bluuebunny/crossref_metadata_2025 huggingface dataset:
Institutional change and political conflict in a structuralist model
Authors: Porcile Gabriel , Sanchez-Ancochea Diego
Published: June 2021

External conditions have historically influenced economic outcomes and have also impacted political institutions in developing countries. Focusing on these changes, this article develops a theoretical model of political conflict and democratic stability in a small open developing economy, using as the basis a structuralist macroeconomic model. In this model, political institutions are given in the medium run but vary in the long run as a result of political conflict between capitalists, formal workers, and informal workers excluded from the benefits of social protection. The model suggests that a democratic breakdown is more likely the larger the informal sector, the lower the structural competitiveness of the economy, and the weaker the country’s democratic tradition. The model also links the possibility of coups and democratization process with external shocks. Based mainly on the Latin American experience in democratic and dictatorial regimes, the article claims that combining industrial and technological policies—which ease the Balance-of-Payments constraint—with the building of a comprehensive system of social protection is key for the consolidation and stability of democracy.
Vedolizumab Experience in Children and Adolescents With Inflammatory Bowel Disease: A Multicenter Observational Study
Authors: Hajjat Temara M , Mosha Maua , Whaley Kaitlin G , Rosen Michael J , Suppa Carmine , Markowitz James , Dufour Lauren , Sauer Cary , Shukla-Udawatta Monica , Boyle Brendan , Gibson Meghan , Shapiro Jason , Sams Derica , Sylvester Francisco , Hunter Gabriele , Perez Maria E , Hyams Jeffrey S
Published: June 2021

Background

Vedolizumab is increasingly used off-label to treat children and adolescents with inflammatory bowel disease (IBD). In the absence of rigorous clinical trial experience, multicenter observational data are important to establish expectations for efficacy and safety. We examined 1-year outcomes following vedolizumab therapy in a large multicenter pediatric IBD cohort.

Methods

We performed a retrospective study of 159 pediatric patients (4–17 years old) with IBD [78, Crohn disease (CD); 81, ulcerative colitis/IBD-unspecified (UC/IBD-U)] treated with vedolizumab for 1 year at 8 pediatric medical centers in the United States. Demographics, clinical outcomes, laboratory data, and vedolizumab dosing were recorded. The primary outcome was corticosteroid (CS)-free clinical remission at 1 year. Other measured outcomes were clinical remission at 12 and/or 24 weeks, laboratory outcomes at 1 year, and endoscopy/histology results at 1 year.

Results

Among the 159 patients (mean age, 14.5 ± 2.4 years; 86% anti-TNF experienced), 68/159 (43%) achieved CS-free clinical remission at 1 year (CD, 35/78, 45%; UC/IBD-U, 33/81, 40%). Vedolizumab therapy failed and was discontinued in 33/159 (21%) patients prior to 1 year (CD, 18/78, 23%; UC/IBD-U, 15/81, 19%). While week 12 clinical remission was not predictive of 1-year clinical remission in either CD or UC/IBD-U, week 24 clinical remission was predictive of 1-year clinical remission only in CD patients. No infusion reactions or serious side effects were noted.

Conclusions

Vedolizumab was safe and effective in this pediatric population with approximately 43% achieving CS-free clinical remission at 1 year. Similar efficacy was noted in both CD and UC.
Coordination and consensus: the role of compromisers in Tibetan macaques
Authors: Wang Xi , Xia Dong-Po , Sun Bing-Hua , Li Jin-Hua
Published: June 2021

Coordination and consensus in collective behavior have attracted a lot of research interest. Although previous studies have investigated the role of compromisers in group consensus, they provide little insight into why compromisers would allow such social arrangements to persist. In this study, the potential relationship between group movements and conflict management in Tibetan macaques in Anhui province, China, was investigated using hierarchical cluster analyses. Some members with higher social centrality or social rank often formed a front-runner cluster during group movements. They had higher leadership success than individuals outside the front-runner cluster. Other members with lower social centrality or social rank often followed the group movements initiated by the front-runner cluster, and thus formed the compromiser cluster. Compromisers’ proximity relations with front-runners increased with their following scores to front-runners. Compromisers had fewer events of being attacked when they followed group movements initiated by the front-runners. The compromising process made compromisers lose the choice of direction preference, but it could increase their individual safeties. This trade-off suggests that compromisers play a role of decision-maker in coordination and consensus scenarios among social animals.
Non-invasive characterization of pleural and pericardial effusions using T1 mapping by magnetic resonance imaging
Authors: Rosmini Stefania , Seraphim Andreas , Knott Kristopher , Brown James T , Knight Daniel S , Zaman Sameer , Cole Graham , Sado Daniel , Captur Gabriella , Gomes Ana Caterina , Zemrak Filip , Treibel Thomas A , Cash Lizette , Culotta Veronica , O’Mahony Constantinos , Kellman Peter , Moon James C , Manisty Charlotte
Published: June 2021

Aims

Differentiating exudative from transudative effusions is clinically important and is currently performed via biochemical analysis of invasively obtained samples using Light’s criteria. Diagnostic performance is however limited. Biochemical composition can be measured with T1 mapping using cardiovascular magnetic resonance (CMR) and hence may offer diagnostic utility for assessment of effusions.

Methods and results

A phantom consisting of serially diluted human albumin solutions (25–200 g/L) was constructed and scanned at 1.5 T to derive the relationship between fluid T1 values and fluid albumin concentration. Native T1 values of pleural and pericardial effusions from 86 patients undergoing clinical CMR studies retrospectively analysed at four tertiary centres. Effusions were classified using Light’s criteria where biochemical data was available (n = 55) or clinically in decompensated heart failure patients with presumed transudative effusions (n = 31). Fluid T1 and protein values were inversely correlated both in the phantom (r = −0.992) and clinical samples (r = −0.663, P < 0.0001). T1 values were lower in exudative compared to transudative pleural (3252 ± 207 ms vs. 3596 ± 213 ms, P < 0.0001) and pericardial (2749 ± 373 ms vs. 3337 ± 245 ms, P < 0.0001) effusions. The diagnostic accuracy of T1 mapping for detecting transudates was very good for pleural and excellent for pericardial effusions, respectively [area under the curve 0.88, (95% CI 0.764–0.996), P = 0.001, 79% sensitivity, 89% specificity, and 0.93, (95% CI 0.855–1.000), P < 0.0001, 95% sensitivity; 81% specificity].

Conclusion

Native T1 values of effusions measured using CMR correlate well with protein concentrations and may be helpful for discriminating between transudates and exudates. This may help focus the requirement for invasive diagnostic sampling, avoiding unnecessary intervention in patients with unequivocal transudative effusions.
Patch augmentation of small ascending aorta during stage I procedure reduces the risk of morbidity and mortality
Authors: Hoganson David M , Piekarski Breanna L , Quinonez Luis G , Kheir John J , Kaza Aditya K , Zurakowski David , Emani Sitaram M , Baird Chris W
Published: June 2021

OBJECTIVES

Hypoplastic left heart syndrome (HLHS) with aortic atresia (AA) patients are prone to coronary insufficiency due to a small ascending aorta. Prophylactic patch augmentation of the small ascending aorta during the stage I procedure (S1P) may reduce the risk of coronary insufficiency as marked by ventricular dysfunction, need for extracorporeal membrane oxygenator (ECMO) support or mortality.

METHODS

Retrospective analysis of patients with HLHS with AA who underwent an S1P was completed. Baseline ascending aorta size, right ventricular (RV) function and outcome variables of transplant-free survival, ECMO support after the stage 1 operation and RV function at the time of the bidirectional Glenn and latest follow-up were collected.

RESULTS

Between January 2010 and April 2020, 11 patients underwent prophylactic ascending aorta augmentation at the time of the S1P as a planned portion of the procedure. A total of 125 patients underwent S1P during this period as a comparison. Overall survival was 100% for the augmented group and 74% for the control group (P = 0.66). A composite end point of transplant-free survival, no post-S1P ECMO and less than moderate RV dysfunction was created. At the time of BDG, this composite end point was 100% for the augmented group and 61.8% for the control group (P = 0.008) and at most recent follow-up was 100% for the augmented group and 59.3% for control (P = 0.007). Eight patients required a rescue procedure for the clinical evidence of coronary insufficiency following S1P that included ascending aorta patch augmentation or stent placement. When comparing these rescue versus prophylactic ascending aortic augmentations, there were also differences in the composite outcome 100% for augmented and 60% for rescue (P = 0.009) and at the time of most recent follow-up 100% for augmented and 50% for rescue (P = 0.029).

CONCLUSIONS

Prophylactic patch augmentation of the ascending aorta in HLHS patients with AA may reduce the risk of mortality, ECMO and reduced RV function. Patients not initially undergoing augmentation but then requiring a rescue procedure have particularly poor outcomes. Patch augmentation for smaller ascending aortic diameters should be considered and further clinical experience may help delineate aorta diameter threshold for augmentation.
The V6-V1 interpeak interval: a novel criterion for the diagnosis of left bundle branch capture
Authors: Jastrzębski Marek , Burri Haran , Kiełbasa Grzegorz , Curila Karol , Moskal Paweł , Bednarek Agnieszka , Rajzer Marek , Vijayaraman Pugazhendhi
Published: June 2021

Aims

We hypothesized that during left bundle branch (LBB) area pacing, the various possible combinations of direct capture/non-capture of the septal myocardium and the LBB result in distinct patterns of right and left ventricular activation. This could translate into different combinations of R-wave peak time (RWPT) in V1 and V6. Consequently, the V6-V1 interpeak interval could differentiate the three types of LBB area capture: non-selective (ns-)LBB, selective (s-)LBB, and left ventricular septal (LVS).

Methods and results

Patients with unquestionable evidence of LBB capture were included. The V6-V1 interpeak interval, V6RWPT, and V1RWPT were compared between different types of LBB area capture. A total of 468 patients from two centres were screened, with 124 patients (239 electrocardiograms) included in the analysis. Loss of LVS capture resulted in an increase in V1RWPT by ≥15 ms but did not impact V6RWPT. Loss of LBB capture resulted in an increase in V6RWPT by ≥15 ms but only minimally influenced V1RWPT. Consequently, the V6-V1 interval was longest during s-LBB capture (62.3 ± 21.4 ms), intermediate during ns-LBB capture (41.3 ± 14.0 ms), and shortest during LVS capture (26.5 ± 8.6 ms). The optimal value of the V6-V1 interval value for the differentiation between ns-LBB and LVS capture was 33 ms (area under the receiver operating characteristic curve of 84.7%). A specificity of 100% for the diagnosis of LBB capture was obtained with a cut-off value of >44 ms.

Conclusion

The V6-V1 interpeak interval is a promising novel criterion for the diagnosis of LBB area capture.
How the PC was born and why it hasn't died yet
Authors: Cooper Martin
Published: June 2021

Tablets and smartphones might be cool but one class of computer has reshaped the working world more than any other: the personal computer. Martin Cooper MBCS charts the PC's birth, life and ongoing success.
Why we must teach computer history
Authors: McNab Gary
Published: June 2021

Gary McNab, Code Show founder and computer history advocate, explains why teaching children the keyboard and mouse basics is essential in this tablet-focused world. He shares a little of his PC-passion with Johanna Hamilton AMBCS.
The evolution of the PC
Authors: Fowler Kylie , Josey Richard , Norfolk David
Published: June 2021

A collaborative article by Strategy Consultant Kylie Fowler FBCS, Lead Service Management Solution Architect Richard Josey CITP MBCS and Bloor Analyst David Norfolk CITP MBCS: all committee members of the BCS SM-ITAM Specialist Group. They explore the demand, usage and evolution of the device.
Insight: Cybersecurity
Authors: Ratnayake Deepthi
Published: June 2021

Deepthi Ratnayake MBCS, Senior Lecturer in Computer Science (Cyber Security & Networks) at the University of Hertfordshire, discusses the impact of the SolarWinds hack.
The big interview: How cybersecurity can learn from its past
Authors: Cooper Martin
Published: June 2021

History has a habit of repeating itself if we don't study the past and learn from it, Professor Steven Furnell FBCS tells Martin Cooper MBCS. And this maxim holds true, even in the world of cybersecurity.
From Wargames to Wfh
Authors: O'Connor Patrick
Published: June 2021

Patrick O’Connor MBCS, Principal Systems Analyst Programmer at Amadeus, writes about the evolution of the PC: from the excitement of the first IBM PC-XT clone, to VPNs.
Big data applications in industry fields
Authors: Gazis Alexandros , Gazi Theodora
Published: June 2021

Big data is not just another buzzword, write Alexandros Gazis, PhD candidate at the Democritus University of Thrace, School of Engineering and Theodora Gazi, PhD candidate at Athens University Law School. So, which industry fi elds can benefi t from its use?
Digital Transformation in the Age of Covid
Authors: James Mivy
Published: June 2021

Mivy James FBCS, Digital Transformation Director at BAE Systems Applied Intelligence, talks to Johanna Hamilton AMBCS about change, enterprise architecture and the long overdue rise of #ImmodestWomen.
Does AI need symbols?
Authors: Lindsay Grace
Published: June 2021

Inspired by the brain, artificial neural networks are core to modern artificial intelligence. Grace Lindsay, author of Models of the Mind, explains concerns over the cognitive limits of these systems.
A divide and conquer approach to leads-to-model checking
Authors: Phyo Yati , Do Canh Minh , Kazuhiro Ogata
Published: June 2021

The paper ‘A Divide and Conquer Approach to Leads-to Model Checking’, by Yati Phyo, Canh Minh Do and Kazuhiro Ogata, published in The Computer Journal (February 2021), explores a new leads-to model method to negate the state involvement in model checking.
The effect of short-term phytase supplementation on the apparent total tract digestibility of calcium and phosphorus and the reproductive performance of late-gestation and lactating sows fed diets without mineral phosphorus
Authors: Zhai H , Cowieson A J , Pappenberger G , Zhang J , Wu J
Published: June 2021

The objective of this study was to measure apparent total tract digestibility (ATTD) of Ca and P as well as reproductive performance in late-gestation and lactating sows supplemented with a novel phytase and to compare the response to phytase supplementation between late-gestation and lactating sows. Forty-five late-gestation sows and 45 lactating sows were used in experiments 1 and 2, respectively, in a completely randomized design. The sows were provided with a control diet or the control diet supplemented with 187.5 or 375 FYT phytase/kg feed for 10 days. The diets were prepared according to the formulas in use for production but without any inorganic P supplement. Titanium dioxide was included at 3 g/kg feed as an indigestible marker. Each dietary treatment was replicated with 15 sows individually-housed in farrowing stalls. The sows were allowed to adapt to the experimental diets for 5 days before a 5-d fecal collection by grab sampling, and the performance of the sows and their litters were measured until weaning. The results showed that the ATTD of Ca increased linearly (P < 0.001) while the ATTD of P increased both linearly and quadratically (P < 0.01) with increasing supplementation of phytase in both late-gestation and lactating sows. There was no significant effect of phytase on the ATTD of dry matter, crude protein, and gross energy, and the performance of the sows and their progenies. The phytase added at 187.5 and 375 FYT/kg feed released 0.07% and 0.10% digested P, respectively, in late-gestation sows, which compared with 0.09% and 0.12% digested P in lactating sows. In conclusion, a novel phytase at 187.5 to 375 FYT/kg feed could release 0.07 to 0.12% digestible P for sows. It appeared that using the P digestibility values of feed ingredients listed by NRC (2012) to formulate a diet for sows might overestimate dietary P supply and a greater response to phytase supplementation could be expected in lactating sows than in late-gestation sows.
Dermal Nanoemulsion Treatment Reduces Burn Wound Conversion and Improves Skin Healing in a Porcine Model of Thermal Burn Injury
Authors: Dolgachev Vladislav A , Ciotti Susan , Liechty Emma , Levi Benjamin , Wang Stewart C , Baker James R , Hemmila Mark R
Published: June 2021

Burn wound progression is an inflammation-driven process where an initial partial-thickness thermal burn wound can evolve over time to a full-thickness injury. We have developed an oil-in-water nanoemulsion formulation (NB-201) containing benzalkonium chloride for use in burn wounds that is antimicrobial and potentially inhibits burn wound progression. We used a porcine burn injury model to evaluate the effect of topical nanoemulsion treatment on burn wound conversion and healing. Anesthetized swine received thermal burn wounds using a 25-cm2 surface area copper bar heated to 80°C. Three different concentrations of NB-201 (10, 20, or 40% nanoemulsion), silver sulfadiazine cream, or saline were applied to burned skin immediately after injury and on days 1, 2, 4, 7, 10, 14, and 18 postinjury. Digital images and skin biopsies were taken at each dressing change. Skin biopsy samples were stained for histological evaluation and graded. Skin tissue samples were also assayed for mediators of inflammation. Dermal treatment with NB-201 diminished thermal burn wound conversion to a full-thickness injury as determined by both histological and visual evaluation. Comparison of epithelial restoration on day 21 showed that 77.8% of the nanoemulsion-treated wounds had an epidermal injury score of 0 compared to 16.7% of the silver sulfadiazine-treated burns (P = .01). Silver sulfadiazine cream- and saline-treated wounds (controls) converted to full-thickness burns by day 4. Histological evaluation revealed reduced inflammation and evidence of skin injury in NB-201-treated sites compared to control wounds. The nanoemulsion-treated wounds often healed with complete regrowth of epithelium and no loss of hair follicles (NB-201: 4.8 ± 2.1, saline: 0 ± 0, silver sulfadiazine: 0 ± 0 hair follicles per 4-mm biopsy section, P < .05). Production of inflammatory mediators and sequestration of neutrophils were also inhibited by NB-201. Topically applied NB-201 prevented the progression of a partial-thickness burn wound to full-thickness injury and was associated with a concurrent decrease in dermal inflammation.
Xanthogranulomatous pyelonephritis presenting as a cystic mass: a rare case report
Authors: Saadi Mohamed Hafedh , Bibi Mokhtar , Rekik Issam , Ouanes Yassine , Dali Khaireddine Mrad , Kassar Alia Zehani , Sellami Ahmed , Rhouma Sami Ben , Nouira Yassine
Published: June 2021

Xanthogranulomatous pyelonephritis may, rarely, occur as a renal cystic mass. We report a case report of a 50-year-old with a history of medically treated renal lithiasis, who consults for left low back pain. Imaging findings concluded to a Bosniak type-3 hemorrhagic cystic mass of the left kidney. The diagnosis of xanthogranumolatous pyelonephritis on its focal form was made histologically. The diagnosis of xanthogranulomatous pyelonephritis is often difficult even with surgical findings and frequently a histological surprise. This points out the importance of identifying it in pre-operative staging; the diagnosis may be suggested by the association of chronic pyelonephritis, renal stones and hypovascular renal tumor syndrome without specificity at sonography and CT.
Comparisons of photosynthetic and anatomical traits between wild and domesticated cotton
Authors: Lei Zhangying , Liu Fang , Wright Ian J , Carriquí Marc , Niinemets Ülo , Han Jimei , Jia Mengmeng , Atwell Brian J , Cai Xiaoyan , Zhang Wangfeng , Zhou Zhongli , Zhang Yali
Published: June 2021

Mesophyll conductance (gm) is a crucial leaf trait contributing to the photosynthetic rate (AN). Plant domestication typically leads to an enhancement of AN that is often associated with profound anatomical modifications, but it is unclear which of these structural alterations influence gm. We analyzed the implication of domestication on leaf anatomy and its effect on gm in 26 wild and 31 domesticated cotton genotypes (Gossypium sp.) grown under field conditions. We found that domesticated genotypes had higher AN but similar gm to wild genotypes. Consistent with this, domestication did not translate into significant differences in the fraction of mesophyll occupied by intercellular air spaces (fias) or mesophyll and chloroplast surface area exposed to intercellular air space (Sm/S and Sc/S, respectively). However, leaves of domesticated genotypes were significantly thicker, with larger but fewer mesophyll cells with thinner cell walls. Moreover, domesticated genotypes had higher cell wall conductance (gcw) but smaller cytoplasmic conductance (gcyt) than wild genotypes. It appears that domestication in cotton has not generally led to significant improvement in gm, in part because their thinner mesophyll cell walls (increasing gcw) compensate for their lower gcyt, itself due to larger distance between plasmalemma and chloroplast envelopes.
Application of Raman spectroscopy for detection of histologically distinct areas in formalin-fixed paraffin-embedded glioblastoma
Authors: Klamminger Gilbert Georg , Gérardy Jean-Jacques , Jelke Finn , Mirizzi Giulia , Slimani Rédouane , Klein Karoline , Husch Andreas , Hertel Frank , Mittelbronn Michel , Kleine-Borgmann Felix B
Published: June 2021

Background

Although microscopic assessment is still the diagnostic gold standard in pathology, non-light microscopic methods such as new imaging methods and molecular pathology have considerably contributed to more precise diagnostics. As an upcoming method, Raman spectroscopy (RS) offers a “molecular fingerprint” that could be used to differentiate tissue heterogeneity or diagnostic entities. RS has been successfully applied on fresh and frozen tissue, however more aggressively, chemically treated tissue such as formalin-fixed, paraffin-embedded (FFPE) samples are challenging for RS.

Methods

To address this issue, we examined FFPE samples of morphologically highly heterogeneous glioblastoma (GBM) using RS in order to classify histologically defined GBM areas according to RS spectral properties. We have set up an SVM (support vector machine)-based classifier in a training cohort and corroborated our findings in a validation cohort.

Results

Our trained classifier identified distinct histological areas such as tumor core and necroses in GBM with an overall accuracy of 70.5% based on the spectral properties of RS. With an absolute misclassification of 21 out of 471 Raman measurements, our classifier has the property of precisely distinguishing between normal-appearing brain tissue and necrosis. When verifying the suitability of our classifier system in a second independent dataset, very little overlap between necrosis and normal-appearing brain tissue can be detected.

Conclusion

These findings show that histologically highly variable samples such as GBM can be reliably recognized by their spectral properties using RS. As conclusion, we propose that RS may serve useful as a future method in the pathological toolbox.
Descriptive and retrospective analysis of diffuse glioma patients with symptomatic SARS-CoV2 infection during the first wave of the pandemic
Authors: Lozano-Sanchez Fernando , Ursu Renata , Di-Stefano Anna Luisa , Ducray Francois , Younan Nadia , Touat Mehdi , Groh Matthieu , Agguini Hanane , Belin Catherine , Garnier Luois , Delattre Jean-Yves , Carpentier Antoine , Idbaih Ahmed
Published: June 2021

Background

Little is known about diffuse glioma patients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2).

Methods

We performed a descriptive and retrospective analysis of 41 diffuse glioma patients with symptomatic SARS-CoV2 infection during the first wave of the COVID-19 pandemic.

Results

Confusion with or without fever was the most common neurological symptom (32%) supporting SARS-CoV2 testing in glioma patients with acute and unexplained confusion. Sixteen patients (39%) died after a median delay of 13 days. While multiple clinical, biological, and pathological features, COVID-19- or diffuse glioma-related, at hospital admission appeared to have a pejorative prognostic impact, none was significantly associated with death. Oncological treatments were interrupted at COVID-19 diagnosis and re-initiated with a median delay of 30 days after the end of COVID-19 symptoms.

Conclusions

Interestingly, our retrospective study describes for the first time the characteristics of a cohort of diffuse glioma patients with symptomatic COVID-19. Diffuse glioma patients with poorly symptomatic COVID-19 did not come to the attention of physicians and were not enrolled in the study skewing the denominator for prognostic analysis. Further studies are warranted to specify prognosis of overall population of diffuse glioma patients with COVID-19, including asymptomatic patients, and interactions of prognostic factors of both COVID-19 and diffuse gliomas.
Ethics consultations in neuro-oncology
Authors: Sener Ugur , Neil Elizabeth C , Scharf Amy , Carver Alan C , Buthorn Justin B , Bossert Dana , Sigler Allison M , Voigt Louis P , Diamond Eli L
Published: June 2021

Background

Management of patients with brain tumors can lead to ethical and decisional dilemmas. The aim of this study was to characterize ethical conflicts encountered in neuro-oncologic patients.

Methods

Retrospective review of ethics consultations performed upon patients with primary and metastatic brain tumors at a tertiary cancer center. An ethics consultation database was examined to characterize ethical conflicts, contextual factors, and interventions by the consultation team.

Results

Fifty consultations were reviewed; 28 (56%) patients were women, median age 54 (range 4-86); 27 (54%) patients had a primary central nervous system malignancy; 20 (40%) had brain metastasis. At the time of consultations, 41 (82%) patients lacked decisional capacity; 48 (96%) had a designated surrogate decision maker; 3 (6%) had an advance directive outlining wishes regarding medical treatment; 12 (24%) had a Do Not Attempt Resuscitation (DNAR) order. Ethical conflicts centered upon management of end-of-life (EOL) circumstances in 37 (72%) of cases; of these, 30 did not have decisional capacity. The most common ethical issues were DNAR status, surrogate decision making, and request for nonbeneficial treatment. Consultants resolved conflicts by facilitating decision making for incapacitated patients in 30 (60%) cases, communication between conflicting parties in 10 (20%), and re-articulation of patients’ previously stated wishes in 6 (12%).

Conclusions

Decisional capacity at EOL represents the primary ethical challenge in care of neuro-oncologic patients. Incomplete awareness among surrogate decision makers of patients’ prognosis and preferences contributes to communication gaps and dilemmas. Early facilitation of communication between patients, caregivers, and medical providers may prevent or mitigate conflicts and allow the enactment of patients’ goals and values.
Financial Intermediation in the Age of FinTech: P2P Lending and the Reinvention of Banking
Authors: Bavoso Vincenzo
Published: June 2021

This article focuses on the rise of FinTech over the past 10 years, particularly with respect to the role of technology-based platforms in the provision of credit. In this specific context, peer-to-peer (P2P) lending has acquired an increasing importance, with a larger share of loans having been originated through P2P platforms instead of traditional banking channels. This trend has been welcomed by policy makers as a move towards alternative market-based finance, which should contribute to better risk diversification by moving risks away from systemic financial institutions. At the same time, this shift presents a number of regulatory questions that have remained largely unexplored. This is so because the nature and role of P2P platforms have remained loosely defined, which means that it has been difficult to identify relevant regulatory challenges emerging from these channels of finance. This research tackles two interrelated questions. First, it addresses the conceptual redefinition of financial intermediation. This enables understanding of the function of P2P platforms, and whether they have supplemented the intermediation role traditionally conducted by banks. Secondly, it explores the risks that arise in connection with P2P lending channels. This second enquiry highlights outstanding policy and regulatory issues that have remained unexplored or downplayed in current debates.
Listeriosis in infants: Prospective surveillance studies in Canada and Switzerland
Authors: Abu-Raya Bahaa , Jost Marianne , Bettinger Julie A , Bortolussi Robert , Grabowski Janet , Lacaze-Masmonteil Thierry , Robinson Joan L , Posfay-Barbe Klara M , Galanis Eleni , Schutt Elizabeth , Mäusezahl Mirjam , Kollmann Tobias R
Published: June 2021

Objectives

International data on listeriosis during infancy from large populations are essential to guide evidence-based empiric antibiotic guidelines for sepsis in infancy. We aimed to determine the incidence, clinical manifestations, and outcome of listeriosis in infants <6 months of age in Canada and Switzerland.

Methods

Prospective, active surveillance of listeriosis in infants <6 months of age was conducted through the Canadian Paediatric Surveillance Program (May 2015 to April 2017) and the Swiss Paediatric Surveillance Unit (April 2017 to March 2018). Confirmed and probable cases were included.

Results

In Canada, eight sporadic listeriosis cases were reported (incidence, 1.1/100,000 live births/year). In Switzerland, four cases were reported (incidence, 4.5/100,000 live births/year) of which three were part of a confirmed outbreak with an unclear source. In the two countries, eight of the 12 cases (66.6%) presented as early-onset disease (within the first 7 days of life) and none presented after 28 days life.

Conclusions

Neonatal listeriosis is rare. Infants presenting with sepsis, especially after 4 weeks of life, may not routinely require empiric antibiotic coverage for listeriosis. Outbreak-related cases still occur. Continued surveillance is important.
The Arabidopsis circadian clock protein PRR5 interacts with and stimulates ABI5 to modulate abscisic acid signaling during seed germination
Authors: Yang Milian , Han Xiao , Yang Jiajia , Jiang Yanjuan , Hu Yanru
Published: June 2021

Seed germination and postgerminative growth require the precise coordination of multiple intrinsic and environmental signals. The phytohormone abscisic acid (ABA) suppresses these processes in Arabidopsis thaliana and the circadian clock contributes to the regulation of ABA signaling. However, the molecular mechanism underlying circadian clock-mediated ABA signaling remains largely unknown. Here, we found that the core circadian clock proteins PSEUDO-RESPONSE REGULATOR5 (PRR5) and PRR7 physically associate with ABSCISIC ACID-INSENSITIVE5 (ABI5), a crucial transcription factor of ABA signaling. PRR5 and PRR7 positively modulate ABA signaling redundantly during seed germination. Disrupting PRR5 and PRR7 simultaneously rendered germinating seeds hyposensitive to ABA, whereas the overexpression of PRR5 enhanced ABA signaling to inhibit seed germination. Consistent with this, the expression of several ABA-responsive genes is upregulated by PRR proteins. Genetic analysis demonstrated that PRR5 promotes ABA signaling mainly dependently on ABI5. Further mechanistic investigation revealed that PRR5 stimulates the transcriptional function of ABI5 without affecting its stability. Collectively, our results indicate that these PRR proteins function synergistically with ABI5 to activate ABA responses during seed germination, thus providing a mechanistic understanding of how ABA signaling and the circadian clock are directly integrated through a transcriptional complex involving ABI5 and central circadian clock components.
The Impact of Airport Noise on House Prices
Authors: Kaur Kanwal Preet , Cardak Buly A , McAllister Richard
Published: June 2021

Using individual house sale data and the release of an airport noise contour map, the relationship between airport noise contours and house prices in Melbourne is studied. House prices are not related to noise contours but annual aircraft movements and distance from the runway are both identified as important determinants of the price of houses near the airport. Houses farther from the airport runway but with the same observable characteristics command a premium of up to 37 per cent which is likely attributable to a range of externalities from the nearby airport including airport noise. Results are robust to tests for time variation in airport disamenity values. The results suggest households use distance to the runway as a proxy for the effects of airport noise.
Anti-nuclear matrix protein 2 antibody-positive inflammatory myopathies represent extensive myositis without dermatomyositis-specific rash
Authors: Ichimura Yuki , Konishi Risa , Shobo Miwako , Inoue Sae , Okune Mari , Maeda Akemi , Tanaka Ryota , Kubota Noriko , Matsumoto Isao , Ishii Akiko , Tamaoka Akira , Shimbo Asami , Mori Masaaki , Morio Tomohiro , Kishi Takayuki , Miyamae Takako , Tanboon Jantima , Inoue Michio , Nishino Ichizo , Fujimoto Manabu , Nomura Toshifumi , Okiyama Naoko
Published: June 2021

Objectives

Myositis-specific autoantibodies (MSAs) define distinct clinical subsets of idiopathic inflammatory myopathies (IIMs). The anti-nuclear matrix protein 2 (NXP2) antibody, a MSA detected in juvenile/adult IIMs, has been reported to be associated with a high risk of subcutaneous calcinosis, subcutaneous oedema and internal malignancies. The study aimed to clarify the clinical features of anti-NXP2 antibody-positive IIMs in detail.

Methods

This was a multicentre retrospective observational study on 76 anti-NXP2 antibody-positive patients. The antibody was detected via a serological assay using immunoprecipitation and western blotting. The patients were selected from 162 consecutive Japanese patients with IIMs.

Results

The cohort of anti-NXP2 antibody-positive IIMs included 29 juvenile patients and 47 adult patients. Twenty-seven (35.5%) patients presented with polymyositis phenotype without dermatomyositis-specific skin manifestations (heliotrope rash or Gottron sign/papules); this was more common in the adults than children (48.9% vs 15.8%, P < 0.01). Nine (11.8%) patients had subcutaneous calcinosis, and 20 (26.3%) patients had subcutaneous oedema. In addition, the proportion of patients with muscle weakness extending to the distal limbs was high (36 patients [47.4%]) in this cohort. Adult patients had a higher prevalence of malignancy than the general population (age-standardized incidence ratio of malignancies: 22.4).

Conclusion

Anti-NXP2 antibody-positive IIMs, which include dermatomyositis sine dermatitis, are characterized by atypical skin manifestations and extensive muscular involvement.
Objective rapid eye movement sleep characteristics of recurrent isolated sleep paralysis: a case–control study
Authors: Kliková Monika , Piorecký Marek , Miletínová Eva , Janků Karolina , Dudysová Daniela , Bušková Jitka
Published: June 2021

Study Objectives

Recurrent isolated sleep paralysis (RISP) is a rapid eye movement (REM) parasomnia characterized by a dissociative state with characteristics of REM sleep and wakefulness. Pathophysiology has not yet been clarified and very little research has been performed using objective polysomnographic measures with inconsistent results. The main aim of our study was to find whether higher REM sleep fragmentation is consistent with the theory of state dissociation or whether signs of dissociation can be detected by spectral analysis.

Methods

A total of 19 participants in the RISP group and 19 age- and gender-matched participants in the control group underwent two consecutive full-night video-polysomnography recordings with 19-channel electroencephalography. Apart from sleep macrostructure, other REM sleep characteristics such as REM sleep arousal index, percentage of wakefulness and stage shifts within REM sleep period were analyzed, as well as power spectral analysis during REM sleep.

Results

No difference was found in the macrostructural parameters of REM sleep (percentage of REM sleep and REM latency). Similarly, no significant difference was detected in REM sleep fragmentation (assessed by REM sleep arousal index, percentage of wakefulness and stage shifts within REM sleep). Power spectral analysis showed higher bifrontal beta activity in the RISP group during REM sleep.

Conclusions

The results showed an underlying persistent trait of higher cortical activity that may predispose patients with sleep paralysis to be more likely to experience recurrent episodes, without any apparent macrostructural features including higher REM sleep fragmentation.
Validity of Self-Reported Endometriosis: A Comparison Across Four Cohorts
Authors: Shafrir A. L. , Wise L. A. , Palmer J. R. , Shuaib Z. O. , Katuska L. M. , Vinayak P. , Kvaskoff M. , Terry K. L. , Missmer S. A.
Published: June 2021

(Abstracted from Hum Reprod 2021;36:1268–1278)

Approximately 10% of reproductive-aged women are affected by endometriosis, a condition in which endometrial-like tissue is found outside of the uterus causing severe pain and infertility. Diagnosis requires surgical visualization resulting in many studies relying on medical record abstraction or insurance claim information for diagnosis.
Detection of Growth-Restricted Fetuses During Pregnancy Is Associated With Fewer Intrauterine Deaths But Increased Adverse Childhood Outcomes: An Observational Study
Authors: Andreasen L. A. , Tabor A. , Nørgaard L. N. , Rode L. , Gerds T. A. , Tolsgaard M. G.
Published: June 2021

(Abstracted from BJOG 2021;128:77–85)

Fetal growth restriction (FGR) is associated with a number of adverse outcomes, including stillbirth, need for early delivery, and long-term neurodevelopmental problems. Identifying FGR early allows for heightened monitoring of the fetus in utero and during labor and for planning an appropriate time for delivery.
Emergency Department-initiated Buprenorphine and Referral to Follow-up Addiction Care: A Program Description
Authors: Regan Susan , Howard Sydney , Powell Elizabeth , Martin Alister , Dutta Sayon , Hayes Bryan D. , White Benjamin A. , Williamson Dawn , Kehoe Laura , Raja Ali S. , Wakeman Sarah E.
Published: June 2021

Introduction:

Emergency department (ED) initiated opioid use disorder (OUD) care is effective; however, real-world predictors of patient engagement are lacking.

Objective:

This program evaluation examined predictors of ED-based OUD treatment and subsequent engagement.

Method:

Program evaluation in Boston, MA. Adult patients who met criteria for OUD during an ED visit in 2019 were included. Patients were included if a diagnosis of OUD or opioid-related overdose was associated with the ED visit or if they met previously validated criteria for OUD within the previous 12 months. We assessed predictors of ED-OUD treatment receipt and subsequent engagement, using Healthcare Effectiveness Data and Information Set definition of initial encounter within 14 days of discharge and either 2 subsequent encounters or a subsequent buprenorphine prescription within 34 days of the initial encounter. We used generalized estimating equations for panel data.

Results:

During 2019, 1946 patients met criteria for OUD. Referrals to Bridge Clinic were made for 207 (11%), buprenorphine initiated for 106 (5%), and home induction buprenorphine kits given to 56 (3%). Following ED discharge, 237 patients (12%) had a visit within 14 days, 122 (6%) had ≥2 additional visits, and 207 (11%) received a subsequent buprenorphine prescription. Young, White, male patients were most likely to receive ED-OUD care. Patients who received ED-OUD care were more likely to have subsequent treatment engagement (adjusted rate ratio: 2.30, 95% confidence intervals: 1.62–3.27). Referrals were made less often than predicted for Black (-49%) or Hispanic/Latinx (-25%) patients.

Conclusions:

Initiating treatment for OUD in the ED was associated with increased engagement in outpatient addiction care.
A Pilot Investigation of Nonpharmacological Pain Management Intervention Groups in Methadone Maintenance Treatment
Authors: DiMeola Kimberly A. , Haynes Jeff , Barone Meredith , Beitel Mark , Madden Lynn M. , Cutter Christopher J. , Raso Anthony , Gaeta Marina , Zheng Xiaoying , Barry Declan T.
Published: June 2021

Objectives:

We examined the feasibility (i.e., single-session attendance) of conducting 3 counselor-delivered nonpharmacological pain management intervention (NPMI) groups in methadone maintenance treatment (MMT): (1) Coping with Pain, an intervention based on cognitive-behavioral therapy, (2) Wii-Covery, an exergame intervention to facilitate exercise, and (3) Juggling Group, an intervention to promote social inclusion and reduce stress. We examined pre-post session changes in pain and mood associated with group attendance.

Methods:

Over 1 month at an MMT clinic with 1800 patients, each NPMI group was offered daily Monday-Friday and 1 was offered on Saturdays. A standardized but unvalidated measure was administered before and after sessions to assess acute changes in current pain intensity and mood states. Paired t-tests with Bonferroni corrections were performed for each NPMI group (P < 0.0007 [.05/7]).

Results:

About 452 patients (67% male, 84% White, mean age, 40) attended at least 1 NPMI group. About 57% reported current chronic pain. Attendance at any NPMI group (for the whole sample and the subset with chronic pain) was significantly associated with acute reductions in current pain intensity, anxiety, depression, and stress, and acute increases in current energy and happiness. Attendance at Coping with Pain and Juggling Group was also associated with acute increases in compassion.

Conclusions:

Coping with Pain, Wii-Covery, and Juggling Group are feasible to conduct in MMT, and acute improvements in current pain intensity and specific mood states associated with a single session attendance point to the importance of examining systematically the efficacy of these and other NPMIs in MMT.
Risk of Feeding Problems Among Infants With Neonatal Abstinence Syndrome
Authors: Mensah Nana A. , Madden Erin F. , Qeadan Fares
Published: June 2021

Background:

The rate of infants born with neonatal abstinence syndrome (NAS) increased by more than 500% between 2004 and 2016. Although feeding problems among infants diagnosed with NAS have been documented, the risk of feeding problems among infants diagnosed with NAS has not been estimated.

Purpose:

This study evaluates the extent to which feeding problems among infants diagnosed with NAS differ from thise in infants without an NAS diagnosis.

Methods/Search Strategy:

A matched retrospective cohort study (2008-2017) of infants diagnosed with NAS in the United States was conducted using hospital admission data from the Cerner Health Facts Database. Multivariable logistic regressions controlling for confounders were used to assess whether an NAS diagnosis is associated with hospital admission due to feeding problems.

Findings/Results:

Infants with NAS were nearly 3 times as likely (OR = 2.81; 95% CI, 2.68-2.95) to have feeding problems compared with infants without NAS after adjusting for infant and hospital characteristics. Lower birth weight, higher infant age, Hispanic ethnicity, and hospital location in the Midwest region were also associated with higher odds of feeding problems. Infants diagnosed with NAS who had feeding problems had slightly lower odds of being offered lactation services than infants without NAS who had feeding problems.

Implications for Practice:

These findings suggest the need for targeted feeding interventions.

Implications for Research:

Future research on infants with NAS may build on these findings by assessing the role of maternal factors such as nutrition and substance use to understand how parental characteristics also influence the risk for hospitalization.
Separating the Causes of Listening Difficulties in Children
Authors: Dillon Harvey , Cameron Sharon
Published: June 2021

Auditory processing disorder, defined here as a deficit in the way sounds are analyzed by the brain, has remained a controversial topic within audiology for decades. Some of the controversy concerns what it is called. More substantively, even its existence has been questioned. That view has likely emerged because there has not been sufficient rigor in determining when difficulty in understanding speech has been the consequence of some type of auditory processing deficit, versus when it is the consequence of a cognitive deficit or a language deficit. This article suggests that the field use the term “listening difficulty” as an umbrella term to indicate a reported deficit in recognizing sounds or understanding speech, one possible cause of which is an auditory processing disorder. Other possible causes are hearing deficits, cognitive deficits, and language deficits. This article uses a plausible, and hopefully noncontroversial, model of speech understanding that comprises auditory processing, speech processing, and language processing, all potentially affected by the degree of attention applied and the listener’s memory ability. In a fresh approach to the construction of test batteries, the stages of the model are linked to tests designed to assess either all or selected parts of the processes involved. For two of the stages, a listener’s performance is quantified as the additional signal to noise ratio that he or she needs to function equivalently to his or her age peers. Subtraction of the deficits revealed by each test enables the contributions of each processing stage to a listening deficit to be quantified. As a further novel contribution, the impact of memory and attention on each test score is quantitatively allowed for, by an amount that depends on each test’s dependence on memory and attention. Attention displayed during the test is estimated from the fluctuations in performance during the test. The article concludes with a summary of the research that must be conducted before the structured tests can be used to quantify the extent to which different potential causes of listening difficulties are responsible for real-life difficulties in an individual child.