bluuebunny/crossref_metadata_2025 huggingface dataset:
Mount Moses
Authors: Ghyoot Mathias
Published: December 2024

This chapter examines the internal conflict that brewed within the membership once they reached Camp Ṭūr: one that expressed itself along overwhelmingly generational lines and pitted the young, rebellious rank-and-file against the emollient senior Brothers. As we saw in the preceding chapter, this conflict had already flared up in Camp Huckstep as Brothers debated the place of violence in the Muslim Brotherhood’s (MB) policy toward authorities in Egypt. This chapter, however, now shows how this conflict manifested itself from 1949 onward as Brothers (1) established an educational program in Camp Ṭūr, (2) engaged in prison riots in both Camp Ṭūr and Camp Huckstep, (3) attempted to secure their release through press campaigns and judicial measures, and (4) searched not only for al-Bannā’s replacement, but a new war—this time, against the British.
We Are Judges
Authors: Ghyoot Mathias
Published: December 2024

This chapter traces the increasing radicalization of the imprisoned Brothers in the 1960s. Whereas historians have largely treated the radical cadres as a homogenous group inspired by Sayyid Quṭb, I argue that different radical schools emerged among the imprisoned Brothers, the most radical of which did not seek inspiration from Quṭbism, but from the eighteenth-century puritanical reformer Muḥammad b. ʿAbd al-Wahhāb (d. 1792). Tracing the paths of the leading figures of the radical camp from Abū Zaʿbal Penitentiary to Ṭurra Farm, the chapter demonstrates that three schools of radical thought emerged in prison, personified in three Brothers: (1) Muḥammad Quṭb, who continued the thinking associated with Sayyid Quṭb; (2) ʿAlī Ismāʿīl, who further radicalized Quṭbism; and (3) Shukrī Muṣṭafā (d. 1978), whose hybrid ideology blended Quṭbism with Wahhābism.
Conclusion
Authors: Ghyoot Mathias
Published: December 2024

This conclusion brings the story up to date by providing a brief history of the Muslim Brotherhood’s (MB) subsequent periods of imprisonment, most recently after Muḥammad Mursī’s downfall in 2013. Known among Brothers as the “Fourth Ordeal,” the current imprisonment of the Brothers would become the most extensive in the history of the MB. Many Brothers, including Mursī, have died in prison under dubious circumstances, and many more have been subjected to intolerable conditions in detention facilities, some of them familiar, like Ṭurra Penitentiary (although demolished in 2022), and some of them new, like the Scorpion Prison (Sijn al-ʿAqrab). But although scores of new and old Brothers have now entered prison in Egypt, the past ordeals serve as a potent reminder, not of what the institution of prison may restrict them from doing, but what they may accomplish in spite of it as they begin discussing which direction they wish to take a future MB.
“Evangelical Meccas”
Authors: Miller Brian J.
Published: December 2024

Chapter 6 investigates why evangelical nonprofit organizations—parachurch organizations—with a national or international stature cluster in four particular locations: Grand Rapids, Michigan; Wheaton and Carol Stream, Illinois; Colorado Springs, Colorado; and Orange County and suburbs east of Los Angeles in California. Grand Rapids was a center of Dutch Reformed denominations, Orange County emerged in the postwar era as home to religious and political conservatives, and Colorado Springs actively sought evangelical organizations in the early 1990s as part of a strategy of economic growth. Additionally, interviews with leaders and employees in 55 evangelical parachurch groups in these four locations demonstrate that these organizations find value in locations near like-minded organizations. Even as these clusters emerged at different times and in different parts of the country, they each presented opportunities for evangelical nonprofits to effectively compete for resources and contribute to a local sense of evangelical character.
Introduction
Authors: Osei Adjoa
Published: December 2024

This introductory chapter provides an overview of the legacy of Elsie Houston. In the 1920s and 1930s, black and mixed-race women from across the globe came together in Paris and New York to engage in an artistic, sexual, intellectual, and political revolution. As a Brazilian woman of color who was part of the Parisian jazz age, Elsie became notable for performing restylized Afro-Brazilian and Afro-Cuban folk songs in the operatic mode in elite theatres and cabarets. The chapter explains that Elsie’s narrative highlighted a history of Western culture and society where the artistic worlds of Brazil, Paris, and New York connect. It then considers the taxonomy of black identity and its complexity across different cultural settings.
Formers in Lebanon
Authors: Foerch Christina , Norman Julie M.
Published: December 2024

This chapter analyzes the context of conflict in Lebanon and how the resurfaced conflict in 2012 inspired former extremists to form a nongovernmental organization called Fighters for Peace (FFP) to work in conflict prevention and peacebuilding. The chapter argues that if contextual policy design can be effectively implemented, formers can play a significant role in a protracted conflict context such as in Lebanon. This chapter details the context of conflict in Lebanon and the formation of FFP and subsequently provides an analysis of the FFP’s preventing and countering violent extremism (P/CVE) activities. It then shows how the conflict context generates unique prospects and challenges for former fighters. The chapter argues that formers bring a degree of legitimacy to P/CVE interventions, allowing for greater resonance with at-risk communities. At the same time, that same “fighter” identity can alienate victims of violence and their families, requiring attention to reconciliation efforts alongside P/CVE activities.
Days Seventeen to Twenty and the Third Weekend
Authors: Shukman Ann
Published: December 2024

An SdP delegation brings flowers to Hilda who is flattered. Her anti-Czech feelings become more vocal and are reported to Berlin. Her political views, expressed in National Liberal circles at home, would encourage the succession of the Sudetenland. Walter and Hilda spend a restful weekend in the Schwarzenberg forests of southern Bohemia. Meanwhile Ashton-Gwatkin is invited by Hohenlohe to meet Henlein at Marienbad. Henlein gives him notes about Beneš’s Third Plan.
Aftermath
Authors: Shukman Ann
Published: December 2024

On his return, Walter had contemplated advising a partial cession to the Reich of the important majority German populated areas to achieve this. However, Chamberlain had taken over and had already informally discussed with Hitler to cede areas with over 50% German population, with no plebiscite. Ashton-Gwatkin is informed of the outcome of the Berchtesgarden meeting and after meetings with Horace Wilson, switches his views to support Chamberlain. He would re-write the Runciman Report accordingly and become a key figure in the Munich meeting. Stopford was appalled at the content of the final Runciman Report and asked for it to be recalled. In Prague, the final Report caused consternation and dismay at the difference in Walter’s declared position before leaving Prague and that which he was seemingly recommending now. French and British governments met without Runciman and agreed to demand that the Czech government make an outright cession of all Sudeten territories with over fifty percent populations to stop Hitler having any lawful reason to invade Czechoslovakia and thereby drag them into a war. Beneš is last to hear these demands by telephone on the 23rd September from Jan Masaryk in London. Jan betrays Walter.
Ethiopia’s Military Conflicts and Reforms
Authors: Ayele Fantahun
Published: December 2024

Emperor Tewodros II was the first Ethiopian monarch who attempted to introduce military reforms. Among other things, he introduced modern military ranks and a chain of command, and enforced an iron discipline into the national army he created by uniting regional forces. He also managed to manufacture many mortars at Gafat to defend Ethiopia from foreign invasion. In addition, he tried in vain to get technical assistance from Britain to modernize his army. His successors Yohannes IV and Menilek II, on their part, attempted to acquire enormous arms from Europe which enabled the latter to score a resounding victory over the Italians on 1 March 1896. Three decades later the Ethiopian government employed Russian and Belgian military officers to train the Imperial Bodyguard along European lines. In the meantime, Ethiopians were sent to St. Cyr in France for officer training. Meanwhile, a Swedish military mission helped the Ethiopian government in establishing the Holeta Military Academy in 1934. The training of officers was, however, disrupted by the Italian invasion of 1935. Following Ethiopia’s liberation from the Italian occupation, the British Military Mission to Ethiopia was assigned to organize the army. Finally, in the early 1950s the task of training, organizing, and equipping the army was taken over by the American Military Assistance Advisory Group, and that lasted twenty-five years.
Child Labour, Education, and Saving
Authors: Cigno Alessandro , Rosati Furio C.
Published: December 2024

Parents decide how their school-age children should allocate their time between work and education, and how much to give each of them now and when they become adults. If parents are credit rationed, the more children they have, the less education will each child get. Given all other prices, the child labour market determines the child wage rate, and the allocation of the children’s time between work and education. Child labour may be inefficiently high or inefficiently low. If education yields direct utility, child labour yields direct disutility, or there is a positive education externality, however, child labour is unlikely to be inefficiently low.
Social Norms and Family Rules
Authors: Cigno Alessandro , Rosati Furio C.
Published: December 2024

A family rule, or a social norm, is self-enforcing if it is in the interest of every member of that family or society to obey it, and have others obey it. If the cost of negotiating a new rule or norm is at least as large as the benefit, a self-enforcing rule or norm is also renegotiation-proof. A family rule with such characteristics removes one of the possible causes of an inefficient high-fertility, high-child-labour equilibrium. A social norm with such characteristics permits an efficient allocation of tasks between the spouses because it prevents opportunistic bargaining on the husband’s part. If a rule or norm comes to be seen as part of an ethnic group’s identity or religion, it may persist even when the circumstances that made it self-enforcing and renegotiation-proof no longer apply.
Ethnic Visibility, Linked Fate, and Voting
Authors: Robinson Amanda Lea
Published: December 2024

This chapter provides evidence that ethnic visibility drives political support for ethnic parties. It shows that individual-level ethnic visibility among the Lhomwe predicts support for an ethnic party. It also provides multiple of pieces of evidence for the mechanism that ethnic visibility drives party support because it engenders a sense of linked fate. An instrumental variable approach, which relies on variation in ethnic heritage, provides evidence that the relationship between ethnic visibility and ethnic party support is causal. The chapter ends by extending these analyses to the ethnic group-level and shows that across the African continent, ethnic groups with more visible members are more likely to vote in ethnically distinct ways. These group-level findings demonstrate that the theoretical argument linking ethnic visibility to ethnic political behavior is not limited to the individual-level or to the Lhomwe of Malawi.
High-Quality Genome Resource of Eight Strains of Ralstonia pseudosolanacearum Causing Bacterial Wilt in Madagascar
Authors: Nomenjanahary Marie-Véronique , Rasoamanana Hasina , Javegny Stéphanie , Rieux Adrien , Ravelomanantsoa Santatra , Poussier Stéphane , Pecrix Yann
Published: December 2024

The Ralstonia solanacearum species complex (RSSC) is a significant pathogen that causes bacterial wilt, affecting numerous plant species and posing a critical threat to food security in tropical and subtropical regions. In recent years, multiple bacterial wilt outbreaks have been reported in Madagascar and the phylogenetic assignment of the collected strains revealed a high prevalence of phylotype I, belonging to the species Ralstonia pseudosolanacearum. This study presents the first genomic sequences of eight Malagasy phylotype I strains, collected from diverse regions and host plants, representing the phylogenetic diversity and varying levels of prevalence in the field. Genomic analysis, including phylogenetic positioning, revealed that Malagasy strains share evolutionary links with strains from different continents, while some formed unique monophyletic groups. Type III effector (T3E) repertoires, key virulence factors, were analyzed, identifying core and lineage-specific effectors. This genomic data provides essential resources for future studies on host adaptation and the molecular mechanisms driving the epidemic success of RSSC in Madagascar.
An electrolyte disturbance masquerading as a panic attack
Authors: Wildermuth Anne , Lantz Meagan , Sagers Erin
Published: December 2024

Because proton pump inhibitors (PPIs) are so commonly used, their safety and potential adverse reactions often are not considered. This article describes a patient whose paresthesias and severe muscle cramps were attributed to panic attacks but actually were caused by hypocalcemia secondary to PPI-induced hypomagnesemia. This case serves as a reminder that PPIs should be used cautiously and appropriately with consideration for regular monitoring of electrolytes and vitamin B12.
Triple inhaler therapy in adolescents and adults with moderate or severe persistent asthma
Authors: L'Eplattenier Mark , Pontrelli Gina , Loscalzo Carina
Published: December 2024

Expert guidelines, meta-analyses, and multiple randomized controlled trials have demonstrated the effectiveness of long-acting inhaled antimuscarinic agents (LAMAs) as an additive medication for patients with poorly controlled moderate or severe persistent asthma. LAMAs play an essential role in blocking acetylcholine binding to muscarinic receptors and reducing bronchoconstriction and mucus production. By adding this medication to other combination inhalers, patients can use a triple inhaler to improve FEV1 values and reduce exacerbations.
Feasibility of Alerting Systems and Family Care Partner Support for Postoperative Delirium Prevention
Authors: Vlisides Phillip E. , Runstadler Nathan , Martinez Selena , Ragheb Jacqueline W. , Mentz Graciela , Leis Aleda , Schoettinger Amanda , Hickey Kimberly , McKinney Amy , Brooks Joseph , Zierau Mackenzie , Norcott Alexandra , Mody Lona , Inouye Sharon K. , Avidan Michael S. , Min Lillian
Published: December 2024

Background:

The objective of this study was to determine whether postoperative pager alerts to the Hospital Elder Life Program (HELP), a delirium prevention service, would accelerate program enrollment for older surgical patients. This study also tested feasibility of family care partner interventions for delirium prevention.

Methods:

This single-center, pilot clinical trial factorially randomized 57 non-cardiac surgical patients ≥70 years of age to 4 arms: (1) standard care, (2) pager alerts to accelerate HELP enrollment, (3) family care partner-based delirium prevention interventions, or (4) a combined arm with both HELP and family interventions. The primary clinical outcome was delirium (assessed through the Confusion Assessment Method).

Results:

In the pager alerting arms, 13/24 (54%) participants were enrolled by HELP on postoperative day 1 compared with 0/26 (0%, P<0.001) in the non-alerting arms. Median [interquartile range] time spent in delirium prevention protocols was significantly longer in pager alerting arms than in non-alerting arms (39 [5 to 75] min vs. 0 [0 to 0] min; P<0.001). Family care partners spent 18 [11 to 25)] hours at the bedside over the first 3 postoperative days. There was no significant difference in delirium occurrence in participants randomized to pager alert arms compared with non-alerting arms (odds ratio, 1.02, 95% CI, 0.97-1.07; P=0.390). Similarly, there was no significant difference in delirium occurrence in family intervention arms compared with nonintervention arms (odds ratio, 0.97; 95% CI 0.93-10.02; P=0.270).

Conclusions:

Pager alerts significantly reduced time to HELP enrollment, albeit without reducing delirium incidence in this pilot study. Family care partners spent substantial time at the bedside during the study period.
Using the Mismatch Negativity to Evaluate Hearing Aid Directional Enhancement Based on Multistream Architecture
Authors: Slugocki Christopher , Kuk Francis , Korhonen Petri
Published: December 2024

Objectives:

To evaluate whether hearing aid directivity based on multistream architecture (MSA) might enhance the mismatch negativity (MMN) evoked by phonemic contrasts in noise.

Design:

Single-blind within-subjects design. Fifteen older adults (mean age = 72.7 years, range = 40 to 88 years, 8 females) with a moderate-to-severe degree of sensorineural hearing loss participated. Participants first performed an adaptive two-alternative forced choice phonemic discrimination task to determine the speech level—that is, signal to noise ratio (SNR)—required to reliably discriminate between two monosyllabic stimuli (/ba/ and /da/) presented in the presence of ongoing fixed-level background noise. Participants were then presented with a phonemic oddball sequence alternating on each trial between two loudspeakers located in the front at 0° and −30° azimuth. This sequence presented the same monosyllabic stimuli in the same background noise at individualized SNRs determined by the phonemic discrimination task. The MMN was measured as participants passively listened to the oddball sequence in two hearing aid conditions: MSA-ON and MSA-OFF.

Results:

The magnitude of the MMN component was significantly enhanced when evoked in MSA-ON relative to MSA-OFF conditions. Unexpectedly, MMN magnitudes were also positively related to degrees of hearing loss. Neither MSA nor the participant’s hearing loss was found to independently affect MMN latency. However, MMN latency was significantly affected by the interaction of hearing aid condition and individualized SNRs, where a negative relationship between individualized SNR and MMN latency was observed only in the MSA-OFF condition.

Conclusions:

Hearing aid directivity based on the MSA approach was found to improve preattentive detection of phonemic contrasts in a simulated multi-talker situation as indexed by larger MMN component magnitudes. The MMN may generally be useful for exploring the underlying nature of speech-in-noise benefits conferred by some hearing aid features.
Using Electronic Health Records to Identify the Daily Primary Provider During Hospitalization
Authors: Ingraham Nicholas E. , Shyu Daniel , Phelan Tom , Mesfin Nathan , Langworthy Benjamin , Kohn Rachel , Kerlin Meeta Prasad , Dudley R. Adams
Published: December 2024

OBJECTIVES:

Providers vary in their impact on clinical outcomes, but this is rarely accounted for in healthcare research. By failing to identify the provider responsible for a patient’s care, investigators miss an opportunity to account for nonrandom variation in outcomes. Prior methods of identifying responsible providers have relied on manual chart review, which is time-consuming and expensive, or analysis of claims data, which has been demonstrated to be inaccurate. To address these gaps, we sought to develop an algorithm using electronic health record (EHR) data to identify the responsible provider for each day of a patient’s hospitalization.

DESIGN:

A multicenter retrospective cohort study.

SETTING:

Midwest healthcare system.

PATIENTS:

Hospitalized patients and their providers.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

We first confirmed high inter-rater reliability of manual chart review to identify the responsible provider. Using manual chart review as the gold standard, we then assessed the accuracy of an automated algorithm in a set of randomly selected patients. The agreement between two independent physicians in their determination of the responsible provider by chart review was 100%. Among 200 randomly selected patients, the algorithm identified the same responsible provider as the physician chart reviewer on 93% (3372/3626; 95% CI, 92–94%) of patient-days.

CONCLUSIONS:

Readily available EHR data can be used to assign patients to providers daily with a high degree of accuracy. This methodology could be applied in healthcare research to identify sources of variation other than the intervention being studied.
Enhancing HBV-specific T cell responses through a combination of epigenetic modulation and immune checkpoint inhibition
Authors: Urbanek-Quaing Melanie , Chou Yin-Han , Gupta Manoj Kumar , Steppich Katja , Bremer Birgit , Schmaus Hagen , Deterding Katja , Maasoumy Benjamin , Wedemeyer Heiner , Xu Cheng-Jian , Kraft Anke R. M. , Cornberg Markus
Published: December 2024

Objective:

Chronic HBV infection (CHB) exhausts HBV-specific T cells, develops epigenetic imprints that impair immune responses, and limits the effectiveness of immune checkpoint inhibitor (ICI) monotherapy, such as αPD-L1. This study aimed to determine whether the DNA methyltransferase inhibitor decitabine (DAC) could reverse these epigenetic imprints and enhance ICI efficacy in restoring HBV-specific T cell responses.

Methods:

We investigated HBV-specific T cell responses by 10-day in vitro stimulation of peripheral blood mononuclear cells (PBMCs) from patients with CHB. PBMCs were stimulated with HBV core-specific overlapping peptide pools and HLA-A*02-restricted peptides, core18 and pol455. The immunomodulatory effect of the DAC/αPD-L1 combination was assessed by flow cytometry, and our analysis included clinical characteristics, ex vivo DNA methylation of PBMCs, and IFNγ plasma levels.

Results:

Treatment with DAC/αPD-L1 enhanced HBV-specific CD4+ T cell responses in a significant proportion of 53 patients, albeit with some variability. This effect was independent of the HBcrAg levels. Ex vivo DNA methylation revealed hypermethylation of key genes, such as IFNG among DAC-responders versus non-responders, supported by altered ex vivo IFNγ plasma levels. Further analysis of HBV-specific CD8+ T cell responses in 22 HLA-A*02-positive patients indicated distinct response patterns between core18 and pol455 stimulation, with pol455-specific CD8+ T cells showing increased susceptibility to DAC/αPD-L1, surpassing the αPD-L1 monotherapy response.

Conclusions:

The combination of DAC/αPD-L1 shows promise in improving HBV-specific T cell responses in vitro, highlighting the potential of remodeling exhaustion-associated epigenetic signatures to enhance HBV-specific T cell restoration and suggesting a novel immunotherapeutic avenue for CHB.
Orbital Septum Posterior to Medial Canthal Tendon Area
Authors: Teope Jonnah Kristina , Naito Munekazu , Takahashi Yasuhiro , Kakizaki Hirohiko
Published: December 2024

Purpose:

To examine the anatomy of the orbital septum posterior to the medial canthal tendon area.

Materials and Methods:

We performed 3 anatomical dissections in the present study. The first one was a microscopic study in which exenterated specimens from 6 Japanese cadavers (age from 77 to 93 years at death) were cut inferno-horizontally, including the Müller muscle, medial rectus pulley, and lateral rectus pulley, and stained with Masson’s trichrome. The second one was also a microscopic study in which the exenterated specimens from 5 Japanese cadavers (age from 73 to 87 years at death) were cut horizontally, 1 mm superior to the upper eyelid margin and 1 mm inferior to the lower eyelid margin, and stained with Masson’s trichrome. The third one was a macroscopic study in which exenterated specimens from 5 Japanese cadavers (age from 73 to 91 years at death) were cut horizontally at the medial palpebral commissure.

Results:

In the first study, all the specimens showed the orbital septa with close vicinity to the orbicularis oculi muscle in the medial area. The second and third studies both demonstrated the double lamellar structure of the medial canthal tendon area. The anterior one was the fibrous tissue corresponding to the white medial canthal tendon. The posterior one referred to the preseptal orbicularis oculi muscle. The orbital septum was located directly posterior to this muscular structure.

Conclusion:

The orbital septum posteriorly lined the preseptal orbicularis oculi muscle, the muscular part of the medial canthal tendon.
Orbital Intraosseous Abscess After Lateral Bony Orbital Decompression
Authors: Lao Priscilla April O. , Chatha Usma , Fay Aaron , Heffelfinger Ryan , Bilyk Jurij R.
Published: December 2024

A 66-year-old woman status post bony lateral orbital decompression for thyroid eye disease presented with recurrent episodes of left lateral canthal edema and erythema, despite repeated courses of oral antibiotics, titanium hardware removal, and repeated exploratory orbitotomies with debridement and curettage. MRI later revealed an intraosseous fluid collection in the left greater sphenoid wing. Another exploratory orbitotomy was performed and an intraosseous abscess was identified. The purulent fluid was sent for culture, and the area was debrided and irrigated thoroughly with bacitracin solution. Cultures grew Staphylococcus epidermidis. The patient was treated with a 6-week course of intravenous antibiotics and has remained symptom free for 3 years.
Botulinum Toxin Treatment in Thyroid Eye Disease: A Systematic Review and Meta-analysis
Authors: Zong Amanda M. , Giannakakos Vasiliki P. , Delbourgo Patton Caroline , Barmettler Anne
Published: December 2024

Purpose:

Thyroid eye disease–related retraction and strabismus treatment is complicated by the activity level of the disease. Botulinum toxin injection can provide relief of symptoms in lieu of, or while waiting for surgery, radiation, or alternative medications. This study reviews techniques, outcomes, and effectiveness of botulinum toxin usage in thyroid eye disease.

Methods:

A systematic review was conducted using PubMed, Embase, Web of Science, and Cochrane to identify research investigating botulinum toxin treatment of thyroid eye disease through May 2024. A meta-analysis was performed on change in marginal reflex distance in retraction patients, resolution of diplopia in strabismus patients, necessity of further strabismus surgery, and side effects.

Results:

Of 157 studies screened by 2 reviewers, 30 underwent analysis. In 19 upper eyelid retraction studies (299 patients), 1.5 to 15 U Botox (onabotulinum toxin A) or 10 to 40 U Dysport (abobotulinum toxin A) was administered to the superior tarsal border, with an 84% success rate and an average decrease in marginal reflex distance of 2.42 mm lasting 1 to 6 months. In 10 strabismus studies (205 patients), 5 to 20 U Botox or 25 U Dysport was administered in extraocular muscles; 24% achieved resolution of diplopia lasting 2 to 6 months, while 58% required further surgical management. In upper eyelid retraction studies, side effects included ptosis (13%) and diplopia (2%). In strabismus studies, side effects included ptosis (2%).

Conclusions:

This systematic review and meta-analysis confirmed that botulinum toxin is an effective treatment for thyroid eye disease–related lid retraction and strabismus. Randomized controlled studies are warranted to optimize botulinum toxin administration.
National virtual tumor boards to inform the management of children with rare cancers
Authors: Navai Shoba A. , Mahajan Priya , Venkatramani Rajkumar
Published: December 2024

Purpose of review

Due to the infrequent nature of rare pediatric cancers, rigorously studied treatment algorithms are usually nonexistent, and experience with a given tumor may be limited at a single institution. Development of treatment plans for these populations often requires extensive literature review and outreach to experts at other institutions. National or international virtual tumor boards provide a streamlined, collaborative approach to discussing diagnosis and management of these patients through dissemination of collective experience and knowledge. This review highlights current virtual tumor boards for rare pediatric cancers and their benefit as a resource for patient care.

Recent findings

Over the last several years, national virtual tumor boards sponsored by government and academic institutions and cancer foundations have expanded access of pediatric oncologists to rare tumor expertise and guidance. Recommendations from these tumor boards often have an impact on medical decision making, and some serve as a resource for enduring educational reference materials.

National virtual tumor boards are a valuable resource to clinicians caring for patients with rare pediatric tumors. These conferences provide real-time management advice from peers and subject matter experts and provide essential educational content not easily accessible in other formats.
Observational gait analysis
Authors: Donnan Leo
Published: December 2024

Purpose of review

The review is aimed at practising paediatricians who want to improve their clinical skills in observational gait analysis. Many paediatric complaints relate to problems of walking or limb alignment, and only a small proportion of these are pathological. With a deeper understanding of normal gait and a framework to conduct an observational analysis, the clinician can feel more confident diagnosing and recognizing those walking patterns that need further investigation.

Recent findings

Advances in instrumented gait analysis over the last two decades have provided deeper insights into the mechanisms of walking, how to interpret gait deviations, and their effect on locomotion. This has helped improve the quality of observational gait analysis and, in many ways, defined its limitations.

This review explains the components of normal gait and provides a structured approach to observational gait analysis. It also discusses the cause of limps and expands upon the importance of understanding rotational deformities. Finally, some tools to enhance the observational analysis are presented.
Persistent lichen planus pigmentosus inversus in a 45-year-old woman: a decade-long clinical journey and therapeutic challenges in an uncommon dermatological variant
Authors: Alsoleman Moath Moeen , Alkheder Ahmad , Fathallah Ibrahim , Alsodi Zeina
Published: December 2024

Introduction and significance:

Lichen planus pigmentosus inversus (LPPI), a rare variant primarily affecting non-sun-exposed areas in Caucasians, is resistant to standard treatments. This case highlights its clinical challenges and persistence.

Case presentation:

A 45-year-old woman with a decade-long history of light to dark brown macules and patches, initially in the axillary and inguinal regions, experienced progressive spread to her forearms, upper arms, and inframammary areas. Despite normal lab results and no significant family history or trauma, histopathology confirmed LPPI. Treatment with topical steroids, pimecrolimus, tretinoin, and oral prednisolone led to partial resolution, though irritation from pimecrolimus required reduced application.

Clinical discussion:

LPPI is a chronic inflammatory condition, first described by Pock et al. in 2001, affecting primarily intertriginous areas in lighter-skinned individuals. Characterized by hyperpigmented macules with minimal pruritus, LPPI often involves the axillae, groin, and inframammary regions. Histopathological features include atrophic epidermis, pigmentary incontinence, and a lichenoid inflammatory infiltrate. Differential diagnosis includes ashy dermatosis and post-inflammatory hyperpigmentation. LPPI’s clinical course is variable, with treatments like tacrolimus and corticosteroids yielding inconsistent results.

Conclusion:

This case report documents a rare instance of pigmented inverse lichen planus in a 45-year-old woman, highlighting its chronic nature, treatment resistance, and ongoing challenges in managing pigmentation.
The Use of Cannabis Products for the Management of Pain Associated With Gynecologic Conditions
Authors:   The American College of Obstetricians and Gynecologists’ Committee on Clinical Consensus – Gynecology in collaboration, Oelschlager Anne-Marie , Gecsi Kimberly , Rodriguez Melissa
Published: December 2024

(Abstracted from Obstet Gynecol 2024;144:e24–e34

The public perception, use, and legal status of cannabis have shifted dramatically over the last few years, with notable gain in acceptance for medical and nonmedical use. Federal law currently classifies cannabis as a Schedule I substance, and federally, it is outlawed, but individual states have been legalizing cannabis for several decades.
Isolated Sagittal Craniosynostosis and Open or Endoscopic Cranial Vault Remodeling: An Evaluation of Developmental Outcomes
Authors: Paliwoda Ethan D. , Horne Mason J. , Patel Ishan , Gajjar Avi A. , Rudolph Christina , Adamo Matthew A. , Bray Stephanie M.C.
Published: December 2024

Background:

Craniosynostosis, a condition involving the premature fusion of cranial sutures, can impair brain development and﻿ potentially lead to developmental delays. This study compares open cranial vault remodeling versus endoscopic strip craniectomy treatment for isolated sagittal craniosynostosis, primarily focusing on development outcomes.

Methods:

A retrospective cohort study was conducted at a tertiary pediatric surgery center, involving all 45 patients treated surgically ﻿for isolated sagittal craniosynostosis from 2013 to 2024. Patients were categorized into 2 groups based on surgical intervention: open cranial vault remodeling (n=17) and endoscopic strip craniectomy (n=28). Data collected included patient demographics, intraoperative specifics, and postoperative outcomes. Developmental outcomes were assessed using postoperative progress notes.

Results:

Of the 45 patients, those undergoing open surgery were older (10.7 mo and 9.4 kg versus 3.3 mo and 6.4 kg, P<0.001) and experienced higher use of intraoperative drains (65% versus 0%, P<0.001), more prolonged ﻿procedures (189 versus 58 min, P<0.001), more significant ﻿blood loss (102 versus 62 mL, P=0.009), longer stays (3.3 versus 2.6 d, P=0.011), and higher opioid prescription rates (82% versus 43%, P=0.013﻿) compared to ﻿the endoscopic group. Within 12 months postoperatively, social delays were more common in the open group (19 versus 0%, P=0.049), and, postoperatively in general, cognitive delays were more common in the open group (31% versus 4%, P=0.023) when compared to ﻿the endoscopic group.

Conclusions:

Endoscopic cranial vault remodeling produces preferentially better hemodynamic, postoperative, and hospital stay outcomes. Although inferences into long-term developmental delay outcomes were limited due to sample size, a preferential benefit toward endoscopic intervention may exist.
Depilation Before, During, or After Scalp Flap Expansion for Facial Reconstruction Using a Long-pulse 800-nm Diode Laser
Authors: Ding Jianke , Cang Zhengqiang , Fan Xing , Dong Liwei , Yin Yue , Xue Ping , Ma Xianjie , Yang Qing
Published: December 2024

Following facial reconstruction with a scalp flap, unwanted hair is a common esthetic problem. Reports on the safety, effectiveness, and differences in laser hair removal before, during, and after tissue expansion are lacking. The authors aimed to assess the efficacy of 800-nm diode laser hair removal before, during, and after flap expansion. A total of 366 patients who underwent long-pulse 800-nm diode laser hair removal from the scalp flap were included in this study. The patients were divided into 3 groups based on the timing of laser hair removal: nonexpansion, expander, and expanded. Participants received 1 to 8 treatment sessions at intervals of 25 to 30 days. To assess the effectiveness and differences in the treatment of each group, 2 independent observers compared the photographs and measured the reduction in the terminal hair count after treatment. The hair reduction rate was significantly higher with fewer treatment sessions when laser hair removal was performed during tissue expansion compared with after surgery or before surgery. Two cases of blisters were reported in the expanded group, all of which healed after aspiration and dressing changes. No severe adverse events were reported. Hair removal during or after scalp flap expansion is safe and effective when using an 800-nm diode laser. The depilation process during tissue expansion should be extremely accurate and well-designed. Depilation of the scalp before surgery is not recommended because of its low efficiency and long treatment duration.
Deceased Donor Renal Allograft Utility in Adult Single and Multi-organ Transplantation in the United States
Authors: Altshuler Peter J. , Bodzin Adam S. , Andreoni Kenneth A. , Singh Pooja , Yadav Anju , Glorioso Jaime M. , Shah Ashesh P. , Ramirez Carlo Gerado B. , Maley Warren R. , Frank Adam M.
Published: December 2024

Background.

Deceased donor multiorgan transplants utilizing kidneys (MOTs) can improve outcomes for multiorgan recipients but reduces kidneys for chronic renal failure patients.

Methods.

We reviewed the Organ Procurement and Transplantation Network database from 2015 through 2019, for adult deceased donor kidney transplants. Recipients were classified as kidney transplant alone (KTA) (n = 62,252) or MOTs pancreas-kidney, simultaneous pancreas-kidney (n = 3,976), liver-kidney, simultaneous liver-kidney (n = 3,212), heart-kidney, simultaneous heart-kidney (n = 808), and “other”-kidney, simultaneous “other” kidney (n = 73).

Results.

Liver, heart, and lung-alone transplants were at least 7 times more frequent than their MOT correlate, whereas the inverse was true with pancreas transplantation with SPKs being by far the most common pancreas transplant type. On average, KTA recipients waited between 2.8 and 21.4 times longer than MOTs, with SPKs waiting the longest of the MOT types. Predialysis initiation transplants were less frequent in KTAs compared with MOTs. Use of high-quality grafts according to Kidney Donor Profile Index < 35% was frequent among MOTs, but uncommon in KTAs who had an Estimated Post Transplant Survival score (EPTS) of >20%. For recipients older than 65, SPKs and SOKs were rare, but SLKs and SHKs had a higher fraction of recipients than KTAs and were much more likely to use a Kidney Donor Profile Index <35% kidney. SPKs and KTAs with an EPTS ≤20% had the best kidney graft survival. KTAs with an EPTS ≤80% had better kidney graft survival than SLKs, SHKs, and SOKs.

Conclusions.

This study highlights disparities in access to deceased donor kidneys for kidney-alone candidates versus MOTs and suggests opportunities to improve allocation.
Genome-based reclassification of Sphingobacterium soli Fu et al. 2017 as a later heterotypic synonym of Sphingobacterium cellulitidis Huys et al. 2017 and proposal of Sphingobacterium siyangense subsp. siyangense subsp. nov. and Sphingobacterium siyangense subsp. cladoniae subsp. nov.
Authors: Li Shuai , Liu Jun , Huang Jie , Dong Lei , Li Wen-Jun
Published: December 2024

Sphingobacterium, as the type genus of the family Sphingobacteriaceae, comprises a diverse array of species found in various environments. In this study, we aim to reassess and elucidate the taxonomic relationships of Sphingobacterium species. Based on 16S rRNA gene sequences, the phylogeny of 70 validly published Sphingobacterium species was reconstructed. Of which, 50 species with available genomes were further subjected to overall genome relatedness indices (OGRI) analysis, resulting in the identification of distinct pairs of closely related species. One such pair, consisting of the type strains of Sphingobacterium soli and Sphingobacterium cellulitidis, exhibited an average nucleotide identity (ANI) of 97.7%, a digital DNA–DNA hybridization (dDDH) of 80.1% and an average amino acid identity (AAI) of 98.3%, alongside a 16S rRNA gene sequence similarity of 99.8%. Based on the phylogenetic, OGRI and phenotypical evidence, we propose S. soli as a later heterotypic synonym of S. cellulitidis. Additionally, another pair of type strains, Sphingobacterium siyangense and Sphingobacterium cladoniae, possessed ANI, dDDH, AAI and 16S rRNA gene sequence similarity values of 96.3, 70.1, 96.0 and 99.0%, respectively. These values, together with differences in phenotypic traits, support the proposal of two subspecies within this taxonomic lineage. Thus, we propose the establishment of two new subspecies, S. siyangense subsp. siyangense subsp. nov. and S. siyangense subsp. cladoniae subsp. nov.
Pseudomonas serbiensis sp. nov. isolated from watermelon and muskmelon in Serbia
Authors: Fullem Kiersten R. , Obradovi Aleksa , MacLellan Michelle P. , Poudel Mousami , Minsavage Gerald V. , Goss Erica M. , Potnis Neha , Jones Jeffrey B. , Paret Mathews L.
Published: December 2024

Six Pseudomonas strains isolated from muskmelon and watermelon seedlings affected by stem rot and wilting in Serbia were reported as P. cichorii based on pathogenicity, LOPAT and cell wall fatty acid analyses. Recent bacterial isolates from cucurbit crops displaying P. cichorii-like symptoms in Alabama, USA, were identified as P. capsici, prompting polyphasic re-evaluation of the Serbian strains. All six strains were found to cause severe disease in watermelon and squash seedlings under greenhouse conditions. Strains KFB 138 and KFB 140 underwent whole-genome sequencing and were found to have the highest level of 16S rRNA similarity to P. lijiangensis LJ2T (both 99.87%). Phylogenies based on housekeeping genes and core-genome analysis placed both strains into phylogroup 11 of the Pseudomonas syringae species complex, with KFB 138 forming a lineage basal to all other phylogroup 11 members. In core-genome phylogeny, KFB 140 was placed into a clade alongside P. lijiangensis LJ2T. Average nucleotide identity based on blast (ANIb) identified KFB 140 as a member of P. lijiangensis (95.85%), though KFB 138 did not produce an ANIb value over 95% to any Pseudomonas type strain to which it was compared. Values for in silico DNA–DNA hybridization for both strains were below 70% to all reference strains tested, though KFB 140 was found to be most similar to P. lijiangensis (68.2%). KFB 138 and KFB 140 were further characterized using the online Type Genome Server, biochemical profiling with the Biolog Gen III MicroPlate system, matrix-assisted laser desorption/ionization time of flight mass spectrometry and imaged with transmission electron microscopy. From the results of the above analyses, we conclude that KFB 140 is a member of the species P. lijiangensis and that KFB 138 represents a novel Pseudomonas species, for which we propose the name Pseudomonas serbiensis (KFB 138T, NCPPB 4762=LMG 33366), named for its location of isolation.
Streptococcus suis infection on European farms is associated with an altered tonsil microbiome and resistome
Authors: Fredriksen Simen , Neila-Ibáñez Carlos , Hennig-Pauka Isabel , Guan Xiaonan , Dunkelberger Jenelle , de Oliveira Isabela Fernandes , Ferrando Maria Laura , Correa-Fiz Florencia , Aragon Virginia , Boekhorst Jos , van Baarlen Peter , Wells Jerry M.
Published: December 2024

Streptococcus suis is a Gram-positive opportunistic pathogen causing systemic disease in piglets around weaning age. The factors predisposing to disease are not known. We hypothesized that the tonsillar microbiota might influence disease risk via colonization resistance and/or co-infections. We conducted a cross-sectional case–control study within outbreak farms complemented by selective longitudinal sampling and comparison with control farms without disease occurrence. We found a small but significant difference in tonsil microbiota composition between case and control piglets (n=45+45). Variants of putative commensal taxa, including Rothia nasimurium, were reduced in abundance in case piglets compared to asymptomatic controls. Case piglets had higher relative abundances of Fusobacterium gastrosuis, Bacteroides heparinolyticus and uncultured Prevotella and Alloprevotella species. Piglets developing disease post-weaning had reduced alpha diversity pre-weaning. Despite case–control pairs receiving equal antimicrobial treatment, case piglets had a higher abundance of antimicrobial resistance genes conferring resistance to antimicrobial classes used to treat S. suis. This might be an adaption of disease-associated strains to frequent antimicrobial treatment.
A prospective cohort study to investigate the transmission and burden of Staphylococcus aureus in Sri Lanka
Authors: Locke T. , Siribaddana S. , Jayaweera J.A.A.S. , Suligoy C.M. , de Silva T.I. , Corrigan R.M. , Darton T.C.
Published: December 2024

Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of infection in both community and healthcare settings, and the household may be a central component linking these two environments. Strategies to prevent S. aureus transmission and thereby reduce the risk of infection must be informed by a detailed understanding of local epidemiology. These data are typically lacking in many low- and middle-income countries. Therefore, we aimed to investigate the circulation of infecting S. aureus strains in Sri Lanka, with a focus on the community and healthcare interface. A prospective longitudinal cohort study was performed between July and December 2021. Index patients with S. aureus infection and up to four of their household contacts were enrolled in the study. Colonization was assessed by sampling participants’ nose and axilla at two time points over 3 months of follow-up. Whole-genome sequencing (WGS) was used to characterize isolates and assess strain similarity to identify transmission episodes and environmental clusters. A total of 153 participants were recruited, including 42 S. aureus-positive index patients and 111 household contacts. The baseline prevalence of S. aureus colonization amongst household contacts was 11.7% (13/111), of which 30.8% (4/13) were methicillin-resistant. A total of 88 S. aureus isolates underwent WGS and three multilocus sequence types predominated: ST672, ST5 and ST6. Each type had unique virulence characteristics but was identified in both community and healthcare environments. Colonization of household members with the index’s infecting strain was not detected. S. aureus is a major cause of morbidity and mortality in low-resource settings such as Sri Lanka, yet little is known about risk factors and transmission networks. In this descriptive study, we have identified a small number of strains that appear to be well established and capable of causing both severe infection and asymptomatic colonization. Transmission of S. aureus did not appear to be occurring frequently in the household, and, therefore, preventative strategies that target high-risk groups may be more successful than universal community-based measures.