bluuebunny/crossref_metadata_2025 huggingface dataset:
Practical Concerns Regarding the Use of the Mooney-Rivlin Equation to Assess Degree of Crosslinking of Swollen Rubber Vulcanisates
Authors: Sombatsompop N.
Published: January 2025

The Mooney-Rivlin equation was used to determine the degree of crosslinking of rubbers based on their stress-strain behaviour. Non-linear behaviour ofthe Mooney-Rivlin curve under valid elongation and changes in the crosslink density for swollen NR vulcanisates were observed, in contrast to unswollen vulcanisates. The non-linear behaviour was caused by prior-extensibility of the rubbers whereas the change in the degree of crosslinking resulted from differences in the directional stresses in the NR compounds during swelling. The crosslink densities from the use of the Mooney-Rivlin equation were then compared to those obtained from a swelling method based on the Flory-Rehner equation.
Opto-Thermal Properties of Fibres: Evaluation of Colour Parameters of Annealed Nylon 6,6 Fibres
Authors: Hamza A.A. , Fouda I.M. , Kabeel M.A. , El-Shrif M. , El-Sharkawy F.M.
Published: January 2025

A spectrophotometric method was used to study annealed nylon 6,6 in air at 150-180°C for periods ranging from 2 to 10 h. The spectral reflectance values were measured using the ACS600 colour control system of Applied Colour System, USA. The colour difference between annealed and unannealed samples of nylon 6,6 was given. Colour parameters, including luminance factor, dominant wavelength and purity were calculated. Relations between the optical data of spectrophotometric parameters are given for various annealing conditions. Also an empirical formula is given to illustrate the variations due to different colour parameters. These techniques are recommended to monitor oxidative degradation.
Unveiling the Effect of Business Area Diversification: Does it Prevent or Promote the Corporate Efficiency of Biopharmaceutical Companies in Korea?
Authors: Yang Jaehoon , Kim Eungdo , Hwang Junseok
Published: January 2025

This study investigates the impact of business area diversification across vertical and horizontal dimensions on the efficiency of Korean biopharmaceutical companies. Utilising data from 187 firms and 1,830 observations between 2015 and 2021, this study employs Stochastic Frontier Analysis (SFA) and Meta-Frontier Analysis to examine how diversification strategies influence firm efficiency. The results indicate that vertical diversification, particularly in high-value sectors like biopharmaceutical equipment, shows a strong potential for enhancing firm efficiency. On the other hand, the effects of horizontal diversification vary, with efficiency improvements depending on the level of diversification pursued by each company. These findings offer strategic insights for optimising business diversification in the Korean biopharmaceutical sector and guiding decision-making for long-term competitiveness.
Scoping Review of Knowledge, Attitude and Practices Related to NCD Risk Factors Among Medical Undergraduates, India
Authors: Chauhan Arohi , Mahapatra Pranab , Kanungo Srikanta , Pati Sanghamitra
Published: January 2025

India is witnessing an epidemiologic transition from infectious diseases to non-communicable diseases (NCDs). Prevention of the NCD risk factors is an effective way, and future doctors play a vital role in preventing the disease epidemics. Undergraduate medical education forms the basis of knowledge development, including NCD risk factors. With this backdrop, the scoping review aimed to map available evidence on the knowledge, attitude, perception and practices related to NCD risk factors amongst medical undergraduates in India. A systematic search was conducted using key terms from five electronic databases of peer-reviewed articles. Two reviewers independently screened all articles for eligibility and assessed the quality of included studies. Studies were included if they reported on the medical students’ knowledge, attitude, perception and practice related to NCD risk factors. Thirteen studies on undergraduate medical students in India were included in the systematic review. Twelve of these reported on students’ knowledge about NCD risk factors, nine explored their attitude towards NCD risk factor prevention, and eleven studies were on the practice of NCD prevention. The studies revealed a high level of knowledge about NCD risk factors. Still, their attitude and practices about NCD reduction were deficient. An overall rise in health-risking behaviour and a fall in health-promoting behaviour was observed by various studies. The level of physical activity among girls was significantly lower compared to the boys. Studies show many few students take patient history or counsel their patients to quit unhealthy lifestyle habits. Various studies found a rise in health-risking behaviour and a fall in health-promoting behaviour among medical students, which suggest creating an enabling environment and conducive climate for promoting healthy behaviour that can then be taught to their patients.
In the Service of the Hindu Nation: Online Disinformation Campaigns by Far-Right Women Political Influencers in India
Authors: Khan Sarah
Published: January 2025

In the last few years, with the rise of social media, India has witnessed systematic disinformation campaigns attacking Muslim minority communities. Women influencers connected to Hindu nationalism play a crucial role in these campaigns online. This article examines the role of Hindu-Right women as political influencers. I examine the different engagement techniques deployed by these right-wing political influencers to spread disinformation-assisted hate speech online. I argue that the different engagement techniques these influencers deploy are a form of aspirational labour that advances their position within the broader Hindu nationalism project. I develop the concept of virtuous intimacy to explore how women influencers play an important role, especially in drawing women into the fold of Hindutva on the claims of shared experience.
Rural Financial Landscape in Bangladesh: Who is More Convenient for Rural Enterprises—Banks or Microfinance Institutions?
Authors: Mahmud Azim Uddin , Tulla Antoni F.
Published: January 2025

This article presents a comparative position of banks and microfinance institutions (MFIs) in reaching rural enterprises in Bangladesh, particularly in lending and savings services. We have gathered data from 225 respondents through a questionnaire survey on the demand side of the rural market of Bangladesh. The rural financial market is still mostly informal and underserved. MFIs have reached nearer physically and through the lending methodology to rural enterprises despite capability constraints in fund arrangement having organisational limitations to expand as per demand. On the other hand, conventional banks are not as near as MFIs are, particularly in remote rural areas. The attitude of bank officials, including the culture developed within the organisation, is a major barrier for rural enterprises to access credit and other desired financial services. However, people expect more from banks than MFIs despite the persistent reluctance of banks to be nearer. In both cases, products are imperfectly designed to cater to a wide range of rural people and their enterprises.
Introduction: The international political economy of green finance
Authors: Sharma Sarah E. , Babic Milan
Published: January 2025

From IPCC reports to global asset managers and governments, calls for more green finance to fuel the sustainability transition are ubiquitous. Concurrently, the critiques of a benign embrace of financial techniques, products, and flows as solutions to the climate crisis are growing louder. As a field of inquiry, IPE has the right tools to address such controversies productively. Yet, we diagnose a lack of what we call a deep engagement of IPE with epistemic and practical questions of what green finance is, how it operates, and its outcomes. The ambition of this special issue is to develop a research agenda that examines the contemporary global and concrete forms of green finance and its governance in order to better understand the following dynamics: first, how political and economic power relations within global finance shape environmental governance outcomes, and second, how the climate crisis itself influences the governance of global finance. To facilitate such thinking, we propose to understand green finance as an evolving ecosystem in the broader web of global finance instead of a specific instrument, asset class or concept. We hold this to be a fruitful approach to engage questions of green finance in both a global and concrete manner across different sectors, geographies, actors, and structures. By acknowledging the global nature and implications of green financial flows, we can push forward thinking not only on climate change and environmental governance in IPE, but also turn attention to the ongoing contestations, contingencies, and crises of finance in the global political economy.
Beyond the Perinatal Period: Using The Color Purple to Explore Maternal Mental Health Throughout the Lifespan
Authors: Graham Jasmine , Ghoston Michelle R. , Jones Sharon Blackwell
Published: January 2025

This article explores the expansive concept of maternal mental health, challenging the conventional time-limited definition that focuses solely on the perinatal period. The authors argue for a broader, lifespan-oriented understanding that encompasses the ongoing psychological challenges faced by mothers beyond the first postpartum year. Using the 2025 film adaptation of The Color Purple as a case study, the article delves into key aspects of maternal mental health, including the long-term impact of complex trauma, the importance of community support, and the intersection of economic mobility with mental health. The authors conclude the article with a discussion on how counselors can use themes from The Color Purple to provide comprehensive maternal mental healthcare.
An ALK Immunohistochemical Pitfall: ALK-Positive Histiocytosis Versus Angiomatoid Fibrous Histiocytoma
Authors: Chang Justin , Greenwood Anna C. , Kidd Chelsea , Diaz-Perez Julio A , Smith Steven Christopher
Published: January 2025

The proliferation of recognized neoplasms related to related to rearrangements involving kinase genes, arising in diverse somatic tissue lineages, poses an increasing challenge in surgical pathology. For instance, ALK rearrangements have been observed in diverse neoplasms of epithelial, connective tissue, and hematolymphoid lineages, many of which are associated with overexpression of ALK by immunohistochemistry as a useful biomarker. An even higher order challenge and pitfall would be the scenario where a tumor without an ALK rearrangement nonetheless overexpresses the protein, thereby simulating an ALK-defined neoplasm. Herein, we present this exact scenario, where an angiomatoid fibrous histiocytoma, exhibiting the recently-described phenomenon of its overexpression of ALK, clinically, histologically, and immunophenotypically simulated ALK-positive histiocytosis.
A study of the receding contact problem for functionally graded piezoelectric materials
Authors: Huang Zhiqiang , Wen Jiajun
Published: January 2025

We investigated a receding contact problem for the functionally graded piezoelectric coating (FGPC) materials. Both the elastic constants and piezoelectric and dielectric constants of the FGPC are considered to vary exponentially along the gradient direction. This contact system degenerates into a system of singular integral equations by applying a standard Fourier integral transform to the governing equations of the FGPC and the elastic substrate. Then, the Gauss–Chebyshev polynomials are introduced to discrete this singular integral system into an algebraic system, in which the unknowns (i.e., the contact radius and contact stress at both interfaces) can be solved by our proposed iterative algorithm using the given boundary conditions. Numerical examples are performed to verify the accuracy of this iterative algorithm, and the influence of the gradient parameters and applied loads on the top surface of FGPC on the contact radius and contact stress at both interfaces are further analyzed.
Integrating Theory With a User-Centered Design Approach to Maximize mHealth Acceptability and Usability
Authors: Ramírez A. Susana , Ayala Guadalupe Xochitl , Murillo Mary , Glik Debora C. , Guerrero Alma D.
Published: January 2025

Mobile phone interventions are evidence-based methods for preventing obesity among Latino adults and school-aged children; however, few such interventions exist to improve the obesogenic behaviors of children in the developmentally critical preschool years (ages 2–5). Focusing on this age group is important since over one-quarter of 2- to 5-year-old Latino children are overweight or obese. Moreover, most documented interventions target mothers exclusively, ignoring the influence that other caregivers such as fathers and grandparents have on the environment and the child’s behaviors. We describe the development and refinement of a theory-informed mobile phone intervention using an iterative, user-centered approach that supports healthy weight-related behaviors in preschool-aged Latino children by engaging mothers, fathers, and grandparents. The resulting intervention, Familias Unidas, Niños Sanos (FUNS), is a culturally centered bilingual (Spanish/English), 12-week, web-based mobile phone intervention grounded in family systems theory. Through three to four weekly text messages and links to web-based interactive multi-media content, caregivers of 2- to 5-year-old Latino children learn evidence-based practices to support specific child behaviors in three domains: healthy eating, media viewing, and physical activity. Development of specific messages is grounded in social cognitive theory. Participants can connect with a virtual coach and other participants. The prototype received high levels of acceptability and usability among members of the target audience and is ready for feasibility testing. The systematic process of development and refinement of the intervention can serve as a model for other mHealth interventions, addressing the ongoing critique of the general lack of theoretical application in such intervention work.
Flexure-after-impact behaviors of green composite sandwich beams with natural fiber facesheets and balsa cores
Authors: Tsai Shang-Nan , Tsai Sung-Lin
Published: January 2025

Composite sandwich structures composed of artificial materials are widely used. However, manufacturing artificial materials requires extensive energy and significantly impact our environment. Therefore, there is a growing focus on manufacturing composites using natural materials. This study used flax fabric, cotton fabric, glass fiber fabric, and polylactic acid (PLA) to fabricate the facesheets of sandwich beams, with balsa panels used as the cores. Tensile, flexure, tensile-after-impact (TAI), and flexure-after-impact (FAI) tests were conducted on the constituent materials and the sandwich beams. As expected, glass fiber reinforced PLA (GFRP) exhibited the highest tensile, flexural, and TAI properties compared to flax fiber reinforced PLA (FFRP) and cotton fiber reinforced PLA (CoFRP) and contributed to the highest FAI strengths in the sandwich beams using GFRP facesheets. It was also observed that a stiffer facesheet resulted in more core crushing in its sandwich beams when subjected to FAI tests, while a weaker facesheet led to more debonding in its sandwich beams. Since sustainable natural materials have been attracting research interest and are used in various areas, this work contributes to using natural composite materials and sustainable development.
Ilio-femoral impingement angle: a new radiographic measurement
Authors: Ellis Jackson , Rhee Isaac , Babazadeh Sina , Van Bavel Dirk
Published: January 2025

Background:

Hip dislocations after total hip arthroplasty (THA) are a debilitating complication, often occurring in deep flexion. Current 3D modelling allows for simulating the flexion angle at which bone-on-bone impingement occurs, but it is resource-intensive and not widely available for routine clinical use. Therefore, we propose the ilio-femoral impingement angle (IFIa) as a novel, simple radiographic measure to help identify patients at higher risk for dislocation using standard radiographs.

Methods:

A radiographic study was performed on 117 consecutive patients who underwent preoperative planning for THA with 3D remodelling from 2021 to 2022 at a single institution. The flexion angle was recorded at which the femur impingement on the pelvis was identified from the 3D model. This was compared to the angle subtended between a vertical line, the centre of the femoral head and a line rotated upwards to the first point of contact with the ipsilateral ilium. This angle was named the ilio-femoral impingement angle (IFIa).

Results:

The mean IFIa was 142.29° ± 11.49°, and it demonstrated a strong correlation with the 3D impingement angle (r = 0.69, p < 0.05). The inter-rater reliability of the IFIa measurement was high, with an ICC of 0.87, confirming the consistency of this novel radiographic measure.

Conclusions:

This study demonstrates that the novel radiographic measurement of the IFIa represented the deep flexion impingement angle of the femur on the ilium. The IFIa may be used as simple and cost-effective alternative measurement to model impingement during flexion.
Setting realistic expectations: When do citizens appreciate willingness to compromise on specific policies?
Authors: Hjermitslev Ida B
Published: January 2025

Recent research draws mixed conclusions about voters’ appreciation for compromise in politics. On one hand, compromise is touted as a democratic virtue and on the other hand, voters seem to punish politicians that are seen as too compromising. Do voters understand and appreciate that parties will have to make concessions on some issues in order to influence others? Or do voters prefer representatives who vouch to stay ideologically pure across the board? In a conjoint experiment, embedded in a survey of Austrian voters conducted in June 2022, I test various hypotheses about the interactive effects of policy positions, issue importance, and compromise behavior in a pre-electoral setting. I find that voters generally prefer willingness to compromise over steadfast principles, but this is particularly true if it moves policy outcomes closer towards themselves or if it is on issues they care less about.
How ‘International’ Are Sociology Journals? Analysis of Stated Aims and Editorial Board Networks
Authors: Brown Elizabeth , Vega Castillo Maria Antonieta , Hordósy Rita
Published: January 2025

This article analyses leading international sociology journals regarding the global relations as observed within their aims and editorial boards. As such, it explores the geographies and power relations of knowledge production in the context of sociology as a discipline. First, it analyses the aims of journals as outlined via their respective websites, focusing on whether and how any global or international focus appears. Second, it explores the current country affiliation of journal editorial boards to provide an overview of the broader scholarly community. Third, it looks at the network of gatekeepers, exploring editorial board interlocking. The results show a discipline dominated by the global centre, where editorial board interlocking heightens the agenda-setting power of a few academics affiliated predominantly in western contexts.
Perceptions about preclinical Alzheimer's disease biomarker collection procedure influences willingness to participate: Findings from an ethnoracially diverse study
Authors: Gooding Diane Carol , Van Hulle Carol A , Zuelsdorff Megan , Lewis Jordan P , Carter Fabu P , Salazar Hector , Bouges Shenikqua , James Taryn T , Gee Alexander , Gleason Carey E
Published: January 2025

Background

Past research suggests that ethnoracialized groups differ in their willingness to engage in preclinical Alzheimer's disease (AD) research overall. Studies indicated that participation willingness was affected by attitudes toward research and perceived invasiveness of biomarker collection techniques. However, comparative quantitative studies are few, and minoritized groups are under-included.

Objective

In a cross-sectional online survey, we sought to explore community-based adults’ willingness to engage in preclinical AD biomarker testing, comparing their attitudes about research and different types of biomarker procedures.

Methods

We conducted an online survey with a diverse group of participants. African American (AA), American Indian/Alaska Native (AI/AN), Latinx (LTX), and Non-Hispanic White (NHW) adults aged 26–90 were asked about their research attitudes, biomarkers, and willingness to participate in specific biomarker test procedures (i.e., brain imaging via PET scanning, blood draws, and cerebrospinal fluid collection by lumbar puncture). We also assessed participants’ perceived safety, burden, and distress for each of the three biomarker collection methods. To understand the association between research willingness and ethnoracial identity, we ran linear regression models for each procedure, adjusting for age, gender, educational attainment, and attitudes toward research.

Results

The AA group expressed greater willingness to engage in biomarker testing involving blood draws than the NHW group. The AI/AN group was significantly less willing to undergo lumbar puncture than the NHW group; this difference remained after adjusting for various sociodemographic factors and research attitudes.

Conclusions

Respondents’ willingness to engage in preclinical AD biomarker research was affected by their perceptions about the testing collection procedure.
Effect of laser shock peening on the thermomechanically processed ZRE10 novel Mg alloy: Tailoring the biodegradable orthopedic implant material's behaviour
Authors: Parameshwari R. , Raghuraman S. , Sriraman N.
Published: January 2025

Third-generation biodegradable magnesium (Mg) alloys are emerging as promising candidates for orthopedic implants. However, challenges persist regarding their mechanical integrity and bio-corrosion behaviour. Thus, there is a need to develop suitable processing techniques to address these challenges. The combined effect of thermomechanical processing followed by laser shock peening (LSP) surface treatment on a novel Mg-1Zn-0.5Sc (ZRE10) alloy exhibited improved mechanical integrity and bio-corrosion resistance. During thermomechanical processing at 250°C and 350°C, the microstructure and texture evolution of the hot extruded (350°C) alloy (E350) exhibited complete dynamic recrystallization, resulting in better grain refinement with even dispersion of ScZn second-phase particles. Moreover, texture evolved to strong basal plane orientation, influencing an increased strength of 142 MPa, reduced ductility of 10%, and improved corrosion resistance. Further processing through LSP on this extruded alloy (ELSP-3P) surface leads to further recrystallizations owing to the effect of developed compressive residual stress near the peened surface, resulting in large grain formation. Also, favourable texture evolution of basal and non-basal planes due to this LSP-induced plastic strain with significant improvement in strength and ductility to 230 MPa and 16%, respectively. Biocompatibility analysis shows that both E350 and ELSP-3P possess a uniform bio-friendly hydroxyapatite layer and exhibit good cell viability after 72 h of incubation. In-vitro studies have demonstrated that LSP-treated extruded ZRE10 Mg alloy exhibits improved strength, a controlled degradation rate, and excellent cytocompatibility, making it a promising candidate material for orthopaedic implants, and can be harmonized with tissue regeneration and gradual degradation of the implant within the body.
Supervisory controller for minimizing fuel consumption and NOx emissions of plug-in hybrid electric vehicles operating in zero-emission zones
Authors: Pinto Douglas Uberti , Pla Benjamín , Aronis André Nakaema , Frasci Emmanuele , Arsie Ivan
Published: January 2025

This paper introduces a supervisory controller designed for Plug-in Hybrid Electric Vehicles (PHEVs) to minimize total energy consumption and tailpipe NOx emissions while adhering to Zero Emission Zone (ZEZ) constraints. The case study exploits historical driving cycle data from an urban bus route in Zurich to analyze trip correlations, where a ZEZ restriction was added to assess the vehicle performance under such conditions. A PHEV bus model was built, integrating the powertrain and After-Treatment System (ATS), where an electric heater is included to mitigate NOx emissions. The supervisory controller is tasked with determining the optimal power split and the electric heater power to ensure adherence to feasible operating conditions along the route. Historical driving cycle data analysis demonstrates that the speed profiles along the selected route exhibit similarities. This observation is leveraged by a Dynamic Programming (DP) optimization, where an arbitrary bus trip is employed to generate a cost-to-go matrix. Then, the resulting cos-to-go matrix was indexed by the position in the route and is used on the real-time controller by applying the one-step look-ahead roll-out algorithm. Simulation results demonstrate the controller effectiveness in addressing ZEZ restrictions, presenting a trade-off between energy consumption and tailpipe NOx emissions. A benchmark was carried out, comparing the results obtained with the DP solution as the baseline, assuming perfect knowledge of driving cycle disturbances, revealing a 7% increase in tailpipe NOx emissions and a 1.3% increase in fuel consumption compared to the theoretical minimum and fulfilling the ZEZ restrictions in all the cases.
Basics of utilizing NH4+ ions for accurate phthalate ester quantification via selected ion flow tube mass spectrometry in food
Authors: Bhatia Manjeet
Published: January 2025

Phthalate esters, frequently used as plasticizers in consumer products, raise concerns because of potential health effects. Using density functional theory (DFT) with B3LYP and 6-311++G(d, p) basis sets, their properties, such as dipole moment, polarizability, proton affinity and ionization energy of phthalate esters are obtained. Reaction kinetics and thermodynamics of popular reagent ions like H3O[Formula: see text], NH[Formula: see text], NO[Formula: see text] and O[Formula: see text] are computed to know the feasibility of the reactions with such ions. Proton affinity and ionization energy indicate high susceptibility to proton and charge transfer reactions. High dipole moments contribute to elevated rate coefficients in proton transfer reaction mass spectrometry (PTR-MS) and selected ion flow tube mass spectrometry (SIFT-MS). PTR-MS rates are influenced by drift tube conditions, supported by high center-of-mass collisional energy of E[Formula: see text] = 0.28 eV. SIFT-MS rates diminish with rising temperature. The high kinetic energy data of H3O[Formula: see text], NO[Formula: see text] and O[Formula: see text] suggests that simple proton transfer and charge transfer reactions are overruled due to very high internal energy which could lead to extensive fragmentation of phthalate esters. The energetic profile of NH[Formula: see text] ions indicates their suitability for quantifying phthalate esters using NH[Formula: see text]-CI-MS techniques.
Retail spaces and consumer labour in a digital first economy: A comparative study of atmospherics and shopper behaviour in Lush, Disney and Primark
Authors: Martin Cariad
Published: January 2025

A substantial body of work has evidenced the effectiveness of experiential retail design, and yet only a small proportion acknowledges the role of shopper labour in the production of value. Furthermore, studies of retail design often focus on singular elements such as lighting, failing to acknowledge that the act of shopping is always a multisensory, holistic experience. This research addresses that gap, and contributes to discourse regarding the role of brick-and-mortar stores in the digital age. Observations were undertaken in three flagship retail locations on Oxford Street, London: Lush, Disney and Primark. Data was gathered on aspects of the spaces including layout, flow, lighting and scents, as well as shopper behaviour and attitudes towards the in-store experience. Utilising this combined data, this project argues that four types of consumer labour can be seen in contemporary retail spaces: physical, emotional, social and ideological. The findings suggest that retailers may be overlooking the importance of “real life” brand interaction in stores in favour of the perceived profitability of ecommerce. Additionally, it may be pertinent to consider the cultural implications of mass closures of brick-and-mortar stores, as spaces of entertainment, leisure and socialisation, as well as spaces which facilitate certain types of care work.
HELICOBACTER PYLORI TRANSMISSION: IS IT DUE TO KISSING?
Authors: Luman W.
Published: January 2025

Helicobacter pylori ( H. pylori) has been associated with the pathogenesis of chronic active gastritis, peptic ulcer disease1 and gastric carcinoma.2 Understanding the exact mode of transmission of H. pylori is essential in order to limit its spread and serious diseases associated with it. Living on human and ectopic gastric mucosa, the organism has not been convincingly isolated from other animals. Most infections are acquired in childhood and some of the risk factors associated with childhood infection include poor sanitation, overcrowding and lower socioeconomic status.

The theory of direct person-to-person spread is now generally accepted, but the route of transmission remains open to conjecture. No predominant route of transmission has been defined and the possibilities include faecal-oral, oro-oral and gastro-oral. Helicobacter pylori has been identified in saliva and in swabs taken from the oral cavity through molecular techniques. It remains unclear whether the bacteria detected represented colonisation of the oral cavity or transient regurgitation of the micro-organisms from the stomach into the mouth during the process of gastro-oesophageal reflux. Gastrooral or oro-oral routes could be important in the transmission of the infection from mothers to children and between siblings.

It is unlikely that H. pylori could be transmitted between spouses. Most married couples demonstrate little concordance of bacterial strain as typed by molecular techniques and treated patients are seldom re-infected by their untreated infected spouses.
AUTOIMMUNITY IN EPILEPSY
Authors: Farrugia ME
Published: January 2025

Autoimmunity is a contributory factor in the aetiology of some of the epilepsy syndromes. The central nervous system (CNS), previously considered an immune-privileged site, can also become vulnerable to immunological attack. Certain syndromes remain obscure as to their primary aetiology, such as Rasmussen’s encephalitis; despite the systemic presence of a potentially causative antibody, the inflammation remains confined to one hemisphere of the brain. Other epilepsies, termed ‘malignant’ because they present aggressively at a young age and are often progressive, are not clearly inflammatory in origin, although some do respond to immunomodulatory treatments. The presence of certain antibodies also characterises specific neurological syndromes that may be associated with seizures: their presence does not confirm that they are causative and they could merely be secondary to the primary pathology and/or to the uncontrolled electrical activity in the brain. The field of channelopathies is evergrowing, and dysfunction of specific membrane channels characterises certain epilepsy syndromes and postulates them as potential autoantigenic targets. It is often difficult to confirm or refute scientifically that autoimmune attack and circulating autoantibodies are the cause of the epilepsy syndrome, and further studies including the use of animal models would be necessary in order to investigate this hypothesis thoroughly. The aim of this review is to highlight some of the mechanisms that may be responsible for causing epilepsy as well as emphasising the gaps in our understanding of certain other more obscure areas.
MEDICAL PROFESSIONALISM AND CONSCIENTIOUS OBJECTION: ARE THE TWO COMPATIBLE?
Authors: Gordon M
Published: January 2025

A growing concern exists about the tensions that may be found between medical professionalism and the concept of conscientious objection, on the part of physicians and other healthcare professionals, regarding healthcare decisions made by patients or their surrogates. This tension reflects the concept of what it means to be a healthcare professional in contrast to one's strongly held personal or religious ethical convictions. The major concerns revolve around issues at the beginning or at the end of life. These issues must be addressed to avoid serious conflicts with those for whom healthcare professionals have a duty to serve.
PAPER: ACCUMULATION OF IRREVERSIBLE DISABILITY IN MULTIPLE SCLEROSIS - LESSONS FROM NATURAL HISTORY STUDIES AND THERAPEUTIC TRIALS
Authors: Confavreux C , Vukusic S
Published: January 2025

There is good evidence that relapses in multiple sclerosis (MS) are the clinical counterpart of acute focal inflammation of the central nervous system (CNS), whereas progression is that of chronic diffuse neurodegeneration. The classical view is to consider MS solely as an organ-specific auto-immune disease, i.e. inflammation is the cause of neurodegeneration.

Recurring relapses eventually lead to accumulation of disability, and clinical progression could also result from subclinical relapses. Recent observations suggest that this classical concept should be challenged. In particular, striking results have come from the study of the natural history of MS in the Lyons MS Natural History Cohort.1 Progression of irreversible disability from the assignment of a score of 4 on Kurtzke's disability status scale (DSS) to the assignment of a score of 6 or 7 is unaffected by the presence or the absence of a relapsing-remitting phase before the chronic progressive phase of MS. The same observation is true regarding the presence or absence of superimposed relapses during the progressive phase, either primary or secondary. Beta interferons lead to a 30% reduction in the relapse rate and to a more than 50% reduction in conventional magnetic resonance imaging (MRI) activity. Despite this effect on inflammation, the effect of interferons on disability is only marginal and this small effect may be relapse-reduction-driven. Administration of Campath-1H to MS patients with very active disease, results in a profound and prolonged lymphopenia, and the suppression of clinical and MRI activity. In spite of this, progression of clinical disability and cerebral atrophy still occurs. These observations support the view that in MS, relapses and focal inflammation do not influence the rate of progression of irreversible disability and diffuse neurodegeneration. They are consistent with what was shown in individual patients in the 1970s by performing serial quantitative neurological examinations over several years, and with what is emerging currently from early and serial structural brain MRI studies.
Non sinit esse feros An essay on Ovid and the motto of the Royal College of Physicians of Edinburgh
Authors: Donaldson IML
Published: January 2025

Questions are not infrequently asked about the meaning of the motto displayed on the College Arms (see Figure 1). When a translation is offered –usually along the lines of “It is forbidden to be cruel” – there is often puzzlement about why a College of Physicians should have chosen such a phrase to embody its aims and aspirations. In this essay I discuss the motto’s relation to the couplet of Latin verse from which it derives and offer a possible explanation of how the misquotation – for such it is – that forms the motto may have come about. Then I say a little about the circumstances under which, some 2000 years ago, the Roman poet Ovid composed the poem which is its source. Finally, I show how consideration of an accurate text of Ovid’s whole original couplet offers an interpretation of the motto that was apposite at the time of the College’s foundation and is no less so more than three centuries later.
Ritual Male Circumcision:A Brief History
Authors: Doyle D
Published: January 2025

Circumcision is arguably the oldest surgical procedure, performed since before recorded history. This paper looks at its history and speculates on why and how it spread; at what it can teach us about the origins of the Bantu tribes of Southern Africa, all of whom practice circumcision, and finally looks at medical aspects of circumcision and its place in developing societies.
Hyperkalaemia: causes, electrocardiographic changes and management
Authors: McKellar G , Alfonzo A , Isles C
Published: January 2025

Hyperkalaemia is an ever present threat in dialysis units and is encountered frequently on general wards, particularly in patients with renal failure. It is important because it can cause life threatening cardiac dysrhythmia, with death by asystole or ventricular fibrillation commonly the first clinical manifestation. I Preferred therapy varies, reflecting the lack of clear evidence for an optimal regimen, but broadly speaking the choice of treatment is based upon the serum potassium level, the ECG and the likelihood that potassium will rise further. In this review we highlight the causes, sequelae and evidence for the treatment of hyperkalaemia. Our starting point is a serum potassium of 6 mmol/l. Thereafter, we suggest it may be useful to distinguish two groups of patients on the basis of their ECG: those whose ECG is normal, whom we consider to have severe hyperkalaemia, and those with ECG evidence of raised serum potassium or life threatening hyperkalaemia.
Pneumothorax following non-invasive ventilation for acute asthma
Authors: Medford AR , Pepperell JCT
Published: January 2025

We describe a case of pneumothorax occurring in an asthmatic following NIV in a high dependency setting. He had been persistently hypoxaemic related to bilateral lower lobe collapse from extensive mucus plugging with no other secondary cause for his hypoxaemia or mucus plugging found. There was no obvious evidence of initial pneumothorax and we presume that barotrauma related to NIV was responsible. We review the limited evidence for NIV in acute asthma and the recommendations from national guidelines.

We conclude that NIV should only be considered in acute asthma in the context of a randomised controlled trial and applied only in a high dependency or intensive therapy unit. Pneumothorax must be excluded in asthmatics that deteriorate suddenly on NIV.
Dr Latta of Leith: pioneer in the treatment of cholera by intravenous saline infusion
Authors: MacGillivray N
Published: January 2025

The paper assesses the contribution of Dr Thomas Latta of Leith to the treatment of cholera in Leith and Edinburgh during the cholera epidemic of 1832. The historiography of cholera treatment in the nineteenth century is discussed and contemporary analyses of the use of intravenous saline infusion are reviewed. In conclusion, the reasons why Latta’s contribution and reputation did not long survive his death are examined.
Should there be limits to political commentary by medical journals?
Authors: Gordon M , Staples T
Published: January 2025

Within the last three years there has been considerable comment and discussion, especially in electronic online forums, regarding the appropriateness of including political commentary in medical journals. Given the mandates of representative journals, and the direct impact politics can have on the health of populations, it is appropriate that politically related commentaries be included in medical journals. However, these commentaries should adhere to five criteria: the issue should be discussed in terms of its impact on health; any challenges based in ethical principles should use the relevant ethics code; if challenging the actual ethics of a group, the standard should be one that is globally accepted; all defamatory comments should be excluded; and journals should not participate in academic boycotts. Given adherence to these criteria, medical journals can expand their continued impact on health-related topics, without moving beyond their mandates.
Obesity in childhood and adolescence: epidemiology, management and mechanisms
Authors: Drake AJ
Published: January 2025

There is increasing public awareness of the rising incidence of obesity in childhood and adolescence, and its consequences for long-term health – type 2 diabetes, cardiovascular disease and cancer. This year’s symposium meeting focused on epidemiology, management and mechanisms of obesity. The trends in obesity in children and adolescence, at both a global and national level were reviewed. The UK House of Commons Select Committee’s report on obesity suggests that obesity ‘will soon surpass smoking as the greatest cause of premature loss of life’. If we can understand the cause we can potentially make an impact on future healthcare. The review covered primary prevention, early intervention and management of the significantly obese. People want to understand why they are overweight and what impact obesity will have on their health. Rare monogenic causes of severe obesity give insight into central mechanisms underlying weight control. Hormones are intrinsically linked with obesity, but do not provide the easy solution hoped for by many. A discussion around three case studies concluded the symposium.
The Solanaceae: foods and poisons
Authors: Lee MR
Published: January 2025

The plant family Solanaceae contains important foodstuffs such as the potato, tomato and aubergine, together with powerful poisons including mandrake, henbane and deadly nightshade. In the first article in this short series on the family, the history and importance of the potato are described. It was first cultivated by the Inca people in the altiplano of the Andes in prehistoric times. Then it was translocated to Europe by the Spanish invaders. Originally reviled as ‘peasant food’, it was regarded with great suspicion as an evil plant and a potential cause of leprosy. Over several centuries it gradually became established throughout Britain, France and the continent, and in particular in Ireland, where its growth allowed the population to expand very rapidly between 1750 and 1850. In the late 1840s, nemesis arrived in the form of the potato blight and the Irish famine. The ‘tatties’ went black, a great hunger ensued and thousands died. Later, the causative fungus was isolated and steps were taken to avoid further similar disasters.

It is not generally appreciated that potatoes can be poisonous if they are turning green or sprouting (chitting). The tuber is then producing toxic quantities of the alkaloid a-solanine. The clinical syndrome of potato poisoning is described briefly.
Pregnancies in women with epilepsy
Authors: FJE Vajda  , Brien T O , Graham J , Hitchcock A , Lander C , Eadie M
Published: January 2025

The aim of this study was to analyse the outcomes of all the pregnancies of each woman with epilepsy in the Australia Pregnancy Register. Data from 1,290 pregnancies in 612 women with epilepsy were analysed, including 156 women who took no AEDs in the first trimester of at least one pregnancy. Spontaneous miscarriages were more frequent in AED-exposed pregnancies. There was an overall 13·95% risk of a woman taking AEDs during pregnancy having a malformed foetus at some stage of her reproductive career, at least to the time of the present analysis. This risk increased with (i) first trimester exposure to VPA, particularly in maternal doses above 1,100–1,400 mg per day, (ii) the number of pregnancies a woman underwent, although the individual pregnancy risk did not increase from one pregnancy to the next, (iii) history of a previous foetus with a malformation from an AED-associated pregnancy, (iv) twin pregnancies, and (v) family histories of foetal malformations. These findings provide a basis for advising women with epilepsy about the likely overall outcomes of their child-bearing careers,and suggest that both genetic and drug-related factors operate in producing foetal malformations. The issue is one of frequent concern and discussion with participants in the Pregnancy Register.
Portal hypertensive enteropathy; an unusual cause of gastrointestinal bleeding in cirrhosis: or is it?
Authors: Bhala N , Plevris JN
Published: January 2025

We present a patient with liver cirrhosis, and portal hypertensive gastropathy who was transfusion-dependent due to chronic gastrointestinal blood loss. Wireless capsule endoscopy revealed bleeding from extensive vascular ectatic lesions in the small bowel and right colon as well as from the stomach. We discuss briefly the recent literature relating to chronic gastrointestinal bleeding due to portal hypertensive enteropathy, the diagnosis of this condition, and the use of TIPSS in treatment.
Acute fever and headache – is it meningitis?
Authors: Raza MM , Heyderman RS
Published: January 2025

Acute fever and headache is a common clinical problem but clinicians need to remain vigilant with a high index of suspicion for acute bacterial meningitis. Even when the diagnosis is suspected clinically, the subsequent investigation and management is controversial. We discuss the diagnosis and management of these patients relevant to the acute medicine physician. The initial assessment should include severity assessment, as appropriate help can then be obtained early. In the absence of signs of raised ICP, shock, or respiratory failure, a diagnostic LP should be performed. If LP has to be deferred, CSF obtained up to 48 hours after antibiotics have been initiated may still lead to a diagnosis by PCR. Where LP is contraindicated, or it is anticipated that there will be a delay of more than 30 minutes, a dose of 2 g of intravenous cefotaxime or ceftriaxone should be given immediately. Brain imaging is not indicated in the majority of patients. Early treatment with appropriate antibiotics, fluid resuscitation, and management of raised intracranial pressure are key to improving patient outcome. Empirical antibiotic regimens should be guided by the age of the patient and risk factors for resistant pathogens. Microbiological advice should be sought early if there is any uncertainty. Adjunctive dexamethasone therapy for suspected bacterial meningitis should be administered either before or at the time of antibiotic administration.
Newly emerged respiratory infections – SARS and H5N1
Authors: Chu CM , Tsang KWT
Published: January 2025

Two newly emerged respiratory viruses, SARS-CoV and the highly pathogenic avian influenza A H5N1 virus, have arisen in Asia at the turn of the millennium. They both have the potential to cause global pandemics, facilitated by modern high-speed international transportation. Molecular studies suggest that SARS-CoV could be transmitted to humans from civet cats and other game animals consumed as a culinary delicacy. The H5N1 virus appears to be endemic in bird and poultry populations in Asia, with sporadic transmission to humans. Both SARS-CoV and H5N1 begin with a non-specific influenza-like illness, progressing rapidly to severe pneumonia and ARDS. Although various antiviral and immunomodulatory agents have been tried, or postulated to be useful, none has been proven effective by RCTs. Treatment remains supportive and the mortalities are high for both conditions. No vaccine has yet been approved for either infection, although infection control measures have been found to be effective in hospital settings. While all known chains of person-to-person transmission of SARS were broken in July 2003, a few small pockets of outbreak have occurred since, related to laboratory accidents and contact with game animals. The World Health Organisation has consistently warned of a H5N1 pandemic, and the medical community needs to stay vigilant. Minimising human contact with potentially infected animals, sound infection control measures in hospitals, farms, and markets, and prompt isolation of suspected cases are the mainstays in preventing large-scale outbreaks for SARS and H5N1.