bluuebunny/crossref_metadata_2025 huggingface dataset:
Refugee Status Determination
Authors: Burson Bruce
Published: June 2021

This chapter describes refugee status determination (RSD), which is the post-Second World War-era term to describe a process by which the asylum norm, now expressed primarily through the Refugee Convention, is operationalized. While the concept of offering sanctuary from harm—‘asylum’—is old, little has been written about the surrounding decision-making processes in the Convention’s historical antecedents or precursors. The chapter begins by examining the origins of RSD. It charts how contemporary RSD reflects its historical antecedents and questions the robustness of a dichotomy between group and individual determination as a marker of development. The chapter then outlines the increased systemization of RSD through dedicated status determination structures comprising both State and mandate RSD, and juridification via an ever-denser body of law and guidance. It also considers inherent and contextual challenges faced by RSD before detailing various proposals for reform to ensure that RSD is a ‘fit-for purpose’ protection mechanism in the twenty-first century.
Credibility, Reliability, and Evidential Assessment
Authors: Noll Gregor
Published: June 2021

This chapter explores credibility, reliability, and evidential assessment in the asylum procedure. Credibility assessment in asylum appears to be constrained by a conceptual framework, as are other fields of law. Refugee law offers a particular constellation of the burden of proof, the standard of proof, and the benefit of the doubt. However, there are serious logical deficiencies in the way that these three concepts interact in asylum, with the result that they are unable to restrain discretion and regulate decision-making. If one looks beyond these legal concepts and rules in search of restraint in proxies for credibility, scientific studies in psychology and traumatology suggest that standard credibility criteria, such as behaviour or the coherence and plausibility of statements, are also deficient. These studies in effect undermine the validity of the standard criteria used in the UNHCR Handbook and the EU Qualification Directive. Without functioning legal constraints and valid credibility criteria, the discretion of decision-makers occupies too much space. Empirical studies confirm that the allocation of a case to an individual judge is the weightiest factor in dictating the outcome of an asylum case, leading to the conclusion that evidential assessment actually plays a minor role, suggesting that evidential assessment in asylum law is deeply dysfunctional.
The Internal Protection Alternative
Authors: Ní Ghráinne Bríd
Published: June 2021

This chapter discusses the Internal Protection Alternative (IPA), which stems from the premise that if there is a safe place within an individual’s State of nationality or habitual residence where they can relocate, they are not a refugee. Examples of the application of the IPA could include relocating from the countryside to the city where an individual is less likely to be found by their persecutors; or relocating to an area where a clan, tribe, militia, or international organization could provide protection. As refugee law lacks an international mechanism capable of providing a common interpretation of the Refugee Convention, the IPA’s interpretation has primarily been left to Contracting States by means of domestic court decisions. Using the rules of treaty interpretation, it is nonetheless possible to distil a minimum binding standard of relevant IPA criteria from both State practice and the text of the Refugee Convention itself. These criteria are that (i) the proposed IPA must be accessible to the applicant, (ii) there is no risk of exposure to the original risk of persecution, and (iii) there must be no new risk of persecution or of refoulement in the proposed IPA, and the conditions there must not be so unreasonable as to risk driving the individual to a place where there is a risk of persecution.
Displacement in the Context of Climate Change and Disasters
Authors: McAdam Jane
Published: June 2021

The links between climate change, disasters, and displacement are now undisputed. Yet, extant legal frameworks do not expressly address the movement of people across borders in response to or in anticipation of disasters or climate change-related harms. This chapter examines the limits and scope of existing international legal frameworks (refugee law, human rights law, and the law on statelessness) to address displacement in the context of disasters and climate change. It also briefly considers measures that would enable people to remain in their homes, where possible and desirable, or to migrate or relocate elsewhere, as an adaptation strategy in anticipation of potential future harm. While climate change will affect migration, it will not be the sole cause. Rather, climate change will interact with a range of economic, social, and political drivers, which themselves affect migration. For this reason, the chapter argues that it is conceptually sounder to view climate change-related movement as a part of global migration dynamics, rather than as a discrete, independent category.
Internal Displacement
Authors: Kälin Walter
Published: June 2021

This chapter discusses the protection of internally displaced persons (IDPs), who are all too often neglected, not only by their governments, but also by the international community. The experiences of refugees and IDPs have much in common. Thus, it is not surprising that social science approaches tend to lump refugees and IDPs together under the notion of ‘forced displacement’. By contrast, the chapter argues that refugee law and the law related to internal displacement are conceptually fundamentally different because IDPs remain citizens or habitual residents of their countries, and thus depend on the national protection of their governments, while refugees as foreigners are in need of international protection. Discussing the protection of IDPs from a comparative perspective, it analyses the Guiding Principles on Internal Displacement and their impact as a soft law instrument, as well as the legally binding Kampala Convention. Ultimately, IDP-related approaches to durable solutions can help to inform refugee law and policy, and there is already a degree of convergence between the two areas.
Non-refoulement
Authors: Mathew Penelope
Published: June 2021

This chapter highlights the most fundamental of all obligations owed to refugees—that of non-refoulement. The raison d’être of the obligation continues to provoke debate about the validity of the lines drawn between refugees, other beneficiaries of the obligation, and other migrants, and the way the purported provider of surrogate protection—the State—is implicated in the production of forced migration. That background or deep structure of the State system assists in explaining the phenomenon explored in the chapter: the interaction between shrinking and expansive approaches to non-refoulement. The chapter first outlines the sources of the obligation, noting the obligation’s place in the Refugee Convention and other treaties as well as its status as customary international law, and the corresponding beneficiaries of the obligation. It then examines the scope of the obligation, with emphasis on States’ attempts to divest their responsibilities through legal fictions and extraterritorial immigration enforcement. The chapter also discusses the concept of constructive or disguised refoulement—that is, when an asylum seeker spontaneously leaves the country of asylum as a result of their treatment in that country.
The Right to Liberty
Authors: Lester Eve
Published: June 2021

Often arbitrary, the use of immigration detention as a border control measure may impede not only the right to liberty, but also an individual’s right to seek asylum, arguably a principle of customary international law, and may expose them to the risk of refoulement. As such, alongside the catalogue of human rights issues to which the practice commonly gives rise, immigration detention can jeopardize some of international refugee law’s most fundamental principles. This chapter considers how and why immigration detention has become such an intractable problem, international standards notwithstanding. The chapter focuses on the right to liberty, first situating the use of immigration detention in global and historical context. It then provides an overview of key aspects of the international legal architecture. Recognizing that other socio-political dynamics shape State practice, the chapter then considers the role of criminalizing and securitizing discourses that are used to rationalize (and even normalize) immigration detention. It suggests that these discourses are crucial to contemporary understandings of, and justifications for, the use and extraterritorial procurement of immigration detention as a border control measure. It argues that paying attention to the history and context of immigration detention and how it is rationalized will reveal more about what law is and does and the mischiefs of which it is capable than doctrinal analysis can do alone. Finally, it suggests the Global Compact on Migration to be a useful lens through which future research might usefully tackle the problem of immigration detention.
Association of semi-quantitative cryptococcal antigen results in plasma with subclinical cryptococcal meningitis and mortality among patients with advanced HIV disease
Authors: Blasich Nozuko P , Wake Rachel M , Rukasha Ivy , Prince Yvonne , Govender Nelesh P
Published: June 2021

Blood cryptococcal antigen (CrAg) titers >160 are associated with concurrent subclinical cryptococcal meningitis (CM). When lumbar puncture (LP) is not immediately available in a CrAg screening program, semi-quantitative CrAg assays may provide risk stratification for CM. Two semi-quantitative assays (SQ [Immuno-Mycologics, Norman, OK, USA] and CryptoPS [Biosynex, Strasbourg, France]) were evaluated against a qualitative lateral flow assay (LFA) using 194 plasma samples from a cohort of HIV-seropositive individuals with CD4 counts <100 cells/μl. We compared SQ and CryptoPS results to titers for LFA-positive samples. Among patients with LP, we examined the association between semi-quantitative CrAg results and CM. We used a Cox proportional hazards model to determine the association between SQ score and mortality. Of 194 participants, 60 (31%) had positive LFA results, of whom 41 (68%) had a titer of ≤160 and 19 (32%) a titer >160. Fifty individuals with antigenemia had an LP; a clinically useful SQ score that identified all ten cases of subclinical CM was ≥3 (100% sensitivity, 55% specificity). Patients with an SQ score of 3 or 4 also had a 2.2-fold increased adjusted hazards of 6-month mortality (95% CI: 0.79–6.34; p = 0.13) versus those with score of <3. Nine of ten patients with subclinical CM had a strong-positive CryptoPS result versus 10/40 without subclinical CM (p < 0.001). Semi-quantitative assays offered a sensitive though not specific means of gauging the risk of concurrent CM in this patient population.

Lay summary

We evaluated two single-step laboratory tests that can quantify the amount of cryptococcal antigen in plasma of patients with advanced HIV disease and could thus gauge the risk of concurrent cryptococcal meningitis and subsequent mortality. These tests are not a substitute for a lumbar puncture.
In situ measurements and neural network analysis of the profiles of optical turbulence over the Tibetan Plateau
Authors: Su Changdong , Wu Xiaoqing , Wu Su , Yang Qike , Han Yajuan , Qing Chun , Luo Tao , Liu Yi
Published: June 2021

The vertical profile of $C_n^2$ is the main factor for accurate astronomical observation and laser communication, however, hardware-based instruments and associated data are not widely available due to logistical and financial issues. In this article, we developed an indirect method, a hybrid network structure which is a combination of the backpropagation neural network and the simulated annealing algorithm, to fit the vertical profile of $C_n^2$. Radiosonde measurements from a field campaign over the Tibetan Plateau at Dachaidan (37.7○N, 95.3○E, 3180 m ASL) were performed in 2020 August to estimate the accuracy of our model, during which a balloon-borne portable turbulence meteorological radiosonde was used to measure the atmospheric optical profiles. Besides, the integrated astronomical parameters (the coherence length r0, seeing ε0, isoplanatic angle θ0, and the wavefront coherence time τ0), derived from $C_n^2$ and wind-speed vertical profiles, are investigated for astronomical applications using the proposed model. In addition, quantitative evaluations such as the correlation coefficient, the root mean squared error, and the systematic bias are used to quantify the performance of our model. More interesting, this model is found to outperform a widely used external scale model for the prevalent atmospheric conditions and shows better correlation and reliable estimates.
A phase Ib/IIa trial of 9 repurposed drugs combined with temozolomide for the treatment of recurrent glioblastoma: CUSP9v3
Authors: Halatsch Marc-Eric , Kast Richard E , Karpel-Massler Georg , Mayer Benjamin , Zolk Oliver , Schmitz Bernd , Scheuerle Angelika , Maier Ludwig , Bullinger Lars , Mayer-Steinacker Regine , Schmidt Carl , Zeiler Katharina , Elshaer Ziad , Panther Patricia , Schmelzle Birgit , Hallmen Anke , Dwucet Annika , Siegelin Markus D , Westhoff Mike-Andrew , Beckers Kristine , Bouche Gauthier , Heiland Tim
Published: June 2021

Background

The dismal prognosis of glioblastoma (GBM) may be related to the ability of GBM cells to develop mechanisms of treatment resistance. We designed a protocol called Coordinated Undermining of Survival Paths combining 9 repurposed non-oncological drugs with metronomic temozolomide—version 3—(CUSP9v3) to address this issue. The aim of this phase Ib/IIa trial was to assess the safety of CUSP9v3.

Methods

Ten adults with histologically confirmed GBM and recurrent or progressive disease were included. Treatment consisted of aprepitant, auranofin, celecoxib, captopril, disulfiram, itraconazole, minocycline, ritonavir, and sertraline added to metronomic low-dose temozolomide. Treatment was continued until toxicity or progression. Primary endpoint was dose-limiting toxicity defined as either any unmanageable grade 3–4 toxicity or inability to receive at least 7 of the 10 drugs at ≥ 50% of the per-protocol doses at the end of the second treatment cycle.

Results

One patient was not evaluable for the primary endpoint (safety). All 9 evaluable patients met the primary endpoint. Ritonavir, temozolomide, captopril, and itraconazole were the drugs most frequently requiring dose modification or pausing. The most common adverse events were nausea, headache, fatigue, diarrhea, and ataxia. Progression-free survival at 12 months was 50%.

Conclusions

CUSP9v3 can be safely administered in patients with recurrent GBM under careful monitoring. A randomized phase II trial is in preparation to assess the efficacy of the CUSP9v3 regimen in GBM.
Impact of postoperative dexamethasone on survival, steroid dependency, and infections in newly diagnosed glioblastoma patients
Authors: Mistry Akshitkumar M , Jonathan Sumeeth V , Monsour Meredith A , Mobley Bret C , Clark Stephen W , Moots Paul L
Published: June 2021

Background

We examined the effect of dexamethasone prescribed in the initial 3 postoperative weeks on survival, steroid dependency, and infection in glioblastoma patients.

Methods

In this single-center retrospective cohort analysis, we electronically retrieved inpatient administration and outpatient prescriptions of dexamethasone and laboratory values from the medical record of 360 glioblastoma patients. We correlated total dexamethasone prescribed from postoperative day (POD) 0 to 21 with survival, dexamethasone prescription from POD30 to POD90, and diagnosis of an infection by POD90. These analyses were adjusted for age, Karnofsky performance status score, tumor volume, extent of resection, IDH1/2 tumor mutation, tumor MGMT promoter methylation, temozolomide and radiotherapy initiation, and maximum blood glucose level.

Results

Patients were prescribed a median of 159 mg [109-190] of dexamethasone cumulatively by POD21. Every 16-mg increment (4 mg every 6 hours/day) of total dexamethasone associated with a 4% increase in mortality (95% confidence interval [CI] 1%-7%, P < .01), 12% increase in the odds of being prescribed dexamethasone from POD30 to POD90 (95% CI 6%-19%, P < .01), and 10% increase in the odds of being diagnosed with an infection (95% CI, 4%-17%, P < .01). Of the 175 patients who had their absolute lymphocyte count measured in the preoperative week, 80 (45.7%) had a value indicative of lymphopenia. In the POD1-POD28 period, this proportion was 82/167 (49.1%).

Conclusions

Lower survival, steroid dependency, and higher infection rate in glioblastoma patients associated with higher dexamethasone administration in the initial 3 postoperative weeks. Nearly half of the glioblastoma patients are lymphopenic preoperatively and up to 1 month postoperatively.
Understanding human influence on climate change in China
Authors: Sun Ying , Zhang Xuebin , Ding Yihui , Chen Deliang , Qin Dahe , Zhai Panmao
Published: June 2021

China's climate has been warming since the 1950s, with surface air temperature increasing at a rate higher than the global average. Changes in climate have exerted substantial impacts on water resources, agriculture, ecosystems and human health. Attributing past changes to causes provides a scientific foundation for national and international climate policies. Here, we review recent progress in attributing the observed climate changes over past decades in China. Anthropogenic forcings, dominated by greenhouse gas emissions, are the main drivers for observed increases in mean and extreme temperatures. Evidence of the effect of anthropogenic forcings on precipitation is emerging. Human influence has increased the probability of extreme heat events, and has likely changed the occurrence probabilities for some heavy precipitation events. The way a specific attribution question is posed and the conditions under which the question is addressed present persistent challenges for appropriately communicating attribution results to non-specialists.
Smoking Cessation and Preterm Birth in Second Pregnancy Among Women who Smoked in Their First
Authors: Pereira Gavin , Dunne Jennifer , Regan Annette K , Tessema Gizachew A
Published: June 2021

Introduction

The benefit of smoking cessation in reducing the risk of preterm birth is well established. Relatively less well understood is the prevalence of smoking cessation maintenance at the next pregnancy and the associated preterm risk reduction. The aim of this study was to estimate the prevalence of maintenance of smoking cessation at second pregnancy and the associated relative risk of preterm birth.

Methods

This was a longitudinal study with retrospectively obtained records of births to multiparous women who smoked in the pregnancy of their first birth in New South Wales, 1994–2016 (N = 63 195 mothers). Relative risks (RR) of preterm birth of the second child were estimated for smoking cessation with adjustment for final gestational age of the first birth, maternal age at the first birth, change in socioeconomic disadvantage between the first and second pregnancy, interpregnancy interval, and calendar time.

Results

Approximately 34% (N = 21 540) of women who smoked during their first pregnancy did not smoke in the second pregnancy. Smoking cessation among women who smoked at first pregnancy was associated with a 26% (95% CI: 21%, 31%) decrease in risk of preterm birth at a second pregnancy.

Conclusion

Despite smoking during the first pregnancy, smoking cessation was achieved and maintained by more than one-third of women in their second pregnancy with encouraging levels of preterm risk reduction. It is well-established that the period after birth provides an opportunity to reduce smoking-related morbidity for both the mother and neonate. Our results indicate that this period also offers an opportunity to prevent morbidity of future pregnancy.

Implications

A considerable amount of research has been undertaken on the effects of smoking during pregnancy on birth outcomes, the influence of postpartum smoking on the health of the mother and newborn child, and postpartum smoking cessation. However, follow-up of women after giving birth does not tend to be long enough to observe smoking and outcomes of subsequent pregnancies. We show that smoking cessation in the subsequent pregnancy is achievable by a large proportion of women despite smoking in their first pregnancy, which translates to clear reductions in risk of preterm birth in the subsequent pregnancy.
Acute Immune Thrombocytopenia (ITP) Following COVID-19 Vaccination in a Patient With Previously Stable ITP
Authors: Jawed Muzamil , Khalid Amna , Rubin Mayer , Shafiq Ramsha , Cemalovic Nail
Published: June 2021

Immune thrombocytopenia (ITP) is an autoimmune condition associated with multiple risk factors including viral infections (hepatitis B virus/hepatitis C virus/cytomegalovirus, HIV, and recently severe acute respiratory syndrome coronavirus 2) and vaccines. Though immune mechanisms have been proposed to explain the pathogenesis of acute ITP, autoimmunity with the coronavirus disease 2019 (COVID-19) vaccine is still unclear and needs further research. We report a case of acute ITP after administration of the Pfizer-BioNTech mRNA COVID-19 vaccine in a patient with previously stable ITP.
Cavernous Sinus Meningioma: Tumor Decompression for Trigeminal Neuralgia and Anterior Tibial Artery Graft High-Flow Bypass for Brain Ischemia: 2-Dimensional Operative Video
Authors: Qazi Zeeshan , Balasubramanian Sneha Chitra , Abecassis Josh , Hernandez Juan P Carrasco , Shenoy Varadaraya S , Sekhar Laligam N
Published: June 2021

A 62-yr-old man with left cavernous sinus tumor presented with atypical trigeminal neuralgia refractory to medical treatment. He received Gamma Knife (Elekta) radiation for the tumor. However, the facial pain worsened after radiation. Neuropsychological testing done for memory problems had revealed mild neurocognitive disorder. Neurological examination showed trigeminal distribution numbness and partial abducens nerve paralysis. Imaging revealed an enhancing left cavernous sinus and supra-cavernous mass. Angiography revealed severe stenosis of the left cavernous internal carotid artery (ICA). Computed tomography (CT) perfusion study showed diminished blood flow on the left side, and ischemic changes were seen in fluid-attenuated inversion-recovery (FLAIR) magnetic resonance imaging (MRI).

 Surgical resection of the tumor was preferred over ablative treatment for trigeminal neuralgia because of its effectiveness in improving cranial nerve (CN) function.
1
The patient underwent staged surgeries. In the first stage, the tumor was partially excised with decompression of the trigeminal ganglion and nerve root in the lateral cavernous sinus wall, Meckel's cave. Postoperatively, MR angiography revealed worsening of the left ICA caliber. Therefore, a high-flow bypass from the external carotid artery to the middle cerebral artery (MCA) was performed with an anterior tibial artery graft. The patient recovered initially but developed enterococcus meningitis postoperatively, which was promptly identified and treated with antibiotics. At 1-yr follow-up, the graft was patent, and the patient had significant relief of his facial pain and cognitively improved.

 This 2-dimensional video demonstrates the technique of partial excision of cavernous sinus meningioma with CN decompression, and the technique of a high-flow bypass from the external carotid artery to M2 MCA segment using an anterior tibial artery graft.

 The patient gave informed consent for surgery and video recording. All relevant patient identifiers have been removed from the video and accompanying radiology slides.
Lateral Suboccipital Craniotomy With C1-C2 Hemilaminectomies and C1-C3 Fusion for the Treatment of a C1-C2 Synovial Cyst Causing Spinal Cord Compression: 2-Dimensional Operative Video
Authors: Croci Davide Marco , Fredrickson Vance L , Hollon Todd C , Dailey Andrew T , Couldwell William T
Published: June 2021

Atlantoaxial synovial cysts are a rare cause of cervical myelopathy. Here we describe a case of a 26-yr-old woman who presented with progressively decreasing right arm and leg strength and associated gait imbalance. On examination, she had diffuse weakness in the right upper and lower extremities, a positive right-sided Hoffman sign, and clonus in the right lower extremity. Computed tomography demonstrated an os odontoideum and a retro-odontoid cyst. Magnetic resonance imaging demonstrated a T1 hypointense, T2 hyperintense, slightly rim-enhancing retro-odontoid cyst causing a marked narrowing of the spinal canal, with resultant flattening and leftward deviation of the spinal cord. The patient consented to undergo cyst fenestration via a right suboccipital craniotomy and right C1-C2 hemilaminectomies, along with a C1-C3 instrumented posterior spinal fusion. This approach was chosen because it allows for cyst fenestration and instrumentation of the hypermobile cervical spine within the same incision. After the dura was opened and the arachnoid was dissected, the cyst was visualized compressing the spinal cord. The cyst was fenestrated just inferior to the C1 nerve rootlets, resulting in immediate egress of a gelatinous content; thereafter, all accessible cyst wall portions were removed. Fusion was performed with lateral mass screws at C1 and C3 and pars screws at C2. Pathological analysis described the cyst content as reactive fibrovascular tissue with cholesterol deposition. There were no complications associated with the procedure, and the patient's right-sided weakness had nearly resolved by postoperative day 1. Patient consent was granted for publication.
The Effect of Reducing Intravenous Push Opioid Use on Hospital Medicine Patients’ Pain Experience During Hospitalization
Authors: Smith G Randy , Ramalingam Sridevi , Zhou Shuhan , Yeh Chen , Lee Jungwha , O’Leary Kevin J
Published: June 2021

Objective

To determine the efficacy of a program to limit the use of the intravenous (IV) push route for opioids on the experience of pain by inpatients and on associated safety events.

Design

Retrospective cohort study.

Setting

Two inpatient general medicine floor units at an urban tertiary care academic medical center.

Subjects

4,752 inpatient opioid recipients.

Methods

Patients in one unit were exposed to a multidisciplinary intervention to limit the prescription of opioids via the IV push route, with the other unit used as a control unit. The primary study outcome was the mean numeric pain score per patient during the hospital stay. Secondary measures included the hospital length of stay and postdischarge patient satisfaction. Fidelity measures included the percentage of the patient population exposed to each opioid administration route and the amount of opioid administered per route. Safety measures included patient disposition, transfer to intensive care, and incidence of naloxone administration.

Results

The intervention was successful in decreasing both the percentage of patients exposed to IV push opioids and the amount of opioid administered via the IV push route, but no associated changes in other study outcomes were identified.

Conclusions

For the treatment of acute pain in medical inpatients, no evidence of benefit or harm was identified in relation to an increase or decrease in the use of the IV push opioid route.
Moving on Up? Neighborhood Status and Racism-Related Distress among Black Americans
Authors: DeAngelis Reed T
Published: June 2021

At all levels of socioeconomic status, Black Americans can expect to live shorter and sicker lives than their White counterparts. This study advances the perspective that anti-Black stigma from Whites precludes Blacks from reaping the full health rewards of higher status, particularly within the context of neighborhoods. To test this hypothesis, I merge census data with rich survey and biomarker data from the Nashville Stress and Health Study, a representative sample of Black and White adults from Davidson County, Tennessee (n = 1,252). Initially, I find that Blacks who reside in higher status and mostly White communities exhibit lower levels of neuroendocrine stress hormones, relative to their peers living in disadvantaged Black neighborhoods. But Blacks in higher-status areas also report more perceived discrimination. In turn, perceived discrimination is associated with chronic bodily pain, as well as elevated stress hormones and blood pressure tied to high goal-striving stress, or fears of being blocked from reaching life goals. After accounting for racism-related stressors, Blacks exhibit comparable levels of physiological distress regardless of neighborhood context. The inverse is true for Whites, who report fewer stressors in higher-status neighborhoods, and less physiological distress than Blacks overall. Findings are discussed within the context of social evolutionary theories of the human brain and are dovetailed with broader racial health disparities in the United States.
Polio Vaccine Struggles: FAIR and the Failed Reintroduction of Inactivated Polio Vaccine, 1975–1985
Authors: Baylac-Paouly Baptiste , Hendriks Jan , Blume Stuart
Published: June 2021

This article discusses the strategies and trajectories deployed by the Forum for the Advancement of Immunization Research (FAIR) to rehabilitate Salk’s inactivated polio vaccine (IPV), at a time when Sabin’s oral polio vaccine (OPV) had come to dominate the global polio vaccine market. FAIR was an international coalition of scientists and institutions that undertook specific field studies to establish the conditions under which IPV could usefully be introduced in developing countries. Regardless of the evidence it gathered, FAIR failed to convince WHO to integrate IPV into the Expanded Programme on Immunization (EPI). This study of the life of IPV vaccine beyond its initial development and introduction, provides insights in the interplay of evidence and interests in the political decisions made around vaccination.
Building Biofoundry India: challenges and path forward
Authors: Panda Binay , Dhar Pawan K
Published: June 2021

Biofoundry is a place where biomanufacturing meets automation. The highly modular structure of a biofoundry helps accelerate the design–build–test–learn workflow to deliver products fast and in a streamlined fashion. In this perspective, we describe our efforts to build Biofoundry India, where we see the facility add a substantial value in supporting research, innovation and entrepreneurship. We describe three key areas of our focus, harnessing the potential of non-expressing parts of the sequenced genomes, using deep learning in pathway reconstruction and synthesising enzymes and metabolites. Toward the end, we describe specific challenges in building such facility in India and the path to mitigate some of those working with the other biofoundries worldwide.
Barriers and facilitators to physical education, sport, and physical activity program participation among children and adolescents with psychiatric disorders: a systematic review
Authors: Hickingbotham Madison R , Wong Catherine J , Bowling April B
Published: June 2021

Children and adolescents with heterogeneous psychiatric disorders, of whom over 50% have a second psychiatric comorbidity, have low rates of physical activity and experience unique challenges to engaging in community-based exercise programming, school-based physical education programming, and targeted physical activity interventions. This contributes to elevated rates of gross and fine motor delays, lower mood and self-regulation, and increased risk of chronic diseases such as obesity and type 2 diabetes. Perform a systematic scoping review of the literature to assess known barriers to and facilitators of engaging in physical activity programming among children and adolescents with heterogeneous and/or comorbid psychiatric disorders, in order to improve engagement among this population in real world intervention settings. Systematic Boolean diagnostic and physical activity search terms were entered into PubMed, MEDLINE, PsycINFO and Web of Science for English-language studies published between 2005 and 2020, examining barriers and facilitators for common psychiatric diagnoses and general psychiatric population’s engagement in physical activity, physical education, sports, or exercise interventions. Two reviewers independently reviewed titles, abstracts and full articles to determine inclusion. A total of 5,198 articles were returned; 39 relating to children and adolescents were qualified for full-text review. After review, 24 studies were included addressing barriers and facilitators across multiple diagnoses; 7 studies were quantitative, 10 were qualitative, and 7 were mixed methods. Major barriers included low motivation, low self-efficacy, depleted parental reserve capacity, social isolation, lack of staff training, and safety concerns. Major facilitators included peer support/engagement, exergames, supportive parental behaviors, and inclusive/adaptive programming. Numerous barriers and facilitators to physical activity have been identified which should inform community, school, clinical, and research intervention program design. Further research is needed to develop effective strategies that address the challenges to inclusion that children and adolescents with heterogeneous and/or comorbid psychiatric disorders face.
III Middle English
Authors: Ash-Irisarri Kate , Atkinson Laurie , Black Daisy , Brazil Sarah , Calder Natalie , Finn Andrew , Greene Darragh , Grossman Joel , Lazikani Ayoush , Menmuir Rebecca , Pascual Rafael J , Sargan J D , Wolf Johannes
Published: June 2021

This chapter has thirteen sections: 1. Early Middle English; 2. Theory; 3. Manuscript and Technical Studies; 4. Religious Prose and Verse; 5. Secular Prose; 6. Sir Gawain and the Green Knight, Pearl, Patience and Cleanness; 7. Piers Plowman; 8. Gower; 9. Older Scots; 10. Drama; 11. Secular Verse; 12. Romance: Metrical, Alliterative, Prose. 13. Hoccleve and Lydgate. Section 1 is by Ayoush Lazikani; section 2 is by Andrew Finn; section 3 is by J.D. Sargan; section 4 is by Natalie Calder; section 5 is by Johannes Wolf; section 6 is by Rafael J. Pascual; section 7 is by Joel Grossman; section 8 is by Laurie Atkinson; section 9 is by Kate Ash-Irisarri; section 10 is by Daisy Black and Sarah Brazil; sections 11 and 12 are by Darragh Greene, with contributions by Johannes Woolf on Malory; 13 is by Rebecca Menmuir.
Immunogenicity and Safety of a Tetravalent Dengue Vaccine Administered Concomitantly or Sequentially With Quadrivalent Human Papillomavirus Vaccine in Boys and Girls 9–13 Years of Age in Malaysia
Authors: Hassan Jamiyah , Toh Teck-Hock , Sivapunniam Selva Kumar , Hasim Ruziaton , Ghazali Nor Faizah , Sulaiman Sofiah , Koh Mia Tuang , Meyer Stephanie , Toh Myew-Ling , Zocchetti Celine , Vigne Claire , Mascareñas Cesar
Published: June 2021

Background:

Incorporating dengue vaccination within existing vaccination programs could help improve dengue vaccine coverage. We assessed the immunogenicity and safety of a quadrivalent human papillomavirus (HPV) vaccine administered concomitantly or sequentially with a tetravalent dengue vaccine (CYD-TDV) in healthy children 9–13 years of age in Malaysia.

Methods:

In this phase IIIb, open-label, multicenter study (NCT02993757), participants were randomized 1:1 to receive 3 CYD-TDV doses 6 months apart and 2 doses of quadrivalent HPV vaccine concomitantly with, or 1 month before (sequentially), the first 2 CYD-TDV doses. Only baseline dengue-seropositive participants received the 3 doses. Antibody levels were measured at baseline and 28 days after each injection using an enzyme-linked immunosorbent assay for HPV-6, -9, -16 and -18, and the 50% plaque reduction neutralization test for the 4 dengue serotypes; immunogenicity results are presented for baseline dengue-seropositive participants. Safety was assessed throughout the study for all participants.

Results:

At baseline, 197 of 528 (37.3%) randomized participants were dengue-seropositive [n = 109 (concomitant group) and n = 88 (sequential group)]. After the last HPV vaccine dose, antibody titers for HPV among baseline dengue-seropositive participants were similar between treatment groups, with between-group titer ratios close to 1 for HPV-6 and 0.8 for HPV-11, -16, and -18. After CYD-TDV dose 3, dengue antibody titers were similar between treatment groups for all serotypes [between-group ratios ranged from 0.783 (serotype 2) to 1.07 (serotype 4)]. No safety concerns were identified.

Conclusions:

The immunogenicity and safety profiles of CYD-TDV and quadrivalent HPV vaccines were unaffected when administered concomitantly or sequentially in dengue-seropositive children.
Pyloric gland adenoma with low-grade intraepithelial neoplasia
Authors: Li Hai-Long , Wang Yan , Ren Yu-Bo , Yang Xue-Song , Wang Li , Zhang Lei , Lin Xiang-Chun
Published: June 2021

Rationale:

Pyloric gland adenoma (PGA) is often associated with pyloric gland metaplasia. It has high malignant potential but a low clinical diagnosis rate. Therefore, we reported a case of PGA and reviewed the literature to summarize the clinicopathological features of pyloric adenoma.

Patient concerns:

A 62-year-old female underwent gastroscopy due to intermittent acid regurgitation and heartburn, which revealed a 4×6 mm flat, elevated lesion in the greater curvature of the upper gastric body, with depression in the central region and blood scab attachment.

Diagnosis and intervention:

Biopsy revealed gastric adenoma with low-grade intraepithelial neoplasia. The patient was treated with ESD, and pathology showed gastric pyloric gland adenoma with low-grade dysplasia. The cells were positive for MUC6 and MUC5AC immunohistochemically.

Outcomes:

The patient received proton pump inhibitors and gastric mucosal protective agents for one month after ESD. She occasionally presented acid regurgitation and heartburn, with no abdominal pain, abdominal distension, melena, or hematochezia. Follow-up gastroscopy will be reexamined 1 year later.

Lessons:

PGA has nonspecific performance under endoscopy, and its diagnosis mainly depends on pathology. Clinicians need to increase their ability to recognize such lesions and treat them in time to improve the prognosis.
Evaluation of efficiency and safety of combined montelukast sodium and budesonide in children with cough variant asthma
Authors: Tang Qiongyao , Lei Huizhen , You Jinbing , Wang Jiangjiang , Cao Junyi
Published: June 2021

Background:

Cough variant asthma (CVA) is classified as a distinct form of asthma. As the primary or only symptom, cough is the leading cause for the most prevalent chronic cough among kids. The American College of Clinical Pharmacy, British Thoracic Society, and Chinese guidelines established for diagnosing and treating chronic cough in kids recommend inhaled corticosteroids, combined with leukotriene receptor antagonists when necessary.

Methods:

We will conduct a comprehensive search in major databases using keywords to find studies related to the analysis of montelukast sodium and budesonide for treating CVA in kids. Two reviewers will independently assess the quality of the selected research articles and perform data extraction. Next, we will use the RevMan software (version: 5.3) to conduct the statistical analysis of the present study.

Results:

This study will assess the efficacy and safeness of using montelukast sodium and budesonide to treat kids with CVA by pooling the results of individual studies.

Conclusion:

Our findings will provide vigorous evidence to judge whether montelukast sodium and budesonide therapy is an efficient form of therapy for CVA patients.

Ethics and dissemination:

Ethics approval is not needed for the present meta-analysis.

OSF registration number:

May 17, 2021.osf.io/cuvjz (https://osf.io/cuvjz/).
Facing the Inevitable
Authors: Orr Shelly , Falk Mary , Elswick R.K.
Published: June 2021

Health care providers have an ethical obligation to reduce suffering during a patient's end of life (EOL), but few receive formal education on EOL care principles. The objective of this project was to determine the feasibility and potential benefits of an education initiative in which the principles of EOL care were taught to senior-level nursing students and practicing nurses. To assess feasibility, data regarding recruitment rates, retention rates, and implementation issues were collected. Workshop effectiveness was evaluated through use of the End-of-Life Nursing Education Consortium–Knowledge Assessment Test survey, which evaluates knowledge levels regarding EOL care principles. A mixed-effects linear model was used to test for changes from the preworkshop to postworkshop scores. Demographic information and satisfaction data were also collected. Nineteen students and 24 nurses participated (total N = 43). There was a statistically significant time difference (P = .0001), with the postworkshop scores being higher (43.5 ± 0.93) versus the preworkshop scores (41.2 ± 0.93). However, no statistically significant workshop date difference (P = .3146) emerged. Satisfaction data were positive. Retention for the second workshop was negatively affected by COVID-19. The unique needs of patients nearing their EOL are significant. This project describes the implementation and outcomes of an education initiative, focused on EOL care principles, that was both feasible and beneficial.
Exercise and Stress in At-Risk Women during Pregnancy and Postpartum
Authors: Guo Yuqing , Kehoe Priscilla , Pimentel Pamela , Rousseau Julie , Axelin Anna , Rahmani Amir M. , Dutt Nikil
Published: June 2021

Purpose:

We aimed to understand the relationship between exercise and stress among socioeconomically at-risk women who participated in a home visitation service during pregnancy and postpartum.

Methods:

A mixed-methods design was used to support and supplement quantitative data using qualitative data. Convenience sampling was used to collect data from at-risk women via questionnaires and follow-up interviews. The Perceived Stress Scale was used to assess stress. Frequency and duration of exercise were assessed based on the American College of Obstetricians and Gynecologists exercise guidelines. Regression analyses examined the association between stress and exercise controlling for covariates. Content analysis was used to understand women's stress management experiences.

Results:

N = 114 women completed the questionnaire and a subgroup of 11 received follow-up interviews. Greater frequency of exercise was significantly associated with lower levels of stress. Approximately one-third of women reported experiencing significant stress. Talking to their husband or partner was the most used and exercise was the least used coping strategy. Many women recognized the importance of managing stress and benefits of exercise, but were hindered by barriers such as feeling tired, preventing them from exercising.

Clinical Implications:

A personalized and safe exercise program has the potential to be a low-cost stress management strategy for women during pregnancy and postpartum.
Maternal Self-Confidence and Breastfeeding after Participating in a Program about Infant Prone Positioning
Authors: Jesberger Colleen , Chertok Ilana Azulay , Wessells Allyson , Schaumleffel Carol
Published: June 2021

Purpose:

Maternal self-confidence facilitates infant growth and new mother role development. Infant ability to breastfeed and maternal breastfeeding self-confidence are imperative to helping mothers meet their breastfeeding goals. Consistent opportunity for infant movement in the prone position has been shown to improve breastfeeding ability; however, families report a lack of knowledge of how to safely support this activity. Perceptions of maternal self-confidence, infant development, and breastfeeding success upon completion of an infant prone positioning program with focus on posture, movement, and connection were studied.

Study Design and Methods:

Qualitative interviews were conducted among breastfeeding mothers in three states to explore maternal perceptions of learning about infant prone positioning.

Results:

Thirty-five mothers who completed an infant prone positioning program shared their perceptions of infant interaction, prone play and positioning, and breastfeeding self-confidence. Four primary themes were identified from the analysis: maternal knowledge and self-confidence; strategies and practices learned; breastfeeding benefits of infant prone positioning; and motivation for program participation.

Clinical Implications:

Our findings support consideration of teaching new mothers about prone positioning to enhance self-confidence in mothering, breastfeeding skills, infant development, and maternal–infant dyad bonding.
Spindle Cell Sarcoma of the Uterine Corpus With Adipose Metaplasia: Expanding the Morphologic Spectrum of Neoplasms With MEIS1-NCOA2 Gene Fusion
Authors: Kommoss Felix K.F. , Kölsche Christian , Mentzel Thomas , Schmidt Dietmar , von Deimling Andreas , McCluggage W. Glenn , Kommoss Friedrich
Published: June 2021

We report a spindle cell sarcoma arising in the uterine corpus of a 26-yr-old patient. The patient underwent a simple hysterectomy and the uterine corpus contained a 9 cm tumor showing nodular and “finger-like” myometrial invasion. Histologically, the tumor was composed of a monomorphic population of atypical spindle cells which contained widespread foci of cytologically benign adipocytes. Immunohistochemistry revealed diffuse strong positivity for CD10, CD56, and CD99 and diffuse weak positive staining with ER and WT1 while smooth muscle markers, S100, TLE1, and cyclin D1 were negative. Total RNA sequencing identified an in-frame fusion between exon 6 of MEIS1 and exon 12 of NCOA2. Copy number analysis revealed few aberrations with no deletions or amplifications identified. No adjuvant therapy was given and the patient is disease-free 9 yr after initial diagnosis. This case represents the second report of a uterine sarcoma harboring a MEIS1-NCOA2/1 gene fusion and expands the morphologic spectrum of recently reported spindle cell sarcomas arising in the genitourinary tract harboring MEIS1-NCOA2/1 gene fusions. This is the first reported case of such tumors with an adipocytic component.