bluuebunny/crossref_metadata_2025 huggingface dataset:
Elevated micro-topography boosts growth rates in Salicornia procumbens by amplifying a tidally driven oxygen pump: implications for natural recruitment and restoration
Authors: Fivash Gregory S , Belzen Jim van , Temmink Ralph J M , Didderen Karin , Lengkeek Wouter , Heide Tjisse van der , Bouma Tjeerd J
Published: August 2019

Background and Aims

The growth rate of pioneer species is known to be a critical component determining recruitment success of marsh seedlings on tidal flats. By accelerating growth, recruits can reach a larger size at an earlier date, which reduces the length of the disturbance-free window required for successful establishment. Therefore, the pursuit of natural mechanisms that accelerate growth rates at a local scale may lead to a better understanding of the circumstances under which new establishment occurs, and may suggest new insights with which to perform restoration. This study explores how and why changes in local sediment elevation modify the growth rate of recruiting salt marsh pioneers.

Methods

A mesocosm experiment was designed in which the annual salt marsh pioneer Salicornia procumbens was grown over a series of raised, flat and lowered sediment surfaces, under a variety of tidal inundation regimes and in vertically draining or un-draining sediment. Additional physical tests quantified the effects of these treatments on sediment water-logging and oxygen dynamics, including the use of a planar optode experiment.

Key Results

In this study, the elevation of sediment micro-topography by 2 cm was the overwhelming driver of plant growth rates. Seedlings grew on average 25 % faster on raised surfaces, which represented a significant increase when compared to other groups. Changes in growth aligned well with the amplifying effect of raised sediment beds on a tidally episodic oxygenation process wherein sediment pore spaces were refreshed by oxygen-rich water at the onset of high tide.

Conclusions

Overall, the present study suggests this tidally driven oxygen pump as an explanation for commonly observed natural patterns in salt marsh recruitment near drainage channels and atop raised sediment mounds and reveals a promising way forward to promote the establishment of pioneers in the field.
Interictal epileptiform discharges shape large-scale intercortical communication
Authors: Dahal Prawesh , Ghani Naureen , Flinker Adeen , Dugan Patricia , Friedman Daniel , Doyle Werner , Devinsky Orrin , Khodagholy Dion , Gelinas Jennifer N
Published: August 2019

Focal epilepsy is associated with large-scale brain dysfunction. Dahal et al. reveal that interictal epileptiform discharges modulate normal brain rhythms in regions beyond the epileptic network, potentially impairing processes that rely heavily upon intercortical communication, such as cognition and memory.
Clinical and Epidemiological Aspects of Diphtheria: A Systematic Review and Pooled Analysis
Authors: Truelove Shaun A , Keegan Lindsay T , Moss William J , Chaisson Lelia H , Macher Emilie , Azman Andrew S , Lessler Justin
Published: August 2019

Background

Diphtheria, once a major cause of childhood morbidity and mortality, all but disappeared following introduction of diphtheria vaccine. Recent outbreaks highlight the risk diphtheria poses when civil unrest interrupts vaccination and healthcare access. Lack of interest over the last century resulted in knowledge gaps about diphtheria’s epidemiology, transmission, and control.

Methods

We conducted 9 distinct systematic reviews on PubMed and Scopus (March–May 2018). We pooled and analyzed extracted data to fill in these key knowledge gaps.

Results

We identified 6934 articles, reviewed 781 full texts, and included 266. From this, we estimate that the median incubation period is 1.4 days. On average, untreated cases are colonized for 18.5 days (95% credible interval [CrI], 17.7–19.4 days), and 95% clear Corynebacterium diphtheriae within 48 days (95% CrI, 46–51 days). Asymptomatic carriers cause 76% (95% confidence interval, 59%–87%) fewer cases over the course of infection than symptomatic cases. The basic reproductive number is 1.7–4.3. Receipt of 3 doses of diphtheria toxoid vaccine is 87% (95% CrI, 68%–97%) effective against symptomatic disease and reduces transmission by 60% (95% CrI, 51%–68%). Vaccinated individuals can become colonized and transmit; consequently, vaccination alone can only interrupt transmission in 28% of outbreak settings, making isolation and antibiotics essential. While antibiotics reduce the duration of infection, they must be paired with diphtheria antitoxin to limit morbidity.

Conclusions

Appropriate tools to confront diphtheria exist; however, accurate understanding of the unique characteristics is crucial and lifesaving treatments must be made widely available. This comprehensive update provides clinical and public health guidance for diphtheria-specific preparedness and response.
Associations of Hearing Sensitivity, Higher-Order Auditory Processing, and Cognition Over Time in Middle-Aged Adults
Authors: Merten Natascha , Fischer Mary E , Tweed Ted S , Breteler Monique M B , Cruickshanks Karen J
Published: August 2019

Background

Age-related hearing loss (impairment in hearing sensitivity and/or higher-order auditory processing) and cognitive decline are common co-occurring impairments in elderly adults. Their relation in the process of aging remains insufficiently understood. We aim to assess the temporal relations of decline in hearing sensitivity, higher-order auditory processing, and cognition in middle-aged adults.

Methods

This study included 1,274 Beaver Dam Offspring Study participants who participated in three examinations (baseline, 5-year, and 10-year follow-up). We assessed hearing sensitivity through pure-tone audiometry (PTA, averaged thresholds of 0.5, 1, 2, 4 kHz of the better ear), higher-order auditory processing as word recognition in competing message (WRCM) using the Northwestern University 6 word list in the better ear, and cognition through trail-making test performance (TMT). Linear mixed-effects models and linear regression models were used to determine associations over time and to what extent these measures influence each other over time.

Results

The longitudinal decline between all functions was associated with the strongest relationships between PTA and WRCM. The effect of baseline PTA on WRCM 10 years later (standardized ß = –.30) was almost twice as big as the effect of baseline WRCM on PTA 10 years later (standardized ß = –.18). The effect of baseline WRCM on TMT 10 years later and vice versa were small (standardized ß = –.05). No directional relationship between PTA and TMT was identified (standardized ß ≤ .02).

Conclusions

While hearing sensitivity might affect higher-order auditory processing, associations between hearing and cognition appear bidirectional and weak in midlife. We need to be cautious before inferring causal effects of hearing on cognition.
Linking Marital Support to Aging-Related Biomarkers: Both Age and Marital Quality Matter
Authors: Wilson Stephanie J , Bailey Brittney E , Malarkey William B , Kiecolt-Glaser Janice K
Published: August 2019

Objectives

Marital support is central to couples’ relationships, yet support’s health implications can vary widely. Guided by attribution bias and aging theories, the current study examined whether age and marital satisfaction moderate the links of perceived and received spousal support to aging-related biomarkers.

Methods

Couples (N = 93, ages 22–77) rated marital satisfaction, overall perceived spousal support, and the quality of support received from their spouse in a lab-based discussion. Blood samples collected at baseline, immediately post-discussion, 3 hr post-discussion, and end-of-visit were assayed for proinflammatory cytokines tumor necrosis factor (TNF)-α and interleukin (IL)-6, as well as insulin-like growth factor (IGF)-1.

Results

Consistent with predictions, less satisfied older couples who received lower-quality spousal support during their discussion had greater increases in TNF-α than those who received higher-quality support; highly satisfied couples of all ages and less satisfied younger couples did not show these inflammatory changes. Highly satisfied older couples with greater perceived spousal support had lower TNF-α across the day and higher IGF-1.

Discussion

Marital satisfaction and age may shape spousal support’s significance for healthy aging. Rose-colored lenses worn only in the most satisfying marriages may protect couples from the possible health risks of low-quality received support and enhance potential benefits of perceived support. For better or worse, these health implications may grow with older age.
Phenome-wide Mendelian-randomization study of genetically determined vitamin D on multiple health outcomes using the UK Biobank study
Authors: Meng Xiangrui , Li Xue , Timofeeva Maria N , He Yazhou , Spiliopoulou Athina , Wei Wei-Qi , Gifford Aliya , Wu Hongjiang , Varley Timothy , Joshi Peter , Denny Joshua C , Farrington Susan M , Zgaga Lina , Dunlop Malcolm G , McKeigue Paul , Campbell Harry , Theodoratou Evropi
Published: August 2019

Background

Vitamin D deficiency is highly prevalent across the globe. Existing studies suggest that a low vitamin D level is associated with more than 130 outcomes. Exploring the causal role of vitamin D in health outcomes could support or question vitamin D supplementation.

Methods

We carried out a systematic literature review of previous Mendelian-randomization studies on vitamin D. We then implemented a Mendelian Randomization–Phenome Wide Association Study (MR-PheWAS) analysis on data from 339 256 individuals of White British origin from UK Biobank. We first ran a PheWAS analysis to test the associations between a 25(OH)D polygenic risk score and 920 disease outcomes, and then nine phenotypes (i.e. systolic blood pressure, diastolic blood pressure, risk of hypertension, T2D, ischaemic heart disease, body mass index, depression, non-vertebral fracture and all-cause mortality) that met the pre-defined inclusion criteria for further analysis were examined by multiple MR analytical approaches to explore causality.

Results

The PheWAS analysis did not identify any health outcome associated with the 25(OH)D polygenic risk score. Although a selection of nine outcomes were reported in previous Mendelian-randomization studies or umbrella reviews to be associated with vitamin D, our MR analysis, with substantial study power (>80% power to detect an association with an odds ratio >1.2 for per standard deviation increase of log-transformed 25[OH]D), was unable to support an interpretation of causal association.

Conclusions

We investigated the putative causal effects of vitamin D on multiple health outcomes in a White population. We did not support a causal effect on any of the disease outcomes tested. However, we cannot exclude small causal effects or effects on outcomes that we did not have enough power to explore due to the small number of cases.
Rational Singularities, Quiver Moment Maps, and Representations of Surface Groups
Authors: Budur Nero
Published: August 2019

We prove using jet schemes that the zero loci of the moment maps for the quivers with one vertex and at least two loops have rational singularities. This implies that the spaces of representations of the fundamental group of a compact Riemann surface of genus at least two have rational singularities. This has consequences for the numbers of irreducible representations of the special linear groups over the integers and over the $p$-adic integers.
Cervical Intraepithelial Neoplasia Rates in British Columbia Women: A Population-Level Data Linkage Evaluation of the School-Based HPV Immunization Program
Authors: Racey C Sarai , Albert Arianne , Donken Robine , Smith Laurie , Spinelli John J , Pedersen Heather , de Bruin Pamela , Masaro Cindy , Mitchell-Foster Sheona , Sadarangani Manish , Dawar Meena , Krajden Mel , Naus Monika , van Niekerk Dirk , Ogilvie Gina
Published: August 2019

Background

To understand real-world human papillomavirus (HPV) vaccine impact, continuous evaluation using population-based data is critical. We evaluated the early impact of the school-based HPV immunization program on cervical dysplasia in women in British Columbia, Canada.

Methods

Data linkage was performed using records from provincial cervical screening and immunization registries. Precancerous outcomes were compared between unvaccinated and HPV-vaccinated women born 1994–2005. Incidence rate, relative rate (RR), and vaccine effectiveness (VE), using unadjusted and adjusted Poisson regression of cytology (HSIL) and histopathology (CIN2, CIN3, and CIN2+) outcomes, were compared across vaccination status groups.

Results

Women who received a complete series of vaccine on schedule between age 9 and 14 years had an adjusted RR = 0.42 (95% confidence interval [CI], 0.31–0.57) for CIN2+ over 7 years of follow-up compared to unvaccinated women, resulting in a VE of 57.9% (95% CI, 43.2%–69.0%). Adjusted RR for HSIL was 0.53 (95% CI, .43–.64), resulting in a VE of 47.1% (95% CI, 35.6%–56.7%).

Conclusion

Women vaccinated against HPV have a lower incidence of cervical dysplasia compared to unvaccinated women. Immunization between 9 and 14 years of age should be encouraged. Continued program evaluation is important for measuring long-term population impact.
In vitro activity of rezafungin against common and rare Candida species and Saccharomyces cerevisiae
Authors: Tóth Zoltán , Forgács Lajos , Locke Jeffrey B , Kardos Gábor , Nagy Fruzsina , Kovács Renátó , Szekely Adrien , Borman Andrew M , Majoros László
Published: August 2019

Background

Rezafungin is a novel echinocandin with excellent activity against common Candida species; however, limited data are available regarding rare Candida species.

Methods

We determined the in vitro susceptibility of 689 clinical isolates of 5 common and 19 rare Candida species, as well as Saccharomyces cerevisiae. The activity of rezafungin was compared with that of anidulafungin, caspofungin, micafungin, amphotericin B and fluconazole, using CLSI broth microdilution methodology (Fourth Edition: M27).

Results

Rezafungin MIC90 values were 0.06 mg/L for Candida albicans (n=125), Candida tropicalis (n=51), Candida dubliniensis (n=22), Candida inconspicua (n=41), Candida sojae (n=10), Candida lipolytica (n=10) and Candida pulcherrima (n=10), 0.12 mg/L for Candida glabrata (n=81), Candida krusei (n=53), Candida kefyr (n=52) and Candida fabianii (n=15), 0.25 mg/L for Candida lusitaniae (n=46) and Candida auris (n=19), 0.5 mg/L for Candida metapsilosis (n=15) and S. cerevisiae (n=21), 1 mg/L for Candida orthopsilosis (n=15) and Candida guilliermondii (n=27) and 2 mg/L for Candida parapsilosis sensu stricto (n=59). Caspofungin MIC90 values were 0.25–2 mg/L for all species, while micafungin and anidulafungin MIC90 values were similar to those of rezafungin. Fluconazole resistance was found in C. albicans (5.6%) and C. glabrata (4.9%); rezafungin was effective against these isolates as well. Amphotericin B MIC values did not exceed 2 mg/L.

Conclusions

Rezafungin showed excellent in vitro activity against both WT and azole-resistant Candida species, as well as against S. cerevisiae. Rezafungin had similar activity to other echinocandins (excluding caspofungin) against common Candida species and, notably, against clinically relevant uncommon Candida species.
Ensuring innovation through participative antitrust
Authors: Bethell Oliver J , Baird Gavin N , Waksman Alexander M
Published: August 2019

Innovation is fundamental to economic growth, competition, and consumer welfare. It involves five core elements: Creativity, risk-taking, value-addition, adoption, and destruction. When these elements are combined, they produce powerful new technologies that revolutionize the way we work, travel, interact and more. Politicians, regulators, and consumers are asking whether antitrust can adequately promote and protect competition and innovation in the digital sector. Can it ensure access to competitively important data? Can it prevent mergers that eliminate future rivals? And can it address foreclosure by incumbent service providers? This article argues that the solution does not lie in overly broad changes to legal duties, burdens and standards of proof, which could have adverse consequences. Instead, governments, agencies, and industry should cooperate to produce rules that promote innovation by digital platforms and new entrants alike. This model of participative antitrust offers a promising path forward.
Effects of Brewer’s spent grain and carrot pomace on digestibility, fecal microbiota, and fecal and urinary metabolites in dogs fed low- or high-protein diets1
Authors: Eisenhauer Laura , Vahjen Wilfried , Dadi Temesgen , Kohn Barbara , Zentek Jürgen
Published: August 2019

Brewer’s spent grain (BSG) and carrot pomace (CAP) were used as fiber sources in low- or high-protein diets in dogs. Ten adult Beagles were involved in 5 feeding periods of 19 d in a cross-over design. Experimental diets contained 7.5% of total dietary fiber (TDF) from BSG or CAP and 20% or 40% of crude protein in dry matter. A diet with 3.5% TDF from both fiber sources and 20% crude protein was used as reference. Fecal dry matter was 27% higher for diets with BSG compared to CAP (P < 0.001). Apparent fecal digestibility of crude protein was 7% to 11% higher in diets with 40% protein concentration (P < 0.001), while apparent digestibility of crude fat was 2% to 3% higher for diets with CAP (P < 0.001). Carrot pomace increased the apparent fecal digestibility of TDF, phosphorus, and magnesium (P < 0.001), while 40% protein diets had a positive impact on TDF and sodium and a negative effect on magnesium apparent fecal digestibility (P < 0.001). Inclusion of CAP increased fecal short-chain fatty acids (P = 0.010), mainly acetate (P = 0.001). i-butyrate (P = 0.001), i-valerate (P = 0.002), biogenic amines (P < 0.001), and ammonium (P < 0.001) increased with higher dietary protein levels. Diet-induced changes in the fecal microbiome were moderate. Relative abundance of Bifidobacteriales was higher for the low-protein diets (P = 0.001). To conclude, BSG and CAP can be used as fiber sources in canine diets and are well tolerated even at higher inclusion rates, the effect on microbial protein fermentation seems to be limited compared to the dietary protein level.
Prevalence of Lynch syndrome among patients with upper urinary tract carcinoma in a Japanese hospital-based population
Authors: Ito Tetsuya , Kono Koji , Eguchi Hidetaka , Okazaki Yasushi , Yamamoto Gou , Tachikawa Tetsuhiko , Akagi Kiwamu , Okada Yohei , Kawakami Satoru , Morozumi Makoto , Tamaru Jun-ichi , Ishida Hideyuki
Published: August 2019

Background

The prevalence of Lynch syndrome and the use of universal tumor screening to identify Lynch syndrome among unselected patients with upper urinary tract urothelial carcinoma, which is associated with Lynch syndrome, have not been closely investigated yet.

Methods

A total of 166 tumors from 164 upper urinary tract urothelial carcinoma patients were tested for microsatellite instability and expression of mismatch repair proteins (MLH1, MHS2, MSH6 and PMS2) by immunohistochemistry. Genetic testing was performed for patients suspected of having Lynch syndrome. Clinicopathological factors, including familial and personal cancer history associated with mismatch repair deficiency, were evaluated.

Results

The frequency of high-level microsatellite instability and loss of at least one mismatch repair protein was 2.4% (4/164); the microsatellite instability and immunohistochemistry results showed complete concordance. Of these four patients, three were genetically proven to have Lynch syndrome, while the remaining one was highly suggestive for Lynch syndrome based on their personal cancer history. Univariate analysis showed that age<70 years (P = 0.04), ureter as the tumor location (P = 0.052), previous history/synchronous diagnosis of colorectal cancer (P < 0.01) and fulfillment of the criteria per the revised Bethesda guideline (P < 0.01) tended to be or were significantly associated with high-level microsatellite instability/mismatch repair loss.

Conclusions

The prevalence of Lynch syndrome among unselected upper urinary tract urothelial carcinoma patients was at least 1.8% in our study population. The screening efficacies of the microsatellite instability test and immunohistochemistry appear equivalent. Universal tumor screening may be a valid approach; however, selective screening methods that consider factors associated with mismatch repair loss/high-level microsatellite instability tumors require further investigation.
Cathepsin D Expression and Gemcitabine Resistance in Pancreatic Cancer
Authors: Mahajan Ujjwal M , Goni Elisabetta , Langhoff Enno , Li Qi , Costello Eithne , Greenhalf William , Kruger Stephan , Ormanns Steffen , Halloran Christopher , Ganeh Paula , Marron Manuela , Lämmerhirt Felix , Zhao Yue , Beyer Georg , Weiss Frank-Ulrich , Sendler Matthias , Bruns Christiane J , Kohlmann Thomas , Kirchner Thomas , Werner Jens , D’Haese Jan G , von Bergwelt-Baildon Michael , Heinemann Volker , Neoptolemos John P , Büchler Markus W , Belka Claus , Boeck Stefan , Lerch Markus M , Mayerle Julia
Published: August 2019

Background

Cathepsin-D (CatD), owing to its dual role as a proteolytic enzyme and as a ligand, has been implicated in cancer progression. The role of CatD in pancreatic ductal adenocarcinoma is unknown.

Methods

CatD expression quantified by immunohistochemistry of tumor-tissue microarrays of 403 resected pancreatic cancer patients from the ESPAC-Tplus trial, a translational study within the ESPAC (European Study Group for Pancreatic Cancer) trials, was dichotomously distributed to low and high H scores (cut off 22.35) for survival and multivariable analysis. The validation cohort (n = 69) was recruited based on the hazard ratio of CatD from ESPAC-Tplus. 5-fluorouracil-, and gemcitabine-resistant pancreatic cancer cell lines were employed for mechanistic experiments. All statistical tests were two-sided.

Results

Median overall survival was 23.75 months and median overall survival for patients with high CatD expression was 21.09 (95% confidence interval [CI] = 17.31 to 24.80) months vs 27.20 (95% CI = 23.75 to 31.90) months for low CatD expression (χ2LR, 1DF = 4.00; P = .04). Multivariable analysis revealed CatD expression as a predictive marker in gemcitabine-treated (z stat = 2.33; P = .02) but not in 5-fluorouracil-treated (z stat = 0.21; P = .82) patients. An independent validation cohort confirmed CatD as a negative predictive marker for survival (χ2LR, 1DF = 6.80; P = .009) and as an independent predictive marker in gemcitabine-treated patients with a hazard ratio of 3.38 (95% CI = 1.36 to 8.38, P = .008). Overexpression of CatD was associated with a concomitant suppression of the acid sphingomyelinase, and silencing of CatD resulted in upregulation of acid sphingomyelinase with rescue of gemcitabine resistance.

Conclusions

Adjuvant gemcitabine is less effective in pancreatic ductal adenocarcinoma with high CatD expression, and thus CatD could serve as a marker for biomarker-driven therapy.
From Refugee to Entrepreneur? Challenges to Refugee Self-reliance in Berlin, Germany
Authors: Embiricos Alexandra
Published: August 2019

The years following the so-called ‘refugee crisis’ of 2015 saw unprecedented efforts to promote the social and economic inclusion of refugees and asylum seekers. Entrepreneurship has been praised as a promising route to refugee self-reliance, but its viability remains contested and under-researched in developed economies such as Germany. Limited literature on the topic suggests entrepreneurship is a useful route to self-sufficiency, although refugees face more barriers than other immigrant entrepreneurs, such as language barriers and bureaucratic processes. This article uses semi-structured interviews with refugee entrepreneurs, civil society, social enterprises and the public sector to identify the main challenges for refugee entrepreneurs and to examine whether entrepreneurship is effective for achieving self-reliance in one of the most important centres for creating innovative projects supporting refugee inclusion and entrepreneurship, namely Berlin. Though it is too early to demonstrate whether entrepreneurship has long-term economic gains, this research shows that entrepreneurship is not a ‘fast track’ to economic self-reliance, but has several benefits for social inclusion. It also demonstrates the importance of holistic support systems for refugee entrepreneurs and the difficulty of refugee entrepreneurial success even in the most developed economies.
Introduction
Authors: Brian C Kalt
Published: August 2019

The introduction introduces four important themes that will be developed throughout the book. First, Section 4 is useful only in certain narrow circumstances. Second, tempting though it might be to use, Section 4 would not work well in other circumstances. Third, Section 4 is not a substitute for impeachment, nor an end run around it. Fourth, when Section 4 is invoked and the President responds that he is not disabled, he does not retake power immediately. There is a process for his regaining power, but it is certainly not instantaneous or unilateral.
Part I How Section 4 Works, 2 Correcting a Few Misconceptions
Authors: Brian C Kalt
Published: August 2019

A number of misconceptions float around about Section 4 of the Twenty-Fifth Amendment. Not just the general public but respected journalists and academics have misinterpreted several crucial features of the section. This chapter debunks the most important misconceptions. The truth is that: (1) The Vice President and Cabinet, not Congress, are in charge of invoking Section 4; (2) A Section 4 action does not remove the President from office; (3) Section 4 is for use against Presidents who are actually incapacitated, and not for use against merely “unfit” Presidents who are lazy, incompetent, irresponsible, screwy, dishonest, or in violation of constitutional norms; (4) The President cannot retake power immediately upon declaring that he is not disabled. He must have the assent of either the Vice President, the Cabinet, or some portion of Congress.
Part II History: Fact and Fiction, 4 Presidential Disability Before Section 4
Authors: Brian C Kalt
Published: August 2019

The history of the United States is peppered with Presidents who were unable, for various reasons, to fulfil their duties. Despite this, power never transferred until and unless the President died. Although the Constitution permitted transfer of power to the Vice President, it provided no process to make that happen. Some also believed that a disabled President who handed over power would not be able to retake power if he recovered. This dissuaded Vice Presidents from picking up the reins. A brief glance at history, from President Washington, through Presidents Garfield and Wilson, and on to President Eisenhower, shows why it was so important to pass Section 4. Eisenhower’s leadership and the aftermath of the assassination of President Kennedy set the stage for the Twenty-Fifth Amendment’s passage.
Part II History: Fact and Fiction, 5 Section 4: Creation, Evolution, and Approval
Authors: Brian C Kalt
Published: August 2019

The immediate impetus for the Twenty-Fifth Amendment was President Eisenhower’s leadership in the wake of his health problems. After the Kennedy assassination, Senator Birch Bayh led the effort to enact the Twenty-Fifth Amendment. Section 4 underwent many changes before arriving at its final content in 1965 (it was ratified in 1967). These changes shed important light on what the framers intended Section 4 to accomplish, and what limits they intended it to have. The chapter includes a table that traces the evolution of individual parts of Section 4. It concludes with an examination of the framers’ intentions regarding specific issues discussed elsewhere in the book: the overall purpose of Section 4; how Section 4 interplays with the impeachment process; the roles of its decision-makers; technical details; and the tradeoffs between encouraging reluctant Vice Presidents and empowering power-hungry ones.
Part II History: Fact and Fiction, 7 Section 4 in Fiction
Authors: Brian C Kalt
Published: August 2019

Section 4 is an irresistible subject for movies, novels, and television. This chapter examines Section 4 of the Twenty-Fifth Amendment though its portrayal in movies, novels, and television shows. Although many get the details right, others, whether through misunderstanding or unchecked creative license, get it wrong. This chapter analyses and evaluates the uses (and misuses) of Section 4 in the following:

Movies: Dave, The Enemy Within, Air Force One, and White House Down

Books: The President’s Plane Is Missing, Full Disclosure, The Negotiator, The Fourth K, and Father’s Day

TV: The West Wing, 24, The Event, Scandal, House of Cards, Madam Secretary, Homeland, and Designated Survivor
Part III Section 4 in “Practice”, 12 Don’t Just Sit There, Do Something!
Authors: Brian C Kalt
Published: August 2019

The broader issue of when a president is unfit, as opposed to unable, is not within the purview of the Twenty-Fifth Amendment. If the Vice President, the Cabinet, two-thirds of the House, and two-thirds of the Senate (a Section 4 consensus) believe the President must be stopped, there likely would be some point at which a simple majority of the House and two-thirds of the Senate (an impeachment consensus) would reach the same conclusion. Section 4 is not a permanent displacement; impeachment and removal are.

Section 4 is not a mechanism for the voting public to change its mind about the leader it has placed in the White House. Attempts to use it in that way would not work very well, given the difficulty in mustering the necessary votes against the President. Unless a President is truly incapacitated, or if he is potentially incapacitated but is definitely wreaking irreparable havoc, Section 4 is designed to fail.
Part IV Section 4 in Theory, 13 Section 4 and Constitutional Law
Authors: Brian C Kalt
Published: August 2019

Dealing with Section 4 differs greatly from the usual enterprise of constitutional law. First, Section 4 has never been used. Second, if it is ever used and questions arise, the answers will likely come from politicians, not a court. Third, Section 4 is about procedure, not the structure or powers of government or individual rights. Fourth, Section 4 offers some interesting twists on old debates about the use of history in constitutional reasoning. This chapter analyses Section 4 within the larger framework of debates about the best ways to approach constitutional law. In particular, it is much more sensible to analyze Section 4 in terms of the framer’s original understandings and original intentions that it is when interpreting other parts of the Constitution.
Part IV Section 4 in Theory, 14 Improving Section 4
Authors: Brian C Kalt
Published: August 2019

This chapter examines some of the suggestions made for improving Section 4. Those suggestions that would require congressional action or, worse yet, a constitutional amendment, are rejected as being too difficult to make happen. More promising are reforms that require only presidential leadership or keen work by the President’s legal staff. Presidents and their teams typically construct elaborate contingency plans for using Section 4. These plans need to be resolute about handling potentially difficult ambiguities. They also need to be publicized so that wider knowledge—among the President, his staff, and the general public—will prevent damaging uncertainty from ever arising in an actual case.
Automatic detection and visualization of garment color in Western portrait paintings
Authors: Sarı Cihan , Salah Albert Ali , Akdag Salah Alkım Almıla
Published: August 2019

Paintings give us important clues about how males and females were perceived over centuries in the Western culture. In this article, we describe a system that allows scholars to automatically visualize how the clothing colors of male and female subjects changed over time. Our system analyzes a large database of paintings, locates portraits, automatically classifies each portrait’s subject as either male or female, segments the clothing areas and finds their dominant color. An interactive, web-based visualization is proposed to allow further exploration of the results. To test the accuracy of our system, we manually annotate a portion of the Rijksmuseum collection, and use state-of-the-art image processing and computer vision algorithms to process the paintings. We use a deep neural network-based style transfer approach to improve gender recognition (or more correctly, sex recognition) of the sitters of portraits. The annotations and the code of the approach are made available.
Judaism and Neonatology
Authors: Dorff Elliot N.
Published: August 2019

After two introductory comments on why a Jewish perspective on neonatology might matter to anyone but Jews and on the methods of deriving guidance on this very new topic from an ancient tradition that knew nothing of contemporary science, this chapter describes the moral and legal status of the neonate in Jewish law and lore. It then discusses the fundamental Jewish concepts and convictions that underlie care for anyone, including neonates—concepts such as the role of medicine in our lives, the status of the disabled, human mortality, and end-of-life care, including its medical and financial concerns. The chapter then moves to the psychological and emotional aspects of neonatal care, discussing what the Jewish mandate to visit the sick means in the neonatal context and how Jewish mourning rites need to be adjusted to comfort parents of a neonate who dies.
Catholicism and the Neonatal Context
Authors: Lysaught M. Therese
Published: August 2019

Roman Catholics comprise the largest single denomination in the United States and are the nation’s largest group of not-for-profit healthcare providers. Yet, there is little or no available literature to assist neonatal caregivers in understanding how religious beliefs and values might influence parents’ responses to the challenges posed by their newborn’s care. Equally, there is little or no available literature on the academic or pastoral side addressing questions of neonatal medicine from a theological perspective. This chapter addresses how Roman Catholic teachings might affect the ways in which parents and caregivers make treatment decisions. It examines the neonatal context in light of five aspects of Catholic teaching—the dignity of the human person, patient decision making, withholding and withdrawing treatment, palliative care, and Catholic social thought—as well as three important Catholic practices—baptism, the anointing of the sick, and the care of babies’ bodies, living and dead.
Reading Tragedy through the Christian Story
Authors: Dufault-Hunter Erin
Published: August 2019

This chapter tells the story of a Mennonite couple whose fetus was diagnosed with Trisomy 13. By exploring the heartbreak that dying or stillborn babies evoke, this essay not only explains evangelical Mennonite beliefs but also displays how such faith shaped the response to that tragedy. Their story encourages medical professionals to engage with Christian patients, coming alongside them as parents access their faith and, when possible, enabling them to attach to their infant with a limited future. In doing so, healthcare providers collaborate with families of faith to create sacred spaces even in the valley of the shadow of death. These reflections also issue a challenge to medical personnel, pressing them to attend to their own grief. Defying our efforts to ignore it, the emotion of grief refuses to be neglected and instead can arise unheeded to choke out compassionate care.
Spirituality in a Time of Crisis
Authors: Cole-Turner Ronald
Published: August 2019

American mainstream Protestants are diverse, but several common religious motifs are likely to surface when caregivers and family members are faced with caring for a high-risk newborn. One of the first will be theological questions about cause or responsibility. Did I (or we) do something to cause this? Why is God letting this happen? Is God testing us? A second motif has to do with how to mark religiously the acceptance of the gift of the baby’s life. Although for Protestants there is no concern about the salvation of a baby dying without baptism, a hospital baptism can be the strongest possible affirmation of the life that is present, is soon to be gone, and yet will be fulfilled in some unspecifiable or mysterious way. A third motif draws these first two together. Caring for the high-risk infant can call out or create reserves of personal and spiritual strength.
Shiva’s Babies
Authors: Bhattacharyya Swasti
Published: August 2019

Discussing religious views from within any tradition is challenging because they are not monolithic. However, it is worth exploring religious perspectives because they are often the foundation, whether conscious or not, of the reasoning underlying people’s decisions. Following a brief discussion on the importance of cultural humility and understanding the worldview of patients, the author focuses on Hindu perspectives regarding the care of infants in the neonatal intensive care unit. Along with applying six elements of Hindu thought (underlying unity of all life, multivalent nature of Hindu traditions, dharma, emphasis on societal good, karma, and ahimsa), the author incorporates perspectives of Hindu adults, living in the United States, who responded to a nationwide survey regarding the care of high-risk newborn infants in the hospital.
Life Before Birth
Authors: Tsomo Karma Lekshe
Published: August 2019

Buddhists acknowledge no central institutional authority. Ethical issues are approached very differently in the widely diverse Buddhist traditions that have developed over more than 2,500 years. This chapter considers questions related to the cessation or withdrawal of treatment for high-risk newborns within the context of Buddhist ethical values and principles—both in general and in a range of Buddhist traditions, many of which are influenced by non-Buddhist beliefs and practices. The chapter also reflects on the ontological and ethical status of newborn infants cross-culturally and explores the diversity of Buddhist beliefs and practices related to bioethical decision making by religious leaders, medical professionals, lawyers, and parents.
Moral Status and Care of Impaired Newborns
Authors: Smith Patrick T.
Published: August 2019

This chapter addresses the question of moral status and care of impaired African American newborns from the perspective of African American Protestant Christian theology and spirituality. It argues that healthcare professionals must take seriously the impact of race and racism on the disparate health outcomes of African American newborns and maternal reproductive health. Moreover, it suggests how resources from the black Christian tradition inform the understanding of a high moral status of severely impaired newborns with a limited life expectancy in a way that does not require a vitalist approach in end-of-life decision making for these precious little ones.
Afterword
Authors: Smith Vincent C.
Published: August 2019

The author is an African American neonatologist who has worked in a neonatal intensive care unit (NICU) for the past twenty years. Despite belief systems being unique and diverse, he believes they serve an important role in society, especially in the context of NICU care. In this chapter, the author attempts to describe what he considers to be some salient points about being a provider in the NICU and the role that a family’s belief system plays in critical and end-of-life care for their newborn. He tries to emphasize how belief systems are complex and personal.
More Sleep Is a Slam Dunk
Authors: Downey III Ralph , Grigg-Damberger Madeleine , Bae Charles
Published: August 2019

Sleep loss may impair athletic performance. Sleep extension may improve performance in sleep-deprived athletes. In elite sports, where the slightest edge can make a difference in individual and team success, ways to improve performance are of great interest to athletes and teams. In the presented case, a male basketball player sought to improve his free throw shooting accuracy. With a disciplined approach to sleeping longer periods of time each night over a 12-week period, there was a substantial improvement in free throw percentage, sleepiness, and self-reported confidence in making free throws. This result is consistent with an extensive literature showing that improving sleep can improve athletic performance.
No Easy Way Down
Authors: Ralls Frank M. , Grigg-Damberger Madeleine
Published: August 2019

This chapter reviews the evaluation and treatment of a 7-year-old girl with Down syndrome who had difficulty tolerating positive airway pressure (PAP) therapy. Children with Down syndrome are at high risk for symptomatic residual obstructive sleep apnea after AT. Treating children, especially those with developmental delays, behavior problems, and/or anxiety, with PAP requires patience, flexibility, and ingenuity. PAP therapy can be particularly challenging in children with tactile aversion. Gradual exposure to the mask and machine (operant conditioning) can facilitate habituation. PAP practice sessions should start with an enjoyable calming activity so the child begins to associate PAP with pleasant positive experiences. Maternal education about the indications for, risks or, and benefits of PAP to treat sleep apnea in children was the best predictor of mean hours used per night.
A Journey Through Time and Sleep
Authors: Krishnan Vidya
Published: August 2019

Distant travels can affect sleep in many ways. Jet lag disorder is a specific circadian sleep disorder characterized by misalignment of the inherent circadian rhythm and the external environment caused by rapid travel across multiple time zones. Travel fatigue due to repetitive long-distance travels may affect a traveler’s daytime function and mood. Airplane travel and high-altitude locations may contribute to travel-related fatigue. The sleep environment—including the comfort of the bed, the ambient light, sounds, temperature, and air quality—can all interfere with optimal sleep. Changes in daytime eating, drinking, and activity levels can also impose stresses on sleep. Countermeasures for each of these conditions can help ensure a more restful journey. Duration of travel, distance of journey, time for preparation, and time for post-travel recovery will all influence the recommendations to mitigate jet lag disorder symptoms.
To Treat or Not to Treat
Authors: Mashaqi Saif , Mehra Reena
Published: August 2019

The focus of this chapter is central sleep apnea with Cheyne-Stokes breathing (CSA-CSB), a hypocapnic central sleep apnea commonly observed in patients with congestive heart failure (HF). The pathophysiologic aspects of CSA-CSB are discussed, including ventilatory responsiveness and concepts of loop gain, apneic threshold, and narrowing of the carbon dioxide delta gap serving as a predisposing factor. Complexities of the clinical approach are reviewed in terms of clinically contextualizing the findings from a large randomized controlled trial demonstrating increased cardiovascular-specific mortality in patients randomized to adaptive servo ventilation versus controls in those with central-predominant sleep apnea and reduced ejection fraction HF. Potential mechanistic explanations for these findings are reviewed and placed into context with available post hoc analyses from this trial. Treatment options are discussed, including the role of other positive airway pressure (PAP) modalities, supplemental oxygen, relevant medications, and innovative non-PAP therapies such as transvenous phrenic nerve stimulation.
Pregnancy and Health
Authors: Ibrahim Sally , Louis Judette
Published: August 2019

This chapter illustrates the impact of sleep disorders in pregnancy by demonstrating a case of obstructive sleep apnea (OSA) associated with preeclampsia. Maternal-fetal health complications are well documented in association with maternal OSA. OSA in pregnancy is a risk for preeclampsia, eclampsia, gestational hypertension, and gestational diabetes mellitus. A growing body of literature supports the importance of detection and diagnosis of OSA in pregnant women. Pregnancy-related complications may be mitigated by OSA treatment. Treatment with continuous PAP therapy is well tolerated in pregnancy and can be offered during pregnancy. Further investigation is needed to understand the effects of treatment on outcomes in pregnancy.
Tormented Sunrises
Authors: Alattar Maha
Published: August 2019

This chapter covers the relationship between sleep-related headaches and sleep disorders such as obstructive sleep apnea (OSA). Sleep apnea headache (SAH), a type of sleep-related headache that is classified in the International Classification of Headache Disorders, is a distinct subset of headache that is caused by OSA and occurs distinctly on awakening. Once recognized, treatment of OSA is associated with significant improvement in, and often resolution of, SAH. Given the high prevalence of headaches in the general population, sleep disorders must be considered in the evaluation of patients with headaches. A comprehensive sleep evaluation should be an integral part of the assessment of headache disorders. Sleep apnea headache and other types of headaches associated with sleep are reviewed in this chapter.
On the Cutting Edge
Authors: Horan Michael P. , Ibrahim Sally , Olivieri Petra
Published: August 2019

The patient presented in this chapter had uncontrolled obstructive sleep apnea (OSA) and was intolerant of positive airway pressure (PAP). Previous conservative and surgical interventions failed. The patient was successfully treated with maxillomandibular advancement (MMA) surgery. Although many patients benefit from first-line therapy with PAP for OSA, some are intolerant of PAP and require discussion of alternative treatments. Maxillofacial surgical approaches are an option for the treatment of OSA in patients whose craniofacial anatomy is anatomically appropriate. With MMA, patients can achieve significant improvement and in many cases can achieve cure of OSA. Multiple studies support the benefits of MMA in those who are candidates for this treatment.
My Husband Tells Me I’m Lazy
Authors: Bremer Erin , Trotti Lynn Marie
Published: August 2019

Idiopathic hypersomnia is a chronic disorder of excessive daytime sleepiness that is characterized by unrefreshing sleep despite normal or long sleep times and sleep inertia. Both symptoms can interfere with normal functioning. The diagnosis requires confirmation of sleepiness or increased sleep propensity via actigraphy, polysomnography, and/or multiple sleep latency test. Clinical evaluation, sleep diagnostics, and laboratory testing must exclude other disorders of excessive sleepiness. Treatment options are limited by the lack of approval by the U.S. Food and Drug Administration of any medications for this indication, as well as the relatively small number of clinical trials including patients with this disorder. Off-label treatments may be used and new treatments are being researched.
A Case of Sleepiness and Turbulent Dreams
Authors: Alzoubaidi Mohammed S. , Mokhlesi Babak
Published: August 2019

This chapter outlines the growing evidence that obstructive sleep apnea during rapid-eye-movement sleep (REM-related OSA) is a prevalent disorder that is independently associated with adverse cardiovascular, metabolic, and neurocognitive outcomes. The authors also review the clinical implications of the duration of nightly continuous positive airway pressure (CPAP) use that is needed to effectively treat REM-related OSA. Current CPAP adherence guidelines of 4 hours/night potentially leave the majority of REM-related OSA untreated. Thus, the optimal duration of positive airway pressure therapy to effectively treat REM OSA requires clarification. Clinicians should encourage patients with REM-related OSA to increase CPAP usage to include the early morning hours, before awakening. Further research is needed to establish whether patients with significant REM-related OSA but an overall normal Apnea–Hypopnea Index would benefit from treatment.