bluuebunny/crossref_metadata_2025 huggingface dataset:
9. Control of a company
Authors: French Derek
Published: August 2023

This chapter discusses how control of a company can be identified and how it can change. The chapter considers takeovers, the City Code and compulsory acquisition of remaining shares. There is full discussion of the provisions for disclosure of significant holdings both to warn of potential takeover moves and to disclose in the public interest who has significant control of a company. Shares in public companies may be held by nominee owners and this may disguise the fact that one person is building up a significant holding. The statutory definitions of holding company, subsidiary and wholly owned subsidiary are considered.
12. Market abuse
Authors: French Derek
Published: August 2023

This chapter deals with abuses committed in the trading of shares, with particular reference to insider dealing and market manipulation, and the laws intended to control them. The chapter considers forms of control to prevent market abuse under three key pieces of legislation: Regulation (EU) No 596/2014, the Criminal Justice Act 1993 and the Financial Services Act 2012. It looks at regulations governing disclosure to regulated markets and the fiduciary duty of directors, and offences involving insider dealing and creating a false market. The chapter analyses a particularly significant case: Percival v Wright [1902] 2 Ch 421.
D. Other legal forms for business
Authors: French Derek
Published: August 2023

This chapter discusses various general-purpose legal forms for carrying on business. It starts with the simplest form of all, sole proprietorship (or self-employment). Two or more persons carrying on a business or profession in common with a view of profit are in partnership, which has developed into the sophisticated form of the limited liability partnership. The rest of the chapter is devoted to the various lesser used forms of company which can be registered under the Companies Act 2006 (CA 2006). These are guarantee companies, unlimited companies and community interest companies. The chapter also discusses how re-registration can be used to transform various types of company into other types.
8. Members’ remedies
Authors: Roach Lee
Published: August 2023

Each Concentrate revision guide is packed with essential information, key cases, revision tips, exam Q&As, and more. Concentrates show you what to expect in a law exam, what examiners are looking for, and how to achieve extra marks. This chapter discusses the three principal remedies provided by law to members of a company: the derivative claim under Pt 11 of the Companies Act 2006 (CA 2006), the unfair prejudice remedy under Pt 30 of the CA 2006, and the petition for winding up the company under s 122 of the Insolvency Act 1986 (IA 1986).
9. Corporate rescue and liquidation
Authors: Roach Lee
Published: August 2023

This chapter discusses the various procedures available to companies experiencing financial difficulties that are so severe that the company’s survival is in jeopardy. It focuses on the principal statutory procedures that aim to help struggling companies, namely administration, the company voluntary arrangement, the restructuring plan, and the moratorium. It then moves on to discuss liquidation and the distribution of assets to creditors.
6. The Structure of the Courts
Authors: Gillespie Alisdair , Weare Siobhan
Published: August 2023

This chapter discusses the organization of the modern court structure and what each court does. The courts in England and Wales (i.e. excluding the Supreme Court which is a UK court) are administered by a single agency, HM Courts and Tribunals Service. The courts of original jurisdiction (i.e. which hear trials of first instance) are ordinarily the magistrates’ court, county court, Crown Court, and High Court although they have now been joined by the Family Court. The Crown Court and High Court have both an original and appellate jurisdiction. The High Court is divided into three divisions (King’s Bench Division, Chancery Division, and Family Division) and when two or more judges sit together in the High Court it is known as a Divisional Court. The chapter also briefly describes the Judicial Committee of the Privy Council, Court of Protection, and coroners’ courts.
7. The Structure of the Tribunals
Authors: Gillespie Alisdair , Weare Siobhan
Published: August 2023

This chapter examines the jurisdiction and structure of tribunals. It then considers two very different tribunals through the use of case studies, namely the Employment Tribunals and the Investigatory Powers Tribunal. Tribunals have existed for many years but have traditionally operated as an oversight system for administrative issues. In recent years, the number of tribunals has increased and their work has begun to involve more complicated legal questions. Tribunals are now, in essence, a parallel system of dispute resolution and their complexity is recognized by the fact that their presiding officers now bear the title of ‘judge’. This chapter examines this parallel judicial system and identifies similarities between and differences from court justice.
8. The Judiciary and their Appointment
Authors: Gillespie Alisdair , Weare Siobhan
Published: August 2023

This chapter provides an introduction to the courts and tribunals judiciary. It discusses the judicial office, judicial appointments, judicial diversity, and judicial training. There are different levels of judges within the courts and tribunals, with the senior judiciary comprising the Lord Chief Justice and Heads of Division. The Lord Chief Justice is the Head of the Judiciary. The Head of the Tribunals is the Senior President of the Tribunals. There are also part-time members of the judiciary known either as district judges, recorders, or Deputy High Court Judges depending on which court they sit in. This chapter assesses the similarities and differences between the court judiciary and tribunal judiciary. The quasi- judicial role of magistrates is also considered in this chapter. Discussing them in this chapter allows for their role to be considered and contrasted with that of district judges (magistrates’ courts) who also sit within the magistrates’ court.
9. Judicial Independence
Authors: Gillespie Alisdair , Weare Siobhan
Published: August 2023

This chapter considers the fundamental constitutional principle of judges being independent. Securing the independence of the judiciary is difficult and involves not only separation from the legislature and executive, but also from each other and the media. Issues of judicial ethics and restrictions on practice are also discussed.
13. Pre-Trial Matters
Authors: Gillespie Alisdair , Weare Siobhan
Published: August 2023

This chapter on the criminal justice system focuses on preliminary issues, i.e. some of the issues that take place before trial begins. A prosecution begins at the earliest stage through a defendant being charged by the police but under the authority of the Crown Prosecution Service (CPS). The CPS must then review the decision to prosecute, which requires the CPS to have reference to two prosecution tests (evidential and public interest tests). The CPS has the ability to issue out-of-court disposals in appropriate cases as alternatives to prosecution. If a prosecution does take place, it is necessary to identify in which court the proceedings will be heard. Crimes are divided into three categories: summary, indictable-only, and either-way. Criminal matters are heard in the magistrates’ court and the Crown Court and the categorization of offences has an impact on where the matter should be heard.
Heterogenous pathogen profile associated with acute conjunctivitis in Nepal
Authors: Chaudhary Meenu , Sitaula Sanjeeta , Ruder Kevin , Chen Cindi , Zhong Lina , Heng Lu Yu , Abraham Thomas , Yu Danny , Hinterwirth Armin , Lietman Thomas M , Doan Thuy , Seitzman Gerami D ,   the SCORPIO Study Group, Prajna Lalitha , Prajna N Venkatesh , Gunasekaran Ramesh , Sharma Sankalp Singh , Teja Vishnu , Chaudhary Meenu , Sitaula Sanjeeta , Sié Ali , Coulibaly Boubacar , Bountogo Mamadou , Somkijrungroj Thanapong , Satitpitakul Vannarut , Tran Huy , Mai Linh Hoàng , Xuân Thảo Hạ , Tran Yen , Urzua Cristhian A , Vega Fabian , Salgado Felipe , Cuitino Loreto , Pérez Pérez Fernando , Martínez Jaime Macías , Lansingh Van Charles , Thanapaisal Sukhumal , Laovirojjanakul Wipada , McKie George , Chavez Kenia , Redd Travis , Chamberlain Winston , Cheng Angel , Tham Vivien , Sansanayudh Wiwan , Yakoura Abba Kaka Hajia , Amza Abdou , Souley Abdoul Salam Youssoufou , Diori Adam Nouhou , Nassirou Beido , Kadri Boubacar , Mariama Boubacar , Ibrahim Cissé Mamadou , Roufaye Lamyne Aboubacar , Boulhassane Ramatou , Ali Saley , Abdou Zakou , Goren Lee , Sella Ruti , Kelliher Clare , Green Laura , Ong Hon Shing , Mehta Jod , Liu Yu-Chi , Pinsky Benjamin A , Hwang De-Kuang , Fan Nai-Wen , Chiong Hong Sheng , Lacorzana Javier , Cabrera-Aguas Maria , Watson Stephanie , Tsui Edmund , Cherian Nina M , Feit-Leichman Rachel , Hughes Reginald E , Onclinx Tania , Privratsky Joseph K , Yu Carol , McClean Esmeralda , Molina Iliana , Hinterwirth Armin , Chen Cindi , Yu Danny , Liu David , Lebas Elodie , Colby Emily , Seitzman Gerami , Ruder Kevin , Zhong Lina , Deiner Michael , Abraham Thomas , Lietman Thomas , Doan Thuy , Porco Travis , McLeod Stephen , Kanai Kuniyoshi , Whiteside Meredith , Yeh Steven , Fashina Tolulope , Chodosh James , Tarkap Bridgit , Garap Jambi N , Mangot Magdalene , Amel Edwin , Taleo Fasihah , Kasso Johnson , Willie Kalbule , Nanu Madopule , Rymill Prudence , Solomon Anthony W
Published: August 2023

Background

Infectious conjunctivitis is common in Nepal.

Materials and Methods

This prospective study recruited 60 patients with presumed acute infectious conjunctivitis from the B.P. Koirala Lions Center for Ophthalmic Studies in Kathmandu, Nepal. Swabs from the conjunctiva and anterior nares were processed for metagenomic RNA deep sequencing (RNA-seq).

Results

Pathogens were identified in 55% of cases. RNA viruses were the most common pathogen class identified. Severe acute respiratory syndrome coronavirus 2 was the most common RNA virus identified.

Conclusions

Acute infectious conjunctivitis varies by location. Contrary to expectations, RNA viruses predominated. Repeat surveillance may be useful and RNA-seq allows for detection of the unexpected pathogen including RNA viruses.
Novel asphalt pavement with directional heat conduction for melting of ice and snow in plateau and cold areas
Authors: Li Zeren , Zhu Anqi , Zhan You , Luo Zhiwei , Zhang Allen A
Published: August 2023

Because of the low temperature in plateau and cold areas, highway pavements are greatly affected by ice and snow, which typically lead to vehicle skidding, rollover, and even more severe traffic accidents. For infrastructure such as airports and roads, electric heating technology has been used for ice melting and snow removal with the advantage of using clean and renewable energy. However, the traditional electric heating pavement suffers from low thermal conductivity, energy scattering during the heating process, and the lack of an intelligent heating control system. To improve the efficiency of ice and snow melting and realize intelligent control, this study developed an innovative design for the heat conduction structure of the pavement. The proposed structure consists of the upper layer of the highway pavement, heat source layer, heat insulation layer, lower layer, and the base layer from top to bottom, which can realize directional heat conduction and heat insulation. The validity of the design is verified by thermal conductivity test, simulation test, and finite element modelling. The results hold scientific significance in terms of promoting snow melting pavement research and the development of new snow and ice melting technology. .
A new species of Janiralata Menzies, 1951 (Isopoda: Janiridae) from Japanese bathyal waters, with a review of the associations with invertebrates among the species of Janiralata
Authors: Ohta Mizuki , Takano Tsuyoshi , Kojima Shigeaki , Narimatsu Yoji
Published: August 2023

Isopods of the genus Janiralata Menzies, 1951 (Asellota: Janiridae) are known from shallow and deep waters of the Northern Hemisphere. Most species are free-living, but some are symbiotic on the surface of other benthic invertebrates. We obtained from three beam- and four otter-trawl hauls 18 Janiralata asellote specimens from the bathyal zone off the Pacific coasts of Tohoku, northeastern Japan. Partial nucleotide sequences of the mitochondrial cytochrome c oxidase subunit I (COI) gene (505 bp) were determined for 16 of the 18 collected specimens. Non-significant genetic differences (< 0.8%) indicated that the individuals were conspecifics. Morphological analysis indicated that all the specimens belonged to a single species, Janiralata planasp. nov. based on the unique morphology of the anterolateral and distolateral projections on the head and pleotelson, surface and lateral margins of the body, antennula article 1, and of the male pleopod 1. Six of the 18 collected specimens were found attached to the surface of an unidentified sea anemone (Hormathiidae), ten to the solasterid starfish Crossaster borealis Fisher, 1906 and two were obtained from the bottom sediment. Three COI haplotypes of the new species were shared by individuals from two neighboring sites, which suggests that genetic isolation occurs on a relatively narrow horizontal scale, although the bathymetric distribution range was rather wide. We describe a case study of the geographic and bathymetric distributions of an asellote species with low dispersal ability and its genetically differentiated populations. Such approach could help elucidate the diversity and distribution of deep-sea organisms and their diversification processes.
Quantitative cotyloid fossa thickness and proximity to obturator neurovascular bundle: implications for arthroscopic ligamentum teres reconstruction
Authors: Mazek Jacek , Helmy Nader , Salas Antonio Porthos , Skowronek Pawel , Madej Arkadiusz , O´Donnell John M , Dimitriou Dimitris
Published: August 2023

The aim of the present study was to report the in vivo thickness of the cotyloid fossa at the acetabular ligamentum teres (LT) attachment and investigate the clearance of the obturator neurovascular bundle. Fifty-five consecutive patients undergoing a total hip arthroplasty for hip osteoarthritis were included. The thickness of the cotyloid fossa was measured at the acetabular LT attachment using a standard depth gauge. The minimal distance (clearance) of the obturator neurovascular bundle to the center of the acetabular LT attachment was measured in 7 patients (14 hips) who also underwent a computed tomography angiography. The average thickness of the cotyloid fossa at the acetabular LT attachment was 4.1 ± 2.3 (range: 1–10) mm. The obturator vein was closest to the acetabular LT attachment, but the clearance was more than the defined safe zone of 15 mm in all cases. Based on the current findings, it can be assumed that bone anchors might not be suitable for fixation of the graft in LT reconstruction (LTR) and an alternative implant such as a cortical button should be considered. Acetabular fixation of the graft with a 12-mm cortical button is relatively safe concerning injury to obturator neurovascular structures. The results of the present study provide a better understanding of the cotyloid fossa anatomy and might be relevant for surgeons who perform arthroscopic LTR.
The prevalence of human papillomavirus vaccination among racial and ethnic minority adolescents during the COVID-19 pandemic
Authors: Ejezie Chinenye Lynette , Savas Lara S , Durand Casey , Shegog Ross , Cuccaro Paula
Published: August 2023

Background

Human papillomavirus (HPV) vaccination among adolescents has steadily improved over the past several years. However, research conducted to determine whether the COVID-19 pandemic disrupted this positive trend in HPV vaccine initiation among racial and ethnic minority adolescents is limited. Therefore, this study was conducted to determine if the COVID-19 pandemic and the resulting changes in the US health-care sector affected the increasing HPV vaccine initiation among non-Hispanic Black and Hispanic adolescents aged 13-17 years.

Methods

Using a cross-sectional design to examine data from the National Immunization Survey–Teen (2019-2021), logistic regression and moderation analysis were used to model race-specific variations in HPV vaccine initiation (n = 49 031). Two-sided P values of up to .05 were considered statistically significant.

Results

Hispanic (adjusted odds ratio [AOR] = 1.35, 95% confidence interval [CI] = 1.16 to 1.57) and non-Hispanic Black (AOR = 1.29, 95% CI = 1.10 to 1.51) adolescents had higher odds of HPV vaccine initiation than did non-Hispanic White adolescents. Additionally, the odds of HPV vaccine initiation were higher in 2021 (AOR = 1.22, 95% CI = 1.08 to 1.38) than in 2019. Other variables—age, region, sex, insurance status, and poverty status—were also associated with HPV vaccine initiation.

Conclusion

These findings demonstrate that during the COVID-19 pandemic, racial and ethnic minorities had higher odds of receiving the HPV vaccine. Therefore, more research of the impact of the pandemic on HPV vaccine initiation among non-Hispanic White and racial and ethnic minority adolescents is needed.
Kocuria rhizophila prosthetic hip joint infection
Authors: McAleese Timothy , Ahmed Aathir , Berney Mark , O’Riordan Ruth , Cleary May
Published: August 2023

We present the first case report of prosthetic joint infection (PJI) caused by Kocuria rhizophila. Our patient is a 74-year-old male who underwent primary total hip replacement for right hip pain. His recovery was uneventful until 6 weeks postoperatively when he presented to his routine outpatient appointment with significant erythema, swelling, and tenderness over his right hip wound. Based on the acuity of his symptoms and the radiological findings, it was determined that the patient should undergo debridement, antibiotics, and implant retention (DAIR procedure). A consensus decision was also made at our PJI multidisciplinary meeting to treat him with 12 weeks of IV antibiotics. After completing this 12 weeks course of IV Vancomycin, his inflammatory markers returned to normal limits. At 6 months follow-up, our patient was mobilizing independently without any signs of infection recurrence. His radiographs showed the implant was in a satisfactory position with no evidence of loosening. This case adds to an emerging body of literature describing invasive infections associated with Kocuria species. We have demonstrated the effectiveness of managing this condition with debridement, implant retention, and IV Vancomycin therapy for 12 weeks.
The digitization of oil and gas and accompanying data privacy compliance considerations for international investments in China and Brazil
Authors: Phillips Harry
Published: August 2023

This article discusses the evolution of digital enhancements in the oil and gas industry and examines various regulatory and compliance implications that accompany this evolution. It focuses its analysis on compliance considerations related to recently implemented data privacy laws in China and Brazil.
Sustainable Tactical Combat Casualty Care Implementation in Ghana: A Model for Future Development
Authors: Polley Catherine C , Adu-Gyamfi Rossi , Mahama-Toure Tawfik , Okpoti Konney Fattal , Oti-Boateng Emmanuel , Nsohlebna Nsoh Lawrence , Ballard Timothy
Published: August 2023

Introduction

Department of Defense policy for Global Health Engagement (GHE) activities prioritizes interoperability and sustainability within security cooperation, yet these elements, along with monitoring and evaluation, are not well reported.

Materials and Methods

In this case study reviewing 1 year after the implementation of a Tactical Combat Casualty Care (TCCC) program in Ghana, the Ghana Armed Forces (GAF) has conducted five independent TCCC Medical Provider Tier courses and four All Service Member Tier courses. They have certified 240 students, 21 instructors, and appointed 2 affiliate faculty members with the National Association of Emergency Medical Technicians (NAEMT). Ghana is one of the only four active NAEMT-certified TCCC training sites in Africa. The principles that allowed for this achievement could serve as a ‘best practice’ model for GHE.

Results

Principally, the GAF took ownership of the program from the onset. The program also had an extensive preparatory phase 0 before initiating phase 1 on the ground training, which included establishing leadership and a medical modeling and simulation center pre-engagement. The triple partnership achieved between the U.S. DoD’s African Peacekeeping Rapid Response Partnership, the GAF, and the NAEMT, a civilian certifying organization, allowed the sustainment of the TCCC program. African Peacekeeping Rapid Response Partnership also built on experience from other programs to develop a multifaceted model. Persisting challenges to the current program and future GHEs include continued funding and equipment, the associated issues with rapid expansion, and monitoring and evaluation, which all pose barriers to continued sustainment.

Conclusion

The year sustainment of the GAF TCCC training program provides hope as a model for future DoD GHEs to attain sustainable development and points to the possibility of long-term programs with meaningful outcomes.
Long-Term Hearing Loss after Acute Acoustic Trauma in the French Military: A Retrospective Study
Authors: Lachaux Jordan , Giéré Pierre Alexandre , Vuillemin Quentin , Colléony Thomas , Crambert Anna , Siegrist Sophie , Parietti-Winkler Cécile , Schwartzbrod Pierre-Éric , Andéol Guillaume
Published: August 2023

Introduction

Acute acoustic trauma (AAT) is characterized by cochlea–vestibular signs following intense noise exposure, often caused by impulse noise. French military faces a high risk of AAT because of the use of weapons with peak sound levels exceeding 150 dB. Hearing loss (HL) resulting from AAT can have a significant impact on quality of life and operational capacity. The aim of this study was to assess the prevalence of long-term hearing impairment after AAT.

Materials and Methods

The study involved a retrospective review of computer-based patient records from four military medical centers in Northeast France between January 2016 and December 2021. The inclusion criteria required the presence of cochlea–vestibular signs following impulse acoustic exposure and the absence of other causes. Sociodemographic and clinical data were collected, including audiometric data before and after exposure. The primary end point was the presence of a threshold elevation greater than 10 dB between reference and late audiograms.

Results

A total of 419 patients were included in the analysis, with a majority of males (n = 419; 84.7%) and a mean age of 23.6 yrs. The most common causative agent was the 5.56-mm assault rifle (n = 327; 78.0%). Tinnitus was the most frequent symptom (n = 366; 87.4%), followed by hypoacusis (n = 147; 35.1%) and earache (n = 89; 21.2%). The initial audiograms showed no HL in 31.0% of cases, while the mean deficit across all frequencies was 15.4 dB. All patients received corticosteroid therapy, with a mean duration of 6.0 d. Late audiograms conducted at an average interval of 448.0 d after AAT revealed a prevalence of long-term HL exceeding 20%. Higher doses of corticosteroid therapy (>1 mg/kg) were associated with a reduced frequency of long-term HL.

Conclusions

This study highlights the prevalence of long-term hearing impairment after AAT in the French military. The findings emphasize the importance of preventive measures, including proper use of hearing protection devices, and the need for timely diagnosis and treatment. Further research is warranted to explore gender susceptibility to AAT and evaluate the impact of different weapons on AAT characteristics. The study also underscores the potential benefits of higher doses of corticosteroid therapy in reducing the risk of long-term hearing impairment. Overall, the findings contribute to a better understanding of AAT and can inform strategies for its prevention and management in military settings.
First Case of Surgically Treated Chronic Exertional Compartment Syndrome of the Arm
Authors: Bilichtin Emilie , Choufani Camille , Derkenne Clément , Vioujard Clotilde , Pacull Romain
Published: August 2023

This paper reports the first case of chronic exertional compartment syndrome in the arm treated surgically. The diagnosis was made in a patient who is under 30 years old, military, and very athletic, with recurrent exertional pain in the anterior compartment of the arms associated with rhabdomyolysis. The high-pressure measurements in the arms’ anterior compartment after exertional exercise confirmed the diagnosis. Given the patient’s functional demands, a surgical treatment of fasciotomy of the anterior compartment by miniapproach was performed and allowed the resolution of symptomatology with a return to sport at the same level after 3 months.
Incorporation of kartogenin and silk fibroin scaffolds promotes rat articular cartilage regeneration through enhancement of antioxidant functions
Authors: Pan Zejun , Hou Mingzhuang , Zhang Yijian , Liu Yang , Tian Xin , Hu Xiayu , Ge Xiaoyang , Zhao Zhijian , Liu Tao , Xu Yong , Yang Huilin , Liu Hao , Zhu Xuesong , He Fan
Published: August 2023

Treating articular cartilage defects in patients remains a challenging task due to the absence of blood vessels within the cartilage tissue. The regenerative potential is further compromised by an imbalance between anabolism and catabolism, induced by elevated levels of reactive oxygen species. However, the advent of tissue engineering introduces a promising strategy for cartilage regeneration, offering viable solutions such as mechanical support and controlled release of chondrogenic molecules or cytokines. In this study, we developed an antioxidant scaffold by incorporating natural silk fibroin (SF) and kartogenin (KGN)-loaded liposomes (SF-Lipo@KGN). The scaffold demonstrated appropriate pore size, connectivity, and water absorption and the sustained release of KGN was achieved through the encapsulation of liposomes. In vitro experiments revealed that the SF-Lipo@KGN scaffolds exhibited excellent biocompatibility, as evidenced by enhanced cell adhesion, migration, and proliferation of chondrocytes. The SF-Lipo@KGN scaffolds were found to stimulate cartilage matrix synthesis through the activation of the nuclear factor erythroid-2-related factor 2/heme oxygenase-1 antioxidant signaling pathway. In vivo experiments demonstrated the effective promotion of articular cartilage regeneration by the SF-Lipo@KGN scaffolds, which enhanced extracellular matrix anabolism and restored the intrinsic redox homeostasis. Overall, this study successfully developed biomimetic KGN-loaded scaffolds that restore cartilage redox homeostasis, indicating promising prospects for cartilage tissue engineering.
The Impact of Unexpected Billing in Spine Surgery and How the Price Calculator Can Improve Patient Care
Authors: Meade Matthew , Issa Tariq Z. , Lee Yunsoo , Lambrechts Mark J. , Charlton Alexander , Radack Tyler , Kalra Andrew , Mangan John , Canseco Jose A. , Kurd Mark F. , Woods Barrett I. , Kaye I. David , Hilibrand Alan S. , Vaccaro Alexander R. , Schroeder Gregory D. , Kepler Christopher K.
Published: August 2023

Study Design:

Survey study.

Objective:

The objective of this study was to determine the impact of unexpected in-network billing on the patient experience after spinal surgery.

Summary of Background Data:

The average American household faces difficulty paying unexpected medical bills. Although legislative efforts have targeted price transparency and rising costs, elective surgical costs continue to rise significantly. Patients are therefore sometimes still responsible for unexpected medical costs, the impact of which is unknown in spine surgery.

Methods:

Patients who underwent elective spine surgery patients from January 2021 to January 2022 at a single institution were surveyed regarding their experience with the billing process. Demographic characteristics associated with unexpected billing situations, patient satisfaction, and financial distress, along with utilization and evaluation of the online price estimator, were collected.

Results:

Of 818 survey participants, 183 (22.4%) received an unexpected in-network bill, and these patients were younger (56.7 vs. 63.4 y, P<0.001). Patients who received an unexpected bill were more likely to feel uninformed about billing (41.2% vs. 21.7%, P<0.001) and to report that billing impacted surgical satisfaction (53.8% vs. 19.1%, P<0.001). However, both groups reported similar satisfaction postoperatively (Likert >3/5: 86.0% vs. 85.5%, P=0.856). Only 35 (4.3%) patients knew of the price estimator’s existence. The price estimator was reported to be very easy or easy (N=18, 78.2%) to understand and very accurate (N=6, 35.3%) or somewhat accurate (N=8, 47.1%) in predicting costs.

Conclusions:

Despite new regulations, a significant portion of patients received unexpected bills leading to financial distress and affecting their surgical experience. Although most patients were unaware of the price estimator, almost all patients who did know of it found it to be easy to use and accurate in cost prediction. Patients may benefit from targeted education efforts, including information on the price estimator to alleviate unexpected financial burden.
Human Papillomavirus Vaccines
Authors: Conageski Christine
Published: August 2023

Human papillomavirus (HPV) vaccines are highly effective in preventing the transmission of HPV and thus downstream HPV-related lower genital tract neoplasias. First introduced in 2006, the HPV vaccine has demonstrated clinical efficacy in both men and women. Several commercially available vaccines now exist, but only one is available in the United States. Both prelicensure and postlicensure studies demonstrate robust safety profiles. HPV vaccines should be made available to everyone between the ages of 9 and 26 years of age. Newer vaccination recommendations in expanded populations rely on patient-provider shared decision making. Currently, available HPV vaccines offer little therapeutic benefit. Recent research has identified several new DNA vaccines and delivery modifications with early demonstrated success at eliminating prevalent HPV infections and precancerous lesions. Despite the success of the HPV vaccine, vaccination hesitancy and disinformation continue to threaten our ability to eliminate these deadly cancers. Informational, behavioral, and environmental interventions have mixed success in increasing vaccination rates, but several strategies do exist to increase rates of vaccination.
HPV Testing and its Role in Cervical Cancer Screening
Authors: Clarke Megan A.
Published: August 2023

The recognition that persistent infection with carcinogenic human papillomavirus (HPV) is a necessary cause of cervical precancer and cancer has led to the introduction of HPV testing into cervical cancer screening, either as a primary screening test or in conjunction with cervical cytology (i.e., co-testing). HPV testing has much higher sensitivity for detection of cervical precancer and provides greater long-term reassurance if negative compared to cytology. However, most HPV infections are transient, and do not progress to invasive cancer, thus triage tests are required to identify individuals who should be referred to colposcopy for diagnostic evaluation. This chapter begins with a description of the biology, natural history, and epidemiology of HPV as a foundation for understanding the role of HPV in cervical carcinogenesis. This section is followed by a detailed discussion regarding the introduction of HPV-based testing and triage into cervical cancer screening and management. Summarized triage tests include cervical cytology, HPV genotyping, p16/Ki-67 dual stain, and HPV and cellular methylation markers. The final section of this chapter includes an important discussion on cervical cancer disparities, particularly within the United States, followed by concluding remarks.
A New Software for the Calculation of Eye-lens Dosimetry Quantities Based on Dose-rate Coefficients
Authors: Dubeau Jacques , Sun Jiansheng
Published: August 2023

In the last decade, the International Commission on Radiological Protection recommended a reduction in the annual limits to the dose to the lens of the eye from 150 mSv to 20 mSv y−1, averaged over defined periods of 5 y, with no single year exceeding 50 mSv. To assist the health physics community in this task, many groups have calculated protection and operational fluence dose coefficients. This led to the publication of multiple coefficient tables that were calculated for arrays of different parameters, including particle type, angle of incidence, target phantom models, presence or absence of secondary charged particle equilibrium, etc. The coefficients available in the literature include protection dose values calculated in a realistic eye model and operational values calculated in a simplified cylindrical head phantom at a point 3 mm below the surface. This paper reports on a simple Windows™ application that was written to aid health physics professionals in accessing and using the large body of available protection and operational eye-lens data. The application is called the Eye-Lens Dose Calculator, as it also performs calculations of the eye-lens dose for radionuclides, where the complete emissions of the selected radionuclides are considered. Test cases show that there is good agreement between the calculated protection and operational dose quantities when radionuclide emission characteristics are considered.
Evaluating Ultra-widefield Imaging Utility in the Detection of Treatment-requiring Peripheral Retinal Tears and Holes
Authors: Khan Mahmood , Kovacs Kyle , Guan Ivan , Goldblatt Nathaniel , Foulsham William , Wu Alan , Papakostas Thanos , Gupta Mrinali , D’Amico Donald J. , Kiss Szilard , Orlin Anton
Published: August 2023

Purpose:

To determine the utility of Ultra-widefield (UWF) imaging in detecting pathologic peripheral retinal tears and holes.

Methods:

This was a retrospective, observational study. One-hundred and ninety-eight eyes of 198 patients diagnosed with acute posterior vitreous detachment were included. Eyes were divided into two groups: 89 eyes with peripheral retinal holes and tears treated with laser retinopexy (treatment group) and 109 control eyes. Patients underwent UWF imaging and indirect ophthalmoscopy with scleral depression. UWF images from both groups were reviewed by two blinded graders and then compared to funduscopic exam and medical records.

Results:

UWF imaging identified 60 of the 89 eyes (sensitivity of 67.4%) found to have treatment-requiring peripheral retinal lesions and 107 of the 109 control eyes (specificity of 98.2%).The distribution of misses based on octant location did reach statistical significance (p=0.004). Lesions anterior to the equator were more likely to be missed (21/41 eyes, 51.2%) compared to those located posterior to the equator (4/20 eyes, 25.0%) and at the equator (4/28, 14.3%), p=0.002. The combined discordance rate between graders in the entire cohort was 12.1% (24/198 eyes) yielding an inter-rater agreement of 87.9%.

Conclusions:

UWF imaging showed a moderate sensitivity and high specificity in detecting treatment requiring retinal tears and holes, with high inter-rater agreement. Given there is only a moderate sensitivity in identifying treatment requiring retinal tears and holes, UWF imaging can assist with clinical exam, but a 360-degree scleral depressed exam should remain the gold standard.
Stable Ventricular Fibrillation: A Paradigm Rather Than Septal Shift?
Authors: Bracy Connor L. , Kobres Pei-Ying , Hockstein Michael J. , Rao Sriram D. , Gupta Richa , Lam Phillip H. , Sheikh Farooq H. , Hockstein Maxwell A.
Published: August 2023

Awake patients in ventricular fibrillation is a phenomenon limited to patients who are mechanically supported. We describe a cohort of patients supported by left ventricular assist devices (LVADs) presenting to the emergency department (ED) at a high-volume LVAD center while in awake ventricular fibrillation (VF)/ventricular tachycardia (VT). Among 175 patients reviewed, a total of 19 LVAD patients presented to the ED in awake VF/VT between December 2015 and July 2021. On ED presentation, patients maintained a median mean arterial blood pressure (MAP) of 70 mm Hg with a mean LVAD flow of 3.77 L/minute. ED management included cardioversion in the majority of cases: 58% were defibrillated once, 21% were defibrillated multiple times, 68% received amiodarone, and 21% received lidocaine. Inpatient management included defibrillation, ablation, and antiarrhythmic initiation in 37%, 11%, and 84% of cases, respectively. In total, five patients (26%) died with one death attributed to recurrent VT. Our findings support the short-term tolerability of sustained ventricular arrhythmias in LVAD patients, as evidenced by the maintained MAPs and mental status. Clinical teams, however, should be aware of the potential harbinger for in-hospital mortality heralded by an awake VF/VT presentation.
Immunogenicity and reactogenicity of yellow fever vaccine in people with HIV
Authors: Motta Edwiges , Camacho Luiz Antonio B. , Cunha Marcelo , de Filippis Ana Maria Bispo , Lima Sheila M.B. , Costa Marcellus , Pedro Luciana , Cardoso Sandra W. , Cortes Fernanda Heloise , Giacoia-Gripp Carmem B.W. , Morata Michelle , Nazer Sandro , Moreira Ronaldo Ismério , de Oliveira Souza Marta Cristina , Mendes Ygara S. , Souza Azevedo Adriana de , dos Santos Alvez Nathalia , Grinsztejn Beatriz , Coelho Lara E.
Published: August 2023

Objective:

To evaluate immunogenicity and reactogenicity of yellow fever (YF) vaccine in people with HIV (PWH) compared to HIV-uninfected controls.

Design:

In this longitudinal interventional trial (NCT03132311), PWH with CD4+ cell count ≥200 cells/μl and controls, aged 18–59, without a previous history of YF vaccination received a single standard dose of YF vaccine (17DD) and were followed at Days 5, 30 and Year 1.

Methods:

YF-neutralization titers were measured at Days 0, 30 and Year 1 and geometric mean titers (GMT) were calculated. Adverse events (AE) and YF virus detection were measured at Days 5 and 30. Linear regression evaluated factors associated with YF-neutralization titers.

Results:

Two hundred and eighteen PWH and 82 controls were included. At baseline, all PWH were using antiretroviral therapy; 92.6% had undetectable HIV viral load (VL) and median CD4+ cell count was 630 cells/μl [interquartile range (IQR) 463–888]. YF vaccine was safe and there were no serious AEs. At Day 30, seroconversion was observed in 98.6% of PWH [95% confidence interval (CI): 95.6–99.6] and in 100% of controls (95% CI: 93.9–100); at Year 1, 94.0% of PWH (95% CI: 89.6–96.7) and 98.4% of controls (95% CI 90.3–99.9) were seropositive. PWH had lower GMTs than controls at Day 30 and Year 1. Baseline VL >1000 copies/ml, low CD4+ cell count and low CD4+/CD8+ ratio were associated with lower YF-neutralization titers.

Conclusions:

YF vaccine is safe in PWH with CD4+ cell count ≥200 cells/μl. YF vaccine immunogenicity is impaired in PWH, particularly among those with high VL, low CD4+ cell count and low CD4+/CD8+ ratio at vaccination and YF-neutralization titers decays over time.
A systematic review of qualitative research on recently acquired HIV
Authors: Nicholls Emily Jay , Policek Nicoletta , Volny-Anne Alain , Spire Bruno , Burns Fiona , Ruiz-Burga Elisa , Tariq Shema
Published: August 2023

Objective(s):

Recently acquired HIV is a critical time when people may experience debilitating symptoms and is when they are most likely to pass HIV on. Qualitative research offers insights into lived experiences and a deeper understanding of the contextual factors underlying HIV acquisition. We aimed to synthesize qualitative literature on recently acquired HIV.

Design:

Systematic review and textual narrative synthesis.

Methods:

We searched MEDLINE, CINAHL Plus, PsycINFO and Sociology Database. Articles were screened, and two authors completed full text review and data extraction. Quality appraisal was conducted (Critical Appraisal Skills Programme Qualitative Studies Checklist) and certainty of findings graded (GRADE-CERQual).

Results:

We reviewed 1890 articles (1554 following de-duplication), excluding 1539. Fifteen articles were included and an additional article was included after updating the search. We identified 15 themes, three of which we have high confidence in: recent acquisition of HIV facilitates understanding of circumstances of HIV acquisition; indeterminate HIV tests generate uncertainty and anxiety; and people with recently acquired HIV are motivated to reduce risk of onward transmission.

Conclusions:

Our findings highlight the importance of continued research into recently acquired HIV, as well as the need for support to manage the emotional impact of indeterminate test results and negotiate risk reduction. We found no studies exploring sexual risk in the context of recently acquired HIV, or use of pre-exposure prophylaxis or treatment as prevention. The literature is primarily focused on HIV acquisition from an individual and behavioural perspective, neglecting important aspects of lived experience such as immediate ART, stigma, and health and wellbeing.
Modeling the impact of universal TB molecular testing and timing of TB preventive treatment during ART initiation in South Africa
Authors: Balasubramanian Ruchita , Shearer Kate , Mudzengi Don , Hippner Piotr , Golub Jonathan E. , Chihota Violet , Hoffmann Christopher J. , Kendall Emily A.
Published: August 2023

Objectives:

Targeted universal tuberculosis (TB) testing can improve TB detection among people with HIV. This approach is being scaled up in South Africa through Xpert MTB/RIF Ultra testing for individuals starting antiretroviral therapy and annually thereafter. Clarity is needed on how Universal Xpert testing may affect TB preventive treatment (TPT) provision, and on whether TPT should be delayed until TB is ruled out.

Design:

State-transition microsimulation.

Methods:

We simulated a cohort of South African patients being screened for TB while entering HIV care. We compared clinical and cost outcomes between four TB screening algorithms: symptom-based, C-reactive protein-based, and Universal Xpert testing with either simultaneous or delayed TPT initiation.

Results:

Prompt TB treatment initiation among simulated patients with TB increased from 26% (24%–28%) under symptom screening to 53% (50–56%) with Universal Xpert testing. Universal Xpert testing led to increased TPT uptake when TPT initiation was simultaneous, but to approximately 50% lower TPT uptake if TPT was delayed. Universal Xpert with simultaneous TPT prevented incident TB compared to either symptom screening (median 17 cases averted per 5000 patients) or Universal Xpert with delayed TPT (median 23 averted). Universal Xpert with Simultaneous TPT cost approximately $39 per incremental TPT course compared to Universal Xpert with delayed TPT.

Conclusions:

Universal Xpert testing can promote timely treatment for newly diagnosed people with HIV who have active TB. Pairing universal testing with immediate TPT will improve the promptness, uptake, and preventive effects of TPT. Simultaneous improvements to TB care cascades are needed to maximize impact.
African American/black race, Apolipoprotein L1, and the indirect glomerular filtration measure serum creatinine among persons living with HIV
Authors: Shelton Brittany A. , Sawinski Deirdre , Peter Inga , Maclennan Paul A. , Pelletier Nicole F. , Nadkarni Girish , Julian Bruce , Saag Michael , Fatima Huma , Crane Heidi , Lee Wonjun , Moore Richard D. , Christopoulos Katerina , Jacobson Jeffrey M. , Eron Joseph J. , Kumar Vineeta , Locke Jayme E.
Published: August 2023

Objective:

Accurate estimation of kidney function is critical among people living with HIV (PLWH) to avoid under-dosing of antiretroviral therapies and ensure timely referral for kidney transplantation. Existing estimation equations for kidney function include race, the appropriateness of which has been debated. Given advancements in understanding of race and the necessity of accuracy in kidney function estimation, this study aimed to examine whether race, or genetic factors, improved prediction of serum creatinine among PLWH.

Design:

This cross-sectional study utilized data from the Center for AIDS Research Network of Integrated Clinical Systems cohort (2008–2018). The outcome was baseline serum creatinine.

Methods:

Ordinary least squares regression was used to examine whether inclusion of race or genetic factors (apolipoprotein-L1 (APOL1) variants and genetic African ancestry) improved serum creatinine prediction. A reduction in root mean squared error (RMSE) >2% was a clinically relevant improvement in predictive ability.

Results:

There were 4,183 PLWH included. Among PLWH whose serum creatinine <1.7 mg/dL, race was significantly associated with serum creatinine (β = 0.06, SE = 0.01, p < 0.001), but did not improve predictive ability. African ancestry and APOL1 variants similarly failed to improve predictive ability. Whereas, when serum creatinine ≥1.7 mg/dL, inclusion of race reduced the RMSE by 2.1%, indicating improvement in predictive ability. APOL1 variants further improved predictive ability by reducing the RMSE by 2.9%

Conclusions:

These data suggest that, among PLWH, inclusion of race or genetic factors may only be warranted at higher serum creatinine levels. Work eliminating existing healthcare disparities while preserving the utility of estimating equations is needed.
Novel Gurmarin-like Peptides fromGymnema sylvestreand their Interactions with the Sweet Taste Receptor T1R2/T1R3
Authors: Maaroufi Halim
Published: August 2023

Gymnema sylvestre(GS) is a traditional medicinal plant known for its hypoglycemic and hypolipidemic effects. Gurmarin (hereafter Gur-1) is the only known active peptide in GS. Gur-1 has a suppressive sweet taste effect in rodents but no or only a very weak effect in humans. Here, eight gurmarin-like peptides (Gur-2 to Gur-9) and their isoforms are reported in the GS transcriptome. The molecular mechanism of sweet taste suppression by Gur-1 is still largely unknown. Therefore, the complete architecture of human and mouse sweet taste receptor T1R2/T1R3 and its interaction with Gur-1 to Gur-9 were predicted by AlphaFold-Multimer (AF-M) and validated. Only Gur-1 and Gur-2 interact with the T1R2/T1R3 receptor. Indeed, Gur-1 and Gur-2 bind to the region of the cysteine-rich domain (CRD) and the transmembrane domain (TMD) of the mouse T1R2 subunit. In contrast, only Gur-2 binds to the TMD of the human T1R2 subunit. This result suggests that Gur-2 may have a suppressive sweet taste effect in humans. Furthermore, AF-M predicted that Gα-gustducin, a protein involved in sweet taste transduction, interacts with the intracellular domain of the T1R2 subunit. These results highlight an unexpected diversity of gurmarin-like peptides in GS and provide the complete predicted architecture of the human and mouse sweet taste receptor with the putative binding sites of Gur-1, Gur-2 and Gα-gustducin. Moreover, gurmarin-like peptides may serve as promising drug scaffolds for the development of antidiabetic molecules.