histopathology report showed clusters of goblet-like mucinous cells in an infiltrative pattern, in addition to classic neuroendocrine tumor morphology, reminiscent of goblet cell adenocarcinoma of the appendix, staged as pT3pN1M0. This is consistent with primary ampullary GCA given the normal appendix on preoprative CT imaging.

Conclusion

To our knowledge, this is the fourth case of ampullary GCA report in medical literature. There is no consensus on adjunct chemotherapy regimen for systemic treatment. Chicago consensus group (2018) recommends following the colorectal cancer pathway for goblet cell adenocarcinoma. In our experience, given the anatomical location of the tumour and the normal appendix, FOLFIRINOX was offered in line with ampullary adenocarcinoma cancer pathway.
HPB SO20 - Evaluating the Impact of Enhanced Recovery After Surgery Protocols Post Hepatectomy in Patients with Chronic Liver Disease: A Meta-Analysis
Authors: O’Brien Abigail , Ahmed Ola , Ryan Odhrán , McCooey Aine , McEntee Gerry , Conneely John
Published: November 2024

Background

Defined criteria for the resectability of liver disease continue to be refined. In the era of enhanced recovery after surgery (ERAS), data regarding its safety and efficacy in specific patient populations is required. Patients with liver cirrhosis are particularly vulnerable, owing to both operative and peri-operative risk. However, the application of ERAS in cirrhotic patients undergoing hepatectomy is absent from the most recent ERAS Society Group recommendations from 2022. We present a meta-analysis assessing outcomes after liver resection in patients with cirrhosis following an ERAS protocol compared to standard post-operative care.

Method

A systematic literature search was performed using PubMed, Embase and Web of Science. Studies were included if comparing ERAS protocols versus standard post-operative care in patients undergoing liver resection in which more than 50% of the patient population had cirrhosis at time of surgery. The primary outcome analysed was overall complication rates with secondary outcomes of post-operative mortality, estimated blood loss, operation time, post-operative incidence of liver failure, readmission and reoperation rates. Statistical analysis was performed using Review Manager by the Cochrane Collaboration.

Results

930 records were screened for eligibility. Five articles were eligible for inclusion(ERAS n = 425 vs control group n = 423 patients). Cirrhotic patients enrolled in an ERAS program post-hepatectomy had a significantly reduced risk of overall complications (OR 0.45, 95% CI 0.33, 0.61, p<0.00001) and a shorter hospital stay when compared to standard post-operative care by 1.8 days (mean difference -1.83, 95% CI -2.22, -1.45, p<0.00001). No significant differences were noted in post-operative mortality, estimated blood loss, operation time, post-operative incidence of liver failure, readmission or reoperation rates between the ERAS group and control.

Conclusion

Application of an ERAS protocol for patients undergoing liver resection is safe and feasible in cirrhotic patients. ERAS protocols were successful in significantly reducing overall complication rates and length of inpatient hospital stay, and did not negatively impact secondary post-operative outcomes or mortality. ERAS protocols should be reflected in future guidelines, specifically for cirrhotic patients undergoing hepatectomy, and additional research on the utility of ERAS in higher risk patients is encouraged.
HPB SO23 - Implementation and Outcomes of Index Admission Management of Acute Gallstone Pancreatitis on a Specialist Biliary Unit
Authors: Hayyawi Israa , Omran Asmaa , Nassar Ahmad H M
Published: November 2024

Background

While the management of acute gallstone pancreatitis (AP) has recognised guidelines, there are wide variations in compliance with these in various institutions for different reasons. The primary objective of this review was to evaluate the effects of implementing proactive management strategies on a specialist biliary firm receiving most biliary emergency admissions by protocol on the incidence of index admission laparoscopic cholecystectomy (LC) for AP. The secondary aims were to study the admission to LC interval, if such policy was safe and how it can help the optimisation of outcomes of AP.

Method

Analysis of prospectively collected data from AP patients treated by a specialist biliary unit dedicated to index admission LC and single session laparoscopic management of bile duct stones. Almost all patients were referred to the unit as soon as the diagnosis of AP was made. Only patients with severe pancreatitis on imaging or requiring intensive care were not included in the index admission pathway and subsequently underwent delayed surgery. Routine MRCP and ERCP were not part of the management protocol. Following clinical optimisation patients had LC with routine cholangiography (IOC). and if necessary bile duct exploration.

Results

495/6140 patients were identified (8%), 70% females. Median age was 55 years. 92.3% had suspected ductal stones, half with jaundice. 11.9% had previous episodes. Only 6.2% had MRCPs and 2% ERCPs. Admission to LC interval was 5 days. 33.2% required bile duct explorations. LC difficulty grade was III to V in 37.2%. The median operative time was 62 minutes with no conversions, ductal injuries or mortality. Complications occurred in 9.2%, including 14 persistent pancreatitis/collections resulting in 6 of 25 readmissions. Two re-operations resulted from t-tube complications. Median hospital stay was 7 days, 72% having had only one admission.

Conclusion

Index admission LC on all AP patients fit for surgery is perfectly safe in the specialist setting. It optimises preoperative radiological investigations and endoscopic interventions and ,subsequently, a third of the patients require bile duct exploration. Implementing definitive surgical interventions during the index admission for AP offers a substantial reduction in hospital stay, re-admission rates and an overall decrease in hospital attendances. This not only yields significant cost benefits for the health service but also enhances the quality of life for patients.
HPB SO52 - Ambulatory Management of Acute Pancreatitis (A-MAP) – Novel approach: A Pilot study
Authors: Elmetwally Ashraf , French Jeremy , Schofield Diane , Bell Sarah , Crouzier Lily , Khaw Rachel , Canelo Ruben
Published: November 2024

Background

Acute pancreatitis (AP) is a very common problem, and its incidence is increasing over time. NICE guidelines, describes incidence of AP in UK is around 56 cases / 100000 population. Majority of AP cases are self-limiting, whereas only 15% of patients develop serious complications, with an overall mortality of 5%.

Traditionally, Patients with AP managed as inpatients with much pressure on NHS resources. As we now have better understanding of AP, pain becomes the main concern in management of AP, as most of cases are self-limiting.

The aim is to set a protocol for outpatient management of patients with mild AP.

Method

All patient diagnosed with mild acute pancreatitis according to revised Atlanta criteria (2012), aged 18 – 85, living within 1 hour from the hospital, and being attended by a responsible adult at home are eligible to be included in the study.

The management plan includes; pain control, antiemetic, PPIs, oral intake (fluids & low fat diet). A phone call next day of presentation. Patient review on the second day and tenth day following the presentation. All patient provided with Information leaflet with all warning symptoms and contact details in case of worsening symptoms.

Results

Over the period between March 2023 and April 2024, 18 patients (8 Males) with median age 47.5 (IQR 19) included in this prospective study. Ten patients have gallstones/biliary sludge, seven patients known to have alcoholic pancreatitis, & one patient where no cause could identified. All patients managed as outpatients as the protocol, except one female patient who lost follow up on day 2, as she reported no symptoms. Out of the 10 patients who have gallstones/ sludge; six patients had laparoscopic cholecystectomy and one patient had laparoscopic cholecystectomy with bile duct exploration within two weeks from their index presentation (70%).

Conclusion

This pilot study shows the feasibility of this novel approach of ambulatory management of patients presented with mild acute pancreatitis, with compliance to NICE guidelines by offering patients laparoscopic cholecystectomy within two weeks from presentation in cases of biliary pancreatitis. There is a need for a wider study possibly multicentre with the option of subgroup analysis by the cause of pancreatitis, frequency of presentation, and presence of element of chronic pancreatitis.
HPB SO63 - A Closed-Loop Audit on Surgical Ward Round Documentation in a Tertiary Hospital
Authors: Wong Thai Ling , Fouad Mina , Kumarajothy Riana , Sudip Sanyal
Published: November 2024

Background

Surgical ward rounds play a pivotal role in overall patient outcome during surgical and perioperative care. Clear and comprehensive documentations are crucial in providing an accurate account of ward round activities. We aimed to assess the quality of hepatopancreatobiliary (HPB) ward round documentation and the impact of a HPB surgical ward round proforma on the quality of documentation.

Method

50 medical notes were reviewed in a tertiary centre to determine if key components of ward round documentation such as the date, time, diagnosis, procedure, consultant, person documenting, information communicated to patient, observations, investigations and management plan were documented. A proforma for ward round documentation was introduced. A re-audit was performed to review the impact of a proforma on ward-round documentation.

Results

The time of ward round, relevant history, NEWS and management plan were recorded in more than 50% of medical notes. However, the diagnosis, consultant, person documenting, information communicated to patient, wound review, medication review, fluid balance, investigations, follow up and discharge plans were documented in less than 50% of medical notes.

After the introduction of a proforma, the date and time of the surgical ward round were documented in 94% of medical notes. 84% had initials of the consultants leading ward-rounds and the person documenting. More than 80% notes included relevant examination, information communicated to patient, wound and medications review.

Conclusion

Surgical ward round proformas have a role in improving ward round documentation. Good record keeping is essential for continuity of care, optimising quality of care and ensuring patient safety.
HPB SO67 - An audit to improve the perioperative administration of tranexamic acid (TXA) to reduce the need for peri- and post-operative blood transfusion in major HPB resections
Authors: Goulder Lewis , Heinz Jana , Daniels Sarah
Published: November 2024

Background

NHS Blood and Transplant (NHSBT) triggered an ‘amber alert’ on 12 October 2022, meaning hospitals have been asked to put in place management plans to protect blood stocks. In line with these measures requested by NHSBT, The Royal College of Surgeons of England recommended using tranexamic acid in all adult surgical patients if more than 500ml of blood loss is likely. Results from the recent POISE-3 clinical trial confirm the quality, safety and cost-effectiveness of tranexamic acid in surgery, where more than 500ml of blood loss is anticipated.

Method

Patients were identified by searching the Sheffield Teaching Hospital (STH) operation note database using the key words: hepatectomy, pancreatectomy, liver resection, PPPD and pancreaticoduodenectomy. Retrospective case note review identified TXA administration, pre and postoperative haemoglobin level and blood transfusion prescription.

Results

49 patients undergoing major HPB resection at Sheffield Teaching Hospitals (STH) from October 2022 to March 2023 were identified. Following the addition of a prompt in the WHO timeout pre-op checklist, a further 24 patients were reviewed. The audit compared the number of patients who received TXA, pre- and post-operative haemoglobin levels and incidence of intra- or postoperative blood transfusion (within 30 days) between the two groups. Including a prompt did not increase the likelihood of a pre-operative dose of TXA being administered. Mean change in haemoglobin and the proportion of patients requiring transfusion remained similar between the two groups.

Conclusion

Incorporating a preoperative prompt in the WHO timeout checklist did not improve adherence to guidelines for TXA administration in major HPB surgery. Future audits should continue monitoring these trends and investigating further strategies to optimise perioperative blood management. However, there are randomised controlled trials comparing TXA with placebo in liver resection and the recent TAC-PD trial showed that perioperative TXA did not reduce blood loss in pancreaticoduodenectomy.
HPB SO73 - Histopathological Patterns in Emergency and Elective Cholecystectomy
Authors: Zubair Farhan , Di Rollo Domenic , Khan Khurram Shahzad
Published: November 2024

Background

Laparoscopic cholecystectomy (LC) is one of the most frequently performed general surgical procedures. In the United Kingdom, gallbladder specimens are routinely submitted for histopathological analysis to detect occult pathologies, such as carcinoma in situ and early-stage carcinomas. This study aims to assess the results of routine histopathological examination of LC specimens.

Method

A prospectively collected database of all LCs and laparoscopic common bile duct exploration (LCBDE) performed between August 2022 and June 2024 was analysed. The database was populated from a single benign biliary center by two specialized biliary surgeons. Electronic case notes were analysed for the demographics, indication(s), operative findings and the histopathological results. All gallbladder specimens were sent for histopathology analysis, irrespective of their gross appearance.

Results

Of the 201 eligible patients, 164 patients had histopathology results available. Median age was 56 years (IQR 41-66) and 100 (61%) were female. 72 (43.9%) were emergency cases. 48 (29.3%) had cholecystectomy, 70 (42.7%) also had intraoperative cholangiogram and 46 (28%) had LCBDE.

Conclusion

Chronic calculus cholecystitis was the most frequent histopathological finding, followed by acute on chronic cholecystitis and gangrenous acute cholecystitis. Dysplasia was identified in 1.8% of patients, warranting multidisciplinary team discussion. This study underscores the significance of routine histopathological examination after cholecystectomy, as early incidental detection of dysplasia and carcinoma can modify postoperative management and improve patient outcomes.
Overcoming genetic neuromuscular diagnostic pitfalls in a middle-income country
Authors: Frezatti Rodrigo Siqueira Soares , Tomaselli Pedro José , Record Christopher J , Wilson Lindsay A , Alves Gustavo Maximiano , Dominik Natalia , Efthymiou Stephanie , Patel Krutik , Vandrovcova Jana , Männikkö Roope , Pitceathly Robert D S , Sobreira Claudia Ferreira da Rosa , McFarland Robert , Taylor Robert W , Houlden Henry , Hanna Michael G , Reilly Mary M , Marques Wilson
Published: November 2024

Neuromuscular disorders affect almost 20 million people worldwide. Advances in molecular diagnosis have provided valuable insights into neuromuscular disorders, allowing for improved standards of care and targeted therapeutic approaches. Despite this progress, access to genomic diagnosis remains scarce and inconsistent in middle-income countries such as Brazil. The lack of public health policies to enable feasible genetic diagnosis and the shortage of neuromuscular disorders specialists are the main reasons in this process. We report our experience in a transcontinental genomic consortium for neuromuscular disorders highlighting how collaborative efforts have helped overcome various obstacles in diagnosing our patients. We describe several challenging cases categorized into three major themes, underlining significant gaps in genetic diagnosis: (i) reverse phenotyping and variant validation, (ii) deep phenotyping and identifying a bespoke molecular approach, and (iii) exploring the use of genomic tests beyond whole exome sequencing. We applied a qualitative case-based approach to exemplify common pitfalls in genomic diagnosis in a middle-income country. Our experience has shown that establishing a virtual transcontinental partnership is viable, offering effective exchange of scientific experiences, providing both guidance for rational decision-making and specialized training on a local level and access to diverse molecular diagnosis strategies and functional analyses. Collaborative efforts such as these have the potential to overcome local obstacles, strengthen scientific capabilities, foster diverse multi-ethnic cohorts, and ultimately provide improved care for patients.
Into the unknown: the need to reframe risk analysis
Authors: Simpson Andrew
Published: November 2024

In recent years there have been efforts to bring a degree of quantification to the task of security risk analysis. Various arguments in favour of such developments have been offered: ‘checklist’- or ‘tickbox’-based security is insufficiently dynamic; risk matrices are flawed; quantitative approaches must (somehow) be better than qualitative ones; it makes sense to leverage advances in data science, AI, and machine learning in concert with the increasing abundance of data; there is merit in leveraging lessons from economics. While some notes of caution have been offered in the literature (with data availability and quality being prominent concerns), we argue that greater consideration and recognition of the relationship between risk and uncertainty—and, indeed, unawareness—would be of value to the community. In doing so, we look to recent critiques of the prevailing economics orthodoxy before considering potential sources of possible help.
Navigating the landscape of security modelling: the MORS grid
Authors: Spencer Matt , Coles-Kemp Lizzie , Hansen René Rydhof
Published: November 2024

Digital security in all its forms, whether focused on computer security, information security, or cyber security, has practices of modelling at its core. Over recent decades, the goals of security in a digital context have widened to cover not only the protection of data and computing resource but also the protection and enablement of people using technology. Alongside this, there has been a concomitant diversification of the types of modelling that are used in digital security. In recent years, modellers have faced significant epistemological challenges, with tensions between different interdisciplinary perspectives about what models and modelling ought to be, and difficulties adequately communicating the virtues of different kinds of models among modellers and stakeholders such as policymakers or users. In this paper, we present a framework grounded in philosophy and social theory for understanding the methodological diversity of security modelling today: the MORS grid. Using the MORS grid, modellers can locate their own work of modelling, and explore methodological variations and political implications. We argue that in a subject that is increasingly recognized as being composed of different disciplinary positions, such a grid not only enables modellers to locate their own approach but also to appreciate the modelling positions of others. The grid is composed of four simple binaries: whether the modeller is an expert or non-expert, whether the modelling enquiry is model-oriented or target-oriented, whether the referent object (what needs to be protected) is determined prior to or posterior to the task of modelling, and whether the analyst adopts the design stance or the intentional stance. The paper presents the MORS grid through three lines of thought: first, we unpack the theoretical basis for each distinction in existing literature in the philosophy of science, security studies, and philosophy of mind; second, we provide a historical review of security modelling, and examine which positions on the MORS grid have predominated, and why; third, we set out the implications for modellers, policymakers and other stakeholders.
A history of cyber risk transfer
Authors: Woods Daniel W , Wolff Josephine
Published: November 2024

Cyber risk management involves balancing risk acceptance, avoidance, reduction, and transfer. Academic researchers have focused on risk reduction measures. Studies of cyber risk transfer are less common, mainly centering on cyber insurance. This emphasis on risk reduction overlooks the development of many real-world cyber risk transfer products in the last decade. Our study describes the emergence of products including: cyber (re)insurance, parametric insurance, warranties, and cyber cat bonds. We characterize how these solutions addressed four core challenges of transferring cyber risk: (1) tailoring coverage to the threat landscape; (2) managing solvency; (3) data collection for risk assessment; and (4) creating incentives for risk reduction. The result is an integrated history of cyber risk transfer describing how novel products and partnerships emerged to address failings in prevailing business models. Our descriptive study can help other researchers to understand real-world problems, providing a foundation for future research and a richer picture of the overall cyber risk transfer landscape, as well as a deeper understanding of the types of cyber risk that can—and cannot—be effectively transferred.
Cardiac resynchronization therapy by pacing the right ventricular dorsal site of inflow and anterior outflow for congenitally corrected transposition of the great arteries: a case report
Authors: Baba Shigehito , Miyazaki Aya , Watanabe Toru , Shiraishi Shuichi , Saitoh Akihiko
Published: November 2024

Background

Evidence regarding cardiac resynchronization therapy (CRT) for congenitally corrected transposition of the great arteries (ccTGA) is insufficient. The timing to perform CRT and optimal pacing sites have not been systematically studied. We performed CRT for ccTGA with a complete atrioventricular block (CAVB) by pacing the dorsal site of right ventricular inflow (dRVI) and anterior RV outflow tract (aRVOT).

Case summary

We examined a man aged 19 with ccTGA (S.L.L) and Ebstein anomaly, who developed CAVB at 19. We decided to implant CRT rather than a conventional pacemaker for preventing right ventricular (RV) dysfunction. At first, we implanted transvenous pacing leads on the right atrium and dRVI via the coronary sinus. During dRVI pacing, the most delayed contraction site was the aRVOT by the echocardiographic speckle tracking and the electrophysiological study. Accordingly, we implanted additional epicardial lead in the aRVOT and completed the implantation of CRT. After the CRT, the QRS duration was shortened from 187 to 132 ms and RV ejection fraction (RVEF) by right ventriculography increased from 35% to 42%.

The distance between two ventricular leads (dRVI and aRVOT) was 93% with 85% of longitudinal and radial direction in the RV. The effective CRT in this case was characterized by covering RV in the longitudinal and radial direction.

Conclusion

Separate two-point pacing on the dRVI and aRVOT, which assists the contraction in the longitudinal and radial dimension, is considered a potential position for CRT pacing and an effective method in ccTGA.
Cost-effectiveness of implementing a genotype-guided de-escalation strategy in patients with acute coronary syndrome
Authors: van den Broek Wout Willem Antoon , Azzahhafi Jaouad , Chan Pin Yin Dean R P P , van der Sangen Niels M R , Sivanesan Shabiga , Dijksman Lea M , Walhout Ronald J , Tjon Joe Gin Melvyn , Breet Nicoline J , Langerveld Jorina , Vlachojannis Georgios J , van Bommel Rutger J , Appelman Yolande , van Schaik Ron H N , Henriques José P S , Kikkert Wouter J , ten Berg Jurriën M
Published: November 2024

Aims

A genotype-guided P2Y12-inhibitor de-escalation strategy, switching acute coronary syndrome (ACS) patients without a CYP2C19 loss-of-function allele from ticagrelor or prasugrel to clopidogrel, has shown to reduce bleeding risk without affecting the effectivity of therapy by increasing ischaemic risk. We estimated the cost-effectiveness of this personalized approach compared to standard dual antiplatelet therapy (DAPT; aspirin plus ticagrelor/prasugrel) in the Netherlands.

Methods and results

We developed a 1-year decision tree based on results of the FORCE-ACS registry, comparing a cohort of ACS patients who underwent genotyping with a cohort of ACS patients treated with standard DAPT. This was followed by a lifelong Markov model to compare lifetime costs and quality-adjusted life years (QALYs) for a fictional cohort of 1000 patients. The cost-effectiveness analysis was performed from the perspective of the Dutch healthcare system. A genotype-guided de-escalation strategy led to an increase of 57.73 QALYs and saved €808788 compared to standard DAPT based on a lifetime horizon. Probabilistic sensitivity analysis showed that the genotype-guided strategy was cost-saving in 96% and increased QALYs in 87% of simulations. The intervention remained cost-effective in the scenario where prices for all P2Y12 inhibitors were equalized. The genotype-guided strategy remained dominant in various other scenarios and sensitivity analyses.

Conclusion

A genotype-guided de-escalation strategy in patients with ACS was both cost-saving and yielded higher QALYs compared to standard DAPT, highlighting its potential for implementation in clinical practice.

Trial registration: ClinicalTrials.gov identifier: NCT03823547.
Introducing the CEDAW ROCS dataset: A Dataset on the United Nations Treaty the Convention on the Elimination of All Forms of Discrimination against Women––Reservations and Objections of Committed States
Authors: Kreutzer Willow
Published: November 2024

The Convention on the Elimination of All Forms of Discrimination Against Women Reservations and Objections of Committed States (CEDAW ROCS) dataset provides a rich source of information about the United Nations CEDAW treaty from 1979 to 2022. For the first time, all the signatories, ratifiers, reservations, and objections to CEDAW, quantitatively are visible in one place. The dataset provides details about which states objected to which types of CEDAW reservations, when states withdrew CEDAW reservations, and the most prevalent reservations on CEDAW to date. The data are available in country year format. This research note discusses the motivation for the creation of this dataset and discusses coding decisions for key variables. Descriptive statistics and illustrations of the data are provided. The dataset's capabilities for current human rights and international law scholars are also discussed.
Factors Associated With Biologic Therapy After Ileal Pouch–Anal Anastomosis in Patients With Ulcerative Colitis
Authors: Fischman Maya , Godny Lihi , Friedenberg Adi , Barkan Revital , White Ian , Wasserberg Nir , Rabinowitz Keren , Avni-Biron Irit , Banai Hagar , Snir Yifat , Broitman Yelena , Yanai Henit , Dotan Iris , Ollech Jacob E
Published: November 2024

Background

Patients with ulcerative colitis (UC) undergoing proctocolectomy and ileal pouch–anal anastomosis (IPAA) may eventually require biologic therapy. Factors associated with biologic therapy after IPAA have not been previously studied.

Methods

All patients with UC after total proctocolectomy and IPAA who were followed at Rabin Medical Center comprehensive pouch clinic and who consented to prospective observational follow-up were included. The primary outcome was the initiation of biologic therapy after IPAA. Cox proportional hazard models were used to evaluate potential associations.

Results

Out of 400 patients receiving their care at the pouch clinic, 148 patients consented to prospective observational follow-up and constituted the study cohort. The median age at diagnosis was 21 years and the age at IPAA was 30 years. Median time-to-biologic therapy initiation post-IPAA was 9.2 years, with 34 patients (23%) initiating biologic therapy: Associated factors for initiating biologic therapy post-IPAA were preoperative treatment with biologic therapy and immunomodulatory therapy (hazard ratio [HR] 6.1 and 3.6, respectively, P < .001); Arab descent (HR 5.3, P < .001); heterozygosity of NOD2 variant rs2066845 (HR 5.1, P = .03); past smoking status (HR 2.3, P = .03); 3-stage IPAA (HR 2.3, P = .02); immediate postoperative complications (HR 2.1, P = .033); and pediatric-onset UC (HR 2.1, P = .03). None of the patients undergoing IPAA due to dysplasia (n = 27) required biologic therapy.

Conclusions

Several demographic, disease-related, surgery-related, and genetic factors associated with post-IPAA biologic therapy were identified. Physicians treating patients with UC undergoing colectomy should incorporate these factors into their decision-making process. These patients may benefit from closer postoperative follow-up, and earlier initiation of biologic therapy should be considered.
Climate-readiness of fishery management procedures with application to the southeast US Atlantic
Authors: Peterson Cassidy D , Klibansky Nikolai , Vincent Matthew T , Walter John F
Published: November 2024

Global climate change threatens the assumption of stationarity inherent in many fisheries management decisions. This heightens the importance of developing management strategies that are robust to future uncertainty. Management strategy evaluation (MSE) is a framework in which management procedures (MPs) can be developed and tested using closed-loop simulation. We explored the performance of various model-based and empirical MPs with nonstationary future projections for three commercially and recreationally important fish stocks in the southeast US Atlantic. Using openMSE, we tested candidate MP performance across projections designed to emulate plausible future conditions, including regime shifts, nonstationarity, and observation error shifts in the survey index. Candidate MP performance was primarily measured based on its ability to maintain a healthy stock biomass. Results of this MSE demonstrate that several empirical MPs may be better able to adapt to regime shifts and nonstationary dynamics compared to traditional model-based MPs that employ full age-structured stock assessments, though empirical MPs struggle to maintain stock biomass when facing artificial index observation error shifts. Relative performance of model-based versus empirical MPs varied by stock and climate-change scenario. These findings highlight the value that adaptive MPs may hold for climate-ready fisheries management.
Reflections on patchwork ethnography and activist scholarship: The role of methods in witnessing and participating in worldmaking at the margins of the EU
Authors: Bird Gemma
Published: November 2024

The way we do research can and does affect how we think about, engage with, and explore approaches to worldmaking and marginality. Approaches to research play a role in what we recognize and witness and how we influence and construct the worlds we engage with. Building on the work of scholars such as King and Picozza, I ask what role there is for activist scholarship in thinking about questions of worldmaking in spaces and places of marginality. Specifically, I ask how taking an activist approach to our scholarship can facilitate deeper engagements with alternative forms of worldmaking that take place in spaces and places of displacement support. I argue for a research approach grounded in activist scholarship focused on long-term interventions best understood as “patchwork ethnography,” focused on relationship building, reflexivity, and politically driven research. I draw on vignettes and research diaries to explore the relationship between activism and worldmaking to support two arguments. Firstly, researchers themselves can participate in forms of worldmaking when working with communities to develop and enact projects. Secondly, that participation of this sort enables a recognition of different approaches to building collective worlds that may be missed through relying on less embedded research methods.
World Ordering from the Margins: An Introduction
Authors: Rinck Patricia , Tripathi Siddharth , Unrau Christine , Quack Sigrid
Published: November 2024

This Special Forum is an invitation to reconsider the analytical toolbox with which world order has been analyzed in the past. In this introductory article, we propose to focus on processes of world ordering from the margins as a contribution to research on world-order conceptions beyond the Liberal International Order. We examine world-ordering practices by a variety of actors, across the Global North and the Global South, including activists, political parties and actors beyond the state, whose activities are not typically perceived as world-ordering endeavors. Shifting the analytical focus to those at the margins of the world polity offers a better understanding of the plurality and contestations of contemporary world order and helps to (un-)cover critiques and possible alternatives to existing world orders that emerge from these groups, practices and discourses. In this introduction, we propose three perspectives to study and research world ordering from the margins: positionality, methodology, and strategy. We argue that examining world order from these perspectives leads to a nuanced picture of a multitude of positions of marginality, emanating from different experiences, perceptions and discourses, all of which matter for the respective world-ordering endeavors. Retrieving such alternative perspectives is paramount in view of multiple crises that current forms of world order seem unable to address.
Cannabinoid receptor type 2 agonist GP1a attenuates macrophage activation induced by M. bovis-BCG by inhibiting NF-κB signaling
Authors: Valeriano Jessica Do Prado , Andrade-Silva Magaiver , Pereira-Dutra Filipe , Seito Leonardo Noboru , Bozza Patricia Torres , Rosas Elaine Cruz , Souza Costa Maria Fernanda , Henriques Maria G
Published: November 2024

Tuberculosis (TB) is one of the leading causes of death worldwide and a major public health problem. Immune evasion mechanisms and antibiotic resistance highlight the need to better understand this disease and explore alternative treatment approaches. Mycobacterial infection modulates the macrophage response and metabolism to persist and proliferate inside the cell. Cannabinoid receptor type 2 (CB2) is expressed mainly in leukocytes and modulates the course of inflammatory diseases. Therefore, our study aimed to evaluate the effects of the CB2-selective agonist GP1a on irradiated Mycobacterium bovis-BCG (iBCG)-induced J774A.1 macrophage activation. We observed increased expression of CB2 in macrophages after iBCG stimulation. The pretreatment with CB2-agonists, GP1a, JWH-133, and GW-833972A (10 µM), reduced iBCG-induced TNF-α and IL-6 release by these cells. Moreover, the CB2-antagonist AM630 (200 nM) treatment confirmed the activity of GP1a on CB2 by scale down its effect on cytokine production. GP1a pretreatment (10 µM) also inhibited the iBCG-induced production of inflammatory mediators as prostaglandin (PG)E2 and nitric oxide by macrophages. Additionally, GP1a pretreatment also reduced the transcription of proinflammatory genes (inos, il1b, and cox2) and genes related to lipid metabolism (dgat1, acat1, plin2, atgl, and cd36). Indeed, lipid droplet accumulation was reduced by GP1a treatment, which was partially blockade by AM630 pretreatment. Finally, GP1a pretreatment reduced the activation of the NF-κB signaling pathway. In conclusion, the activation of CB2 by GP1a modulated the macrophage response to iBCG by reducing inflammatory mediator levels and metabolic reprogramming.
Model-Fitting Weighted Least Squares as an Alternative to Principal Component Analysis for Analyzing Energy-Dispersive X-ray Spectroscopy Spectrum Images
Authors: Wahlqvist David , Ek Martin
Published: November 2024

Spectrum imaging with energy-dispersive X-ray spectroscopy (EDS) has become ubiquitous in material characterization using electron microscopy. Multivariate statistical methods, commonly principal component analysis (PCA), are often used to aid analysis of the resulting multidimensional datasets; PCA can provide denoising prior to further analysis or grouping of pixels into distinct phases with similar signals. However, it is well known that PCA can introduce artifacts at low signal-to-noise ratios. Unfortunately, when evaluating the benefits and risks with PCA, it is often compared only against raw data, where it tends to shine; alternative data analysis methods providing a fair point of comparison are often lacking. Here, we directly compare PCA with a strategy based on (the conceptually and computationally simpler) weighted least squares (WLS). We show that for four representative cases, model fitting of the sum spectrum followed by WLS (mfWLS) consistently outperforms PCA in terms of finding and accurately describing compositional gradients and inclusions and as a preprocessing step to clustering. Additionally, we demonstrate that some common artifacts and biases displayed by PCA are avoided with the mfWLS approach. In summary, mfWLS can provide a superior option to PCA for analysis of EDS spectrum images as the signal is simply and accurately modeled.
Single Electron Self-coherence and Its Wave/Particle Duality in the Electron Microscope
Authors: Kisielowski C , Specht P , Jinschek J R , Helveg S
Published: November 2024

Intensities in high-resolution phase-contrast images from electron microscopes build up discretely in time by detecting single electrons. A wave description of pulse-like coherent-inelastic interaction of an electron with matter implies a time-dependent coexistence of coherent partial waves. Their superposition forms a wave package by phase decoherence of 0.5 - 1 radian with Heisenbergs energy uncertainty ΔEH = ħ/2 Δt−1 matching the energy loss ΔE of a coherent-inelastic interaction and sets the interaction time Δt. In these circumstances, the product of Planck's constant and the speed of light hc is given by the product of the expression for temporal coherence λ2/Δλ and the energy loss ΔE. Experimentally, the self-coherence length was measured by detecting the energy-dependent localization of scattered, plane matter waves in surface proximity exploiting the Goos–Hänchen shift. Chromatic-aberration Cc-corrected electron microscopy on boron nitride (BN) proves that the coherent crystal illumination and phase contrast are lost if the self-coherence length shrinks below the size of the crystal unit cell at ΔE > 200 eV. In perspective, the interaction time of any matter wave compares with the lifetime of a virtual particle of any elemental interaction, suggesting the present concept of coherent-inelastic interactions of matter waves might be generalizable.
Navigating social reintegration: Experiences of Sri Lankan migrant workers returning from the Gulf
Authors: Ekanayake Anoji
Published: November 2024

Since the economic boom in the Gulf region in the mid-1970s, it has been an attractive destination for Sri Lankan migrant workers seeking better opportunities. However, Gulf monarchies do not grant citizenship to these workers, making return and reintegration into Sri Lanka a crucial aspect of their migration journeys. While numerous studies have explored the economic aspects of the reintegration of returnees from the Gulf, there is a noticeable gap in the literature concerning the social aspects, particularly among returnees at the upper end of the skill spectrum. This study aims to fill this gap by examining the social dimensions of reintegration, which also impact economic reintegration, drawing on primary data from twenty-one in-depth interviews and a survey of 205 returnee migrants across the skill spectrum. The study's findings indicate that while most returnee high-skilled, skilled, and semi-skilled migrant workers find it relatively easy to readjust to life back in Sri Lanka with their family, friends, and relatives, some face hurdles in settling into new workplaces and reintegrating into the local work culture, which negatively affects their overall social reintegration experience. Furthermore, the study underscores the interconnectedness of economic and social reintegration, each influencing and sometimes exacerbating challenges in the other domain.
The Pfam protein families database: embracing AI/ML
Authors: Paysan-Lafosse Typhaine , Andreeva Antonina , Blum Matthias , Chuguransky Sara Rocio , Grego Tiago , Pinto Beatriz Lazaro , Salazar Gustavo A , Bileschi Maxwell L , Llinares-López Felipe , Meng-Papaxanthos Laetitia , Colwell Lucy J , Grishin Nick V , Schaeffer R Dustin , Clementel Damiano , Tosatto Silvio C E , Sonnhammer Erik , Wood Valerie , Bateman Alex
Published: November 2024

The Pfam protein families database is a comprehensive collection of protein domains and families used for genome annotation and protein structure and function analysis (https://www.ebi.ac.uk/interpro/). This update describes major developments in Pfam since 2020, including decommissioning the Pfam website and integration with InterPro, harmonization with the ECOD structural classification, and expanded curation of metagenomic, microprotein and repeat-containing families. We highlight how AlphaFold structure predictions are being leveraged to refine domain boundaries and identify new domains. New families discovered through large-scale sequence similarity analysis of AlphaFold models are described. We also detail the development of Pfam-N, which uses deep learning to expand family coverage, achieving an 8.8% increase in UniProtKB coverage compared to standard Pfam. We discuss plans for more frequent Pfam releases integrated with InterPro and the potential for artificial intelligence to further assist curation. Despite recent advances, many protein families remain to be classified, and Pfam continues working toward comprehensive coverage of the protein universe.
A butterfly-shaped acceptor with rigid skeleton and unique assembly enables both efficient organic photovoltaics and high-speed organic photodetectors
Authors: Shi Wendi , Han Qiansai , Zhu Yu , Xia Yingjun , He Tengfei , Wang Shijie , Li Longyu , Ma Wei , Long Guankui , Li Guanghui , Yao Zhaoyang , Li Chenxi , Wan Xiangjian , Chen Yongsheng
Published: November 2024

It remains challenging to design efficient bifunctional semiconductor materials in organic photovoltaic and photodetector devices. Here, we report a butterfly-shaped molecule, named WD-6, which exhibits low energy disorder and small reorganization energy due to its enhanced molecular rigidity and unique assembly with strong intermolecular interaction. The binary photovoltaic device based on PM6:WD-6 achieved an efficiency of 18.41%. Notably, an efficiency of 19.42% was achieved for the ternary device based on PM6:BTP-eC9:WD-6. Moreover, the photodetection device based on WD-6 demonstrated an ultrafast response speed (205 ns response time at λ of 820 nm) and a high cutoff frequency of −3 dB (2.45 MHz), surpassing the values of most commercial Si photodiodes. Based on these findings, we showcased an application of the WD-6-based photodetection device in high-speed optical communication. These results offer valuable insights into the design of organic semiconductor materials capable of simultaneously exhibiting high photovoltaic and photodetective performance.
Radiation dose estimation for indoor radon, thoron and their progenies using a stochastic method—a small-scale survey in Wuhan, China
Authors: Hu Jun , Kranrod Chutima , Omori Yasutaka , Hosoda Masahiro , Tokonami Shinji
Published: November 2024

Passive radon monitors with CR-39s are widely used in major epidemiological surveys. However, the conventional CR-39 track density determining strategy makes it difficult to accurately estimate the concentration because of the heterogeneity of tracks on CR-39s. This study introduced a stochastic method, Latin hypercube sampling, to improve the track density determining strategy and provide the probability distribution of 222Rn concentration and equilibrium equivalent thoron concentration. The first 222Rn and 220Rn discriminated survey was conducted in Wuhan, China, in 2018 using RADUET® and deposition-based passive 220Rn progeny monitors and applying the stochastic method to the measurement. The results indicate that the stochastic method could decrease the effects of the track heterogeneity on the CR-39s and provide reliable results. The 220Rn progeny contributed more than 40% of the total inhalation dose in the survey, which cannot be ignored in urban family dwellings.