bluuebunny/crossref_metadata_2025 huggingface dataset:
Lavender Images and Poetic Landscapes: My Thirty Years in the Queer Film Ecosystem
Authors: Olson Jenni
Published: November 2021

This chapter by LGBT filmmaker and film historian Jenni Olson is a firsthand account of her thirty-plus years of work across the ecosystem of queer cinema. It covers her curatorial work in the late 1980s and early 1990s (she was codirector of the San Francisco International Lesbian and Gay Film Festival); her extraordinary efforts as an LGBT film collector and archivist over the decades (her collection was acquired by the Harvard Film Archive in 2020); her pioneering work in online queer-film exhibition, as cofounder of PlanetOut.com; her decade as director of marketing for the LGBT film distributor, Wolfe Video; and her work as a maker of digressive and contemplative 16mm essay films, such as The Royal Road (2015) and The Joy of Life (2005), which speak from a butch lesbian perspective and reflect on a wide array of preoccupations.
Queer Theory and Nontheatrical Films: Perversion in the Public Domain
Authors: Pilcher Lauren
Published: November 2021

This chapter considers the intersection of queer theory and nontheatrical film studies by examining antipornography film Perversion for Profit (1962). Produced and distributed by Citizens for Decent Literature, the film visualizes a range of straight and gay pornographic images by censoring and categorizing them as evidence of societal aberrations. Now in the public domain and streaming on Internet Archive, the film’s pornographic images have been repurposed for new meanings. By analyzing Barbara Hammer’s inclusion of Perversion in her experimental film History Lessons (2000) and a mash-up of the original film titled Come Join the Fun! (2004), shared on Internet Archive, the chapter argues that the Perversion’s value now lies in what queer creators make of its cinematic time and space.
A Duet for Sailors and Pansies: Queer Archival Work and Male Same-Sex Dancing in Follow the Fleet (1936) and Other Depression-Era Films
Authors: Lugowski David
Published: November 2021

This chapter explores a queer all-male dance lesson for partnered sailors in the Fred Astaire–Ginger Rogers musical Follow the Fleet (1936), using archival research (scripts, Production Code Administration records) and comparative textual and contextual analysis. It raises the queerness of Rogers and Astaire before exploring two intersecting axes. The association of sailors with queer behavior and effeminate “pansies” occurs in military scandals, paintings, and Depression-era Hollywood films, including Sailor’s Luck and Son of a Sailor (both 1933). The queerness of male same-sex dancing arises in ballet and in film, including Suicide Fleet (1931). Various institutions criticized or attempted to censor such representations, but they also found acceptance. The US Navy, for example, wanted the comical dance lesson removed from Fleet; instead, it was only rewritten, suggesting the inability to remove queerness from culture and its essential role in mass entertainment.
Open Innovation for Development in China
Authors: Chen Jin , Chen Yufen
Published: November 2021

Open innovation shows a new direction for Chinese enterprises to innovate indigenously. Chinese enterprises actively adopt an open innovation model, make full use of external innovation resources, and integrate internal and external resources to promote innovation. This chapter describes the conditions of openness in the process of innovation in Chinese enterprises. Based on the conditions of openness, this chapter elaborates modes for the organization of open innovation in Chinese enterprises, including users being involved in innovation, suppliers participating in innovation, collaborations with firms in other industries and competitors, cooperation with universities and research institutes, intellectual property licensing, mergers and acquisitions, and setup of overseas research and development (R&D) branches. For each mode, this chapter introduces a corresponding case of open innovation practice in enterprise in China. Open innovation provides access to more ideas than could be developed in-house. With an open vision to integrate global innovation resources, Chinese firms’ innovation capability has been greatly enhanced.
Chinese Cost Innovation, the Shanzhai Phenomenon, and Accelerated Innovation
Authors: Williamson Peter J.
Published: November 2021

This chapter traces the evolution of Chinese innovation strategies starting with cost innovation, accelerated innovation, and its roots in Shanzhai and concluding with digital innovation, which is at the leading edge of Chinese innovation. The distinctive features and antecedents of each of these Chinese approaches to innovation are explained and illustrated. Cost innovation involves using Chinese cost advantage in radically new ways to offer customers around the world dramatically more for less. Accelerated innovation is achieved by re-engineering innovation processes to increase the pace of innovation while reducing costs. The genesis of these capabilities to accelerate innovation can be traced back to Shanzhai: the practice of rapidly copying competitors’ products. Finally, digital innovation by Chinese companies using big data, machine learning, and artificial intelligence algorithms is explored.
Chinese Firms’ Move to the Forefront in Digital Technologies
Authors: Yu Jiang , Zhang Yue
Published: November 2021

In the past two decades, China has achieved impressive progress and built competence in digital technology–enabled products, processes, business models, and hyperscale e-infrastructure. Driven by the globally largest internet user scale and fast catching up of information technologies, China’s strategy has been transformed from survival to growth and is transforming to market leadership. Now China has built its competence not only in telecommunication, consumer electronics, and PCs but also in some complex technology products like supercomputer systems. China has also witnessed the rise of hyperscale internet giants and the establishment of super e-commerce and mobile payment systems. However, there are still some great challenges that need to be overcome in some “bottleneck” technologies like the semiconductor and software sectors. China is thus seeking ways to move beyond the “global factory” model and cultivate its own technology-intensive industries and innovation capabilities. In the future, it is critical to maintain an open strategy among fierce global competition.
Innovating for the Poor
Authors: Wu Xiaobo , Lei Linan
Published: November 2021

This chapter introduces the inclusive innovation system in China by showing the roles of bottom-of-the-pyramid (BOP) entrepreneurs, institutions for inclusive innovation, infrastructures supporting inclusive innovation, and emerging governance of inclusive innovation. Based on an integrative review of the literature about the innovation that led to inclusive growth in developing economies, this chapter proposes the conceptual framework of the process toward inclusive innovation by integrating the dynamic inclusive growth with the current static view. Then, considering the Chinese context, especially the turning from formal institutions to the interpenetration of both formal and informal institutions, this chapter finally summarizes some challenges for inclusive innovation and its implications on economic and social growth.
Foreign Technology Transfers in China
Authors: Fu Xiaolan , Hou Jun
Published: November 2021

Innovation can be achieved via various channels, and the effectiveness of each channel depends on the stage of development as well as the local social-economic settings. Based on the concept that innovation is not only limited to invention but also characterized as a learning and adopting process, this chapter discusses the important role of foreign technology sources in China’s innovation path. Different types of foreign knowledge sources are reviewed, including trade, technology licensing, inward and outward foreign direct investment (FDI), internationalization of research and development (R&D), global value chain, and returnees. The discussion highlights the complementary effect between foreign knowledge sources and indigenous innovation efforts in fostering technological upgrading in China. To maximize the benefits from innovation and accelerate catching up, the explicit and well-focused encouragement of indigenous innovation and acquisitions of foreign knowledge must work in parallel.
Convergence and Diversity in the Hedge Fund and Private Equity Industry
Authors: Bajulaiye Omololu , Fenwick Mark , Skultetyova Ivona , Vermeulen Erik P. M.
Published: November 2021

This chapter identifies differences in hedge fund and private equity strategies in terms of investments, strategies, and fundamental terms. These underlying structural differences have implications for the type of investor attracted to each investment style. Previously, investment decisions could be made on a set of trade-offs, but increased competition in the hedge fund industry is now the main factor driving the type of fund operating and competing in investment markets. This chapter describes the terms and conditions which address fund formation and operation, fees and expenses, profit sharing and distributions, as well as corporate governance. No matter how appealing the prospects of hedge fund and private equity convergence, there are significant concerns: can both types of fund combine different investment styles without affecting the level of returns?; can the transition toward financial convergence be blocked if hedge fund investors object to valuations based on subjective, and not actual, market trading?;can ‘side pockets’ in a hedge fund be isolated from the costs of accounting for the two streams of capital?
Hedge Fund Activism and Corporate Innovation
Authors: Santos Roberto S. , Sun Sunny Li
Published: November 2021

While the jury is out on whether hedge fund activism encourages corporate innovation, there is mounting evidence to suggest that this is the case. A firm’s ability to innovate is crucial for its long-term survival. Through multiple mechanisms, activist hedge fund interventions can “shake things up” and stir corporations out of their myopic innovation investments. By bringing an end to the squandering of precious R&D resources, hedge fund activism stimulates and reshapes corporate competitiveness and enhances innovation performance. This chapter explores the strategies and mechanisms that activist hedge funds employ to influence corporate innovation and also offers avenues for future research.
Misconduct at Hedge Funds
Authors: Bollen Nicolas P. B.
Published: November 2021

This chapter discusses crime in the context of hedge fund management and reviews some of the relevant academic work in the area. The chapter provides examples of the different types of misconduct that have been perpetrated and prosecuted in hedge funds. Thereafter, it reviews relevant regulation of hedge funds and the resulting available information which regulators and investors can use to assess the risk of misconduct. Academic work related to hedge fund crime often relies on commercially available databases that are described in the chapter. The chapter further presents techniques developed in the academic literature to quantify the risk of misconduct and assesses their information content in empirical analyses.
Hedge Fund Strategies in the Post-Crisis Era
Authors: Atilgan Yigit , Bali Turan G. , Gunaydin A. Doruk
Published: November 2021

This chapter examines the performances of various hedge fund strategies based on various reward-to-risk ratios after the 2008 global crisis. We document that a majority of hedge fund strategies deliver lower average returns compared to equities and bonds; yet the volatilities of their returns have also been low. The equity hedge strategy has the highest reward-to-risk ratios among the major strategy categories, whereas the relative value arbitrage strategy has the lowest. Technology/healthcare, merger arbitrage, discretionary thematic, and asset-backed arbitrage strategies tend to have the highest reward-to-risk ratios in their respective categories. Time-series regressions of hedge fund strategy returns on various fund pricing factors provide evidence that hedge funds, on average, do not generate abnormal returns once the pricing factors are controlled for. We also document that hedge fund strategy returns generally load negatively on the bond market and aggregate credit risk factors and positively on the market portfolio.
Gone Global: The International Diffusion of Hedge Fund Activism
Authors: Aguilera Ruth V. , Federo Ryan , Ponomareva Yuliya
Published: November 2021

After decades of being primarily a US-based phenomenon, the globalization of hedge fund (HF) activism is increasing at an unprecedented speed. This chapter reviews the empirical research on HF activism by systematically comparing studies conducted in the US and outside the US context. The nascent body of work on HF activism is categorized and discussed within four research sub-streams: the antecedents of HF activism; HF activists’ tactics; the responses of target firms to HF activist campaigns, and the outcomes of the latter for HF activists, target firms, and other stakeholders. Six select cases of interventions by a prominent HF activist illustrate the cross-country differences in hedge fund activist practices outlined in the literature review. The chapter concludes by outlining current research gaps and formulating research questions that could advance our knowledge on hedge fund activism in a global context.
Hedge Funds and Limited Partnership Agreements
Authors: Dai Na
Published: November 2021

Due to the lack of regulations in the hedge fund industry and the great discretion given to hedge fund managers during the daily operations, limited partnership agreements are the most important if not the only tool for investors to incentivize and monitor hedge fund managers and protect their own interests. This chapter reviews the current literature on hedge funds contractual terms and their implications for fund performance and risk taking, before discussing the variation of the contracts conditional on the jurisdiction of the hedge fund. Finally, the development of hedge funds limited partnership agreements is investigated as many jurisdictions have imposed new regulations on hedge funds after the 2008 financial crisis.
Investment Strategies of Hedge Funds
Authors: Shawky Hany A.
Published: November 2021

This chapter reviews a number of different hedge fund strategies, including equity hedge, long/short, market neutral, relative value arbitrage, convertible arbitrage strategy, capital structure arbitrage strategy, fixed income arbitrage strategy, yield curve arbitrage strategy, other relative value arbitrage strategies, emerging markets strategies, global macro strategies, event driven strategies, distressed securities, and merger arbitrage strategies. In addition, the author discusses the growth and performance of different strategies, as well as fraud, fund failures, activism, and regulation.
Frontiers of Civilization in the Age of Mass Migration from Eastern Europe
Authors: Florea Cristina
Published: November 2021

Between the 1870s and 1914, tens of thousands of peasants left Austria-Hungary’s easternmost provinces of Galicia and Bukovina, heading for the Americas. This article places this episode in the context of contemporary global labour migrations while also emphasizing the distinctive characteristics of this mass exodus. Unlike most migrants around the world, Galicians and Bukovinans emigrated overseas rather than internally; their destinations included the United States, Canada, Brazil and Argentina. By moving, the migrants transformed from objects of Austria’s ‘civilizing mission’ in its eastern borderlands into vehicles for multiple, competing imperial expansion and civilizing projects overseas. From an obstacle to Austria’s ambitions to modernize its eastern periphery, the peasant migrants turned into a disputed resource, simultaneously expanding and threatening Austria’s sovereignty. Paradoxically, because they were less economically developed and more peripheral than their counterparts elsewhere in the empire, Galicians and Bukovinans were more sensitive to shifts in global labour markets than to the policies imposed by their own state officials.
Evolution of influenza A virus in intensive and free-range swine farms in Spain
Authors: Encinas Paloma , del Real Gustavo , Dutta Jayeeta , Khan Zenab , van Bakel Harm , del Burgo M Ángeles Martín , García-Sastre Adolfo , Nelson Martha I
Published: November 2021

Swine harbor genetically diverse influenza A viruses (IAVs) with the capacity to host-switch to humans, causing global pandemics. Spain is the largest swine producer in Europe and has a mixed production system that includes ‘white coat’ pigs raised intensively in modern buildings and free-range Iberian pigs that interface differently with humans, wildlife, and other swine. Through active longitudinal IAV surveillance in nine Spanish provinces during 2015–9, we generated forty-seven complete or near-complete genome sequences from IAVs collected from swine in both systems. Genetically diverse IAVs were identified in intensively raised white pigs and free-range Iberian pigs, including new H3N1 reassortants. Both systems are dynamic environments for IAV evolution, but driven by different processes. IAVs in white pigs were genetically related to viruses found in swine raised intensively in other European countries, reflecting high rates of viral introduction following European trade routes. In contrast, IAVs in Iberian pigs have a genetic makeup shaped by frequent introductions of human IAVs, reflecting rearing practices with high rates of human contact. Transmission between white and Iberian pigs also occurred. In conclusion, Iberian swine with high rates of human contact harbor genetically diverse IAVs and potentially serve as intermediary hosts between white pigs and humans, presenting an understudied zoonotic risk that requires further investigation.
Epidural Analgesia During Labor and Autism Risk: Getting Lost on the Causal Path
Authors: Carrier F.M. , Lavoie A. , Zaphiratos V.
Published: November 2021

(Can J Anaesth. 2021;68:277–284. doi: 10.1007/s12630-020-01880-5)

Labor epidural analgesia (LEA) is the anesthetic of choice for over 60% of laboring women in Canada. While there is evidence that LEA allows more parturients to safely labor and deliver, there was a lack of research on long-term effects of LEA on women and infants.
Early Prognostic Capacity of Serum Lactate for Severe Postpartum Hemorrhage
Authors: Basil-Kway  , Castillo-Reyther R. , Domínguez-Salgado L.A. , Espinosa-Tanguma R. , Medina Ú. , Gordillo-Moscoso A.
Published: November 2021

(Int J Gynaecol Obstet. 2021;153:483–488. doi: 10.1002/ijgo.13446)

Severe postpartum hemorrhage (SPPH; blood loss ≥1500 mL in the 24 h following labor) can have serious adverse maternal outcomes. Thus, earlier diagnosis and management of postpartum hemorrhage (PPH) (defined as ≥500 mL during labor or ≥1000 mL during cesarean delivery) is critical. Serum lactate has proven to more accurately predict severity and mortality and lead to better decision making, ultimately improving maternal outcomes. The aim of this study was to assess the relationship between serum lactate concentration at PPH diagnosis and SPPH.
Comparison of Liposomal Bupivacaine and Conventional Local Anesthetic Agents in Regional Anesthesia: A Systematic Review
Authors: Jin Z. , Ding O. , Islam A. , Li R. , Lin J.
Published: November 2021

(Anesth Analg. 2021;132:1626–1634)

Postoperative pain can negatively affect patient satisfaction and is associated with increased risk of complications as well as increased opioid use. Regional anesthesia can reduce postoperative pain and opioid use, but there are limitations to current techniques. Single-injection regional anesthesia has limited duration of analgesic effects, while continuous catheter infusions are more challenging and require greater resources. Liposomal bupivacaine wound infiltration has been shown to prolong analgesic effects and reduce the use of opioids. This systematic review considers recent studies on the use of liposomal bupivacaine compared to local anesthetics in regional anesthesia.
Single-unit Versus Multiple-unit Transfusion in Hemodynamically Stable Postpartum Anemia: A Pragmatic Randomized Controlled Trial
Authors: Hamm R.F. , Perelman S. , Wang E.Y. , Levine L.D. , Srinivas S.K.
Published: November 2021

(Am J Obstet Gynecol. 2021;224:84.e1–7)

Postpartum anemia is often managed by postpartum transfusion, but there is limited data on the appropriate transfusion protocol for hemodynamically stable postpartum anemia. Transfusion carries risks of infectious disease transmission, alloantibody development, and transfusion-related acute lung injury, while undertransfusion can negatively affect postpartum healing, depression, and breastfeeding. Two units of packed red blood cells (pRBCs) for women with hemoglobin (Hb) level <7 g/dL has been common practice, but recent guidelines recommend a single unit of pRBCs. Studies have shown single-unit transfusion protocols do not increase morbidity, but no studies on the subject have been performed in the obstetric population. This study aimed to compare single-unit with multiple-unit transfusion protocols to treat hemodynamically stable postpartum anemia.
The Risk of Adverse Maternal Outcomes in Cases of Placenta Praevia in an Australian Population Between 2007 and 2017
Authors: Balachandar K. , Melov S.J. , Nayyar R.
Published: November 2021

(Aust N Z J Obstet Gynaecol. 2020;60:890–895)

Placenta previa affects 1 in 200 deliveries at term, and 90% resolve by the third trimester. One of the major adverse maternal outcomes associated with placenta previa is antepartum hemorrhage (APH), which can lead to blood transfusions, hysterectomy or admission to the intensive care unit (ICU), among other adverse events. Little has been published about the management of outcomes associated with placenta previa. The aim of this study was to examine the associations between APH, postpartum hemorrhage (PPH) and adverse outcomes in women with placenta previa.
Low-dose Intravenous Dexmedetomidine Reduces Shivering Following Cesarean Delivery: A Randomized Controlled Trial
Authors: Sween L.K. , Xu S. , Li C. , O’Donoghue M.A. , Ciampa E.J. , Kowalczyk J.J. , Li Y. , Hess P.E.
Published: November 2021

(Int J Obstet Anesth. 2021;45:49–55)

In cesarean deliveries (CD) shivering is sometimes brought on by neuraxial anesthesia. Shivering can negatively affect patient comfort and intraoperative monitoring of blood pressure, electrocardiogram and pulse. Meperidine is a synthetic opioid that has been used to treat postanesthetic shivering, but there are concerns about its side effects in pregnant women. Dexmedetomidine at a dose of 30 μg has been found to control shivering after CD, but with some unpleasant side effects like dry mouth. This study aimed to determine whether anesthetic shivering after CD would be reduced using a 10 μg dose of dexmedetomidine administered immediately after delivery.
Efficacy Versus Efficiency Using High Flow Nasal Oxygen in Peri-intubation Oxygenation of Gravid Women
Authors: Murphy N.E. , Coursin D.B. , Pryde P.
Published: November 2021

(Int J Obstet Anesth. 2021;45:17–20)

To prevent apnea and hypoxemia in pregnant women undergoing rapid sequence induction of general anesthesia, preoxygenation to an end-tidal oxygen fraction (FET.O2) of ≥90% is recommended. Preoxygenation is typically carried out using a tight-fitting facemask with 100% inspired oxygen fraction (FiO2) at a flow rate of 10 L/min, with 3 to 5 minutes of tidal breathing. As obstetrical intubation often requires prompt induction, alternative preoxygenation methods are being explored.
The Effect of Cricoid Pressure on Tracheal Intubation in Adult Patients: A Systematic Review and Meta-Analysis
Authors: Hung K.-C. , Hung C.-T. , Poon Y.-Y. , Wu S.-C. , Chen K.-H. , Chen J.-Y. , Chang Y.-J. , Chen I.-W. , Sun C.-K. , Chiang M.-H.
Published: November 2021

(Can J Anesth/J Can Anesth. 2021;68:137–147)

Cricoid pressure (CP) is used during induction of anesthesia to minimize the risk of pulmonary aspiration in high-risk patients. CP compresses the cricoid cartilage and occludes the esophagus, and prevents gastric insufflation during mask ventilation. There is not clear agreement on the effectiveness or risks of CP. This systematic review and meta-analysis aimed to evaluate the association between CP and intubation outcomes.
Postoperative Analgesic Effectiveness of Quadratus Lumborum Block for Cesarean Delivery Under Spinal Anesthesia: A Systematic Review and Meta-Analysis
Authors: Hussain N. , Brull R. , Weaver T. , Zhou M. , Essandoh M. , Abdallah F.W.
Published: November 2021

(Anesthesiology. 2021;134:72–87)

The quadratus lumborum (QL) block has been reported to improve postoperative pain relief after cesarean delivery with spinal anesthesia when used with or without intrathecal morphine (ITM). Studies investigating the use of this block for postoperative cesarean pain have varied in design. This systematic review and meta-analysis was conducted to determine the effectiveness of QL block as postoperative analgesic, with or without ITM, following elective cesarean delivery.
Role of type-2 innate lymphoid cells (ILC2s) in type-2 asthma
Authors: Verma Mukesh , Verma Divya , Alam Rafeul
Published: November 2021

Purpose of review

The purpose of this review is to provide a synthesis of recent discoveries about type-2 innate lymphoid cells, especially, as they relate to the pathogenesis of asthma.

Recent findings

We focused on features and characteristics of type-2 innate lymphoid cells (ILC2s) that distinguish them from other type-2 cells, especially Th2 cells. We collected and reviewed data related to human asthma and airway ILC2s. We examined the concept of ILC2 memory and trained immunity. We also analyzed steroid resistance of ILC2s, which is relevant for steroid-resistant asthma.

The implications of the findings include an understanding of ILC2 inflammation, and pathways and molecules that can be targeted by biologics and other therapeutic agents for management severe and steroid-resistant asthma
Challenging Case: The Role of Genetic Testing in Complex Autism
Authors: Solgi Mohadeseh , Fernandez Jasmine , Zuckerman Katharine E. , Shapiro Desiree , Augustyn Marilyn
Published: November 2021

CASE:

S is a 12-year-old boy with autism spectrum disorder (ASD), seizure disorder, cerebral palsy, and intellectual disability who presented to the primary care clinician for a preventative care visit.

S was born at full term after an unremarkable pregnancy. His developmental delays were first noted at around 8 months, when he could not sit independently and had intermittently poor eye contact. He was referred to Part C Early Intervention and subsequently evaluated by a neurodevelopmental pediatrician, where he was noted to be hypotonic, with delayed motor and cognitive skills. Initial genetics evaluation included karyotype, fragile X testing, Angelman and Prader-Willi DNA fluorescence in situ hybridization probes, POLG sequencing, MECP2 testing, a microarray, creatinine kinase, very long-chain fatty acids, lymphocyte arylsulfatase, urine organic acids, and plasma amino acids, all of which were normal.

As time progressed, S continued to have motor and communication delays and developed choreic movements. He also developed episodes concerning for seizure, including periods of staring while awake and episodes of extremity shaking lasting a few seconds with associated eye deviation, which eventually progressed to generalized seizures. He also developed periods of lethargy. Outpatient workup included several EEGs, which were notable for foci in the right frontal and left temporal regions. He has had several brain MRIs showing generalized volume loss and had critical laboratory tests during a period of lethargy, which were unconcerning. He was treated with multiple antiseizure medications. He was diagnosed with ASD at age 5 years because of delayed language, poor social communication, and repetitive behaviors.

Over time, S continued to experience global developmental delays and autistic-like behaviors and remained minimally verbal. However, clinicians noted a number of developmental strengths, including a generally positive mood, a willingness to participate in therapy, improved receptive language skills, attachment to his mother, and a love of nature and the outdoors. He participated in a number of therapy modalities including speech/language therapy, occupational therapy, physical therapy, applied behavioral analysis, aqua therapy, partner-assisted scanning, and therapeutic horseback riding.

In 2019, whole-exome sequencing was newly covered by the state Medicaid program, and testing was obtained in 2020. Whole-exome sequencing revealed a de novo STXBP1 pathogenic variant c.874C>T (p.Arg292Cys), which is associated with developmental and epileptic encephalopathy. His presentation is consistent with STXBP1 encephalopathy including refractory epilepsy, ASD, intellectual disability, and movement disorders.

What are important considerations in genetic testing for children with autism? How does a genetic testing result alter management for clinicians and families?
Vasoprotective Actions of Nitroxyl (HNO): A Story of Sibling Rivalry
Authors: Kemp-Harper Barbara
Published: November 2021

Nitroxyl (HNO), the 1 electron-reduced and protonated form of nitric oxide (NO•), has emerged as a nitrogen oxide with a suite of vasoprotective properties and therapeutic advantages over its redox sibling. Although HNO has garnered much attention due to its cardioprotective actions in heart failure, its ability to modulate vascular function, without the limitations of tolerance development and NO• resistance, is desirable in the treatment of vascular disease. HNO serves as a potent vasodilator and antiaggregatory agent and has an ability to limit vascular inflammation and reactive oxygen species generation. In addition, its resistance to scavenging by reactive oxygen species and ability to target distinct vascular signaling pathways (Kv, KATP, and calcitonin gene-related peptide) contribute to its preserved efficacy in hypertension, diabetes, and hypercholesterolemia. In this review, the vasoprotective actions of HNO will be compared with those of NO•, and the therapeutic utility of HNO donors in the treatment of angina, acute cardiovascular emergencies, and chronic vascular disease are discussed.
Attitudes May Be Hard to Change: Canadian Organ Donors Consider Face and Hand Donation
Authors: Lafreniere Ann-Sophie , Al-Halabi Becher , Thibaudeau Stephanie , Temple-Oberle Claire
Published: November 2021

Objective:

Despite the success of composite tissue allograft (CTA) such as face and hand transplant at improving recipients’ quality of life, organ donors’ hesitation needs to be better understood. The aim of the study was to assess Canadian organ donors’ willingness to donate their face and hands, and the efficacy of an educational intervention.

Methods:

Canadians registered for organ donation were invited to complete an online survey about CTA. An interactive vignette was introduced part way through to clarify transplant-related concepts, with repeat of questions post-vignette exposure to assess attitudes pliability.

Results:

A total of 942 participants completed the survey. Fifty-two percent of donors were willing to donate their face after passing, whereas 80% were willing to donate their hands. Reasons to refuse CTA donation included the risk of upsetting their family, having someone look like them, and wanting their body to remain intact. Donors’ willingness to donate their face (38%, P < 0.001) and hands (79%, P = 0.67) decreased following vignette exposure. Comparative analysis of our interventional vignette with a similar study where donors’ donation readiness increased after an educational intervention revealed that our vignette lacked a strong enough emotional component to positively impact donors’ attitude to CTA, and may have exposed participants to alternatives to transplant they were not previously aware of.

Conclusions:

Canadian organ donors surveyed were willing to donate their face and hands following death, a willingness reduced after watching our informative vignette. Further qualitative work is required to better understand the educational needs and areas to address to increase donors’ acceptance of CTA.
The Association of Patient Educational Attainment With Cardiac Rehabilitation Adherence and Health Outcomes
Authors: Gaalema Diann E. , Savage Patrick D. , O'Neill Steven , Bolívar Hypatia A. , Denkmann Deborah , Priest Jeffrey S. , Khadanga Sherrie , Ades Philip A.
Published: November 2021

Purpose:

Participating in cardiac rehabilitation (CR) after a cardiac event provides many clinical benefits. Patients of lower socioeconomic status (SES) are less likely to attend CR. It is unclear whether they attain similar clinical benefits as patients with higher SES. This study examines how educational attainment (one measure of SES) predicts both adherence to and improvements during CR.

Methods:

This was a prospective observational study of 1407 patients enrolled between January 2016 and December 2019 in a CR program located in Burlington, VT. Years of education, smoking status (self-reported and objectively measured), depression symptom level (Patient Health Questionnaire), self-reported physical function (Medical Outcomes Survey), level of fitness (peak metabolic equivalent, peak oxygen uptake, and handgrip strength), and body composition (body mass index and waist circumference) were obtained at entry to, and for a subset (n = 917), at exit from CR. Associations of educational attainment with baseline characteristics were examined using Kruskal-Wallis or Pearson's χ2 tests as appropriate. Associations of educational attainment with improvements during CR were examined using analysis of covariance or logistic regression as appropriate.

Results:

Educational attainment was significantly associated with most patient characteristics examined at intake and was a significant predictor of the number of CR sessions completed. Lower educational attainment was associated with less improvement in cardiorespiratory fitness, even when controlling for other variables.

Conclusions:

Patients with lower SES attend fewer sessions of CR than their higher SES counterparts and may not attain the same level of benefit from attending. Programs need to increase attendance within this population and consider program modifications that further support behavioral changes during CR.
Building Capacity Through ICCPR Cardiovascular Rehabilitation Foundations Certification (CRFC)
Authors: Babu Abraham Samuel , Heald Fiorella A. , Contractor Aashish , Ghisi Gabriela L. M. , Buckley John , Mola Ana , Atrey Alison , Lopez-Jimenez Francisco , Grace Sherry L.
Published: November 2021

Purpose:

The International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) developed an online Cardiovascular Rehabilitation Foundations Certification (CRFC; https://globalcardiacrehab.com/Certification) in October 2017, to build cardiac rehabilitation (CR) delivery capacity in low-resource settings based on their guidelines. Herein we evaluate its reach globally, barriers to its completion, as well as satisfaction and impact of the course among those completing it.

Methods:

The country of origin of all applicants was tallied. An online survey was developed for learners who completed the CRFC (completers), and for those who applied but did not yet complete the program (noncompleters), administered using Google Forms.

Results:

With regard to reach, 236 applications were received from 23/203 (11%) countries in the world; 51 (22%) were from low- or middle-income countries. A total of 130 (55%) have completed the CRFC; mean scores on the final examination were 88.3 ± 7.1%, with no difference by country income classification (P= .052). Sixteen (22%) noncompleters and 37 (34%) completers responded to the survey. Barriers reported by noncompleters were time constraints, cost, and technical issues. Overall satisfaction (scale 1-5) with the CRFC was high (4.49 ± 0.51); most completers would highly recommend the CRFC to others (4.30 ± 0.66), and perceived that the information provided will contribute to their work and/or the care of their patients (4.38 ± 0.89); 29 (78%) had used the information from the CRFC in their practice.

Conclusions:

The reach of the CRFC still needs to be broadened, in particular in low-resource settings. Learners are highly satisfied with the certification, and its impacts on CR practice are encouraging. Input has been implemented to improve the CRFC.
Benchmarking Depressive Symptoms in Cardiac Rehabilitation
Authors: Middleton William A. , Savage Patrick D. , Khadanga Sherrie , Rengo Jason L. , Ades Philip A. , Gaalema Diann E.
Published: November 2021

Purpose:

Depression affects cardiac health and is important to track within cardiac rehabilitation (CR). Using two depression screeners within one sample, we calculated prevalence of baseline depressive symptomology, improvements during CR, and predictors of both.

Methods:

Data were drawn from the University of Vermont Medical Center CR program prospectively collected database. A total of 1781 patients who attended between January 2011 and July 2019 were included. Two depression screeners (Geriatric Depression Scale-Short Form [GDS-SF] and Patient Health Questionnaire-9 [PHQ-9]) were compared on proportion of the sample categorized with ≥ mild or moderate levels of depressive symptoms (PHQ-9 ≥5, ≥10; GDS-SF ≥6, ≥10). Changes in depressive symptoms by screener were examined within patients who had completed ≥9 sessions of CR. Patient characteristics associated with depressive symptoms at entry, and changes in symptoms were identified.

Results:

Within those who completed ≥9 sessions of CR with exit scores on both screeners (n = 1201), entrance prevalence of ≥ mild and ≥ moderate depressive symptoms differed by screener (32% and 9% PHQ-9; 12% and 3% GDS-SF; both P< .001). Patients who were younger, female, with lower cardiorespiratory fitness (CRF) scores were more likely to have ≥ mild depressive symptoms at entry. Most patients with ≥ mild symptoms decreased severity by ≥1 category by exit (PHQ-9 = 73%; GDS-SF = 77%). Nonsurgical diagnosis and lower CRF were associated with less improvement in symptoms on the PHQ-9 (both P< .05).

Conclusion:

Our results provide initial benchmarks of depressive symptoms in CR. They identify younger patients, women, patients with lower CRF, and those with nonsurgical diagnosis as higher risk groups for having depressive symptoms or lack of improvement in symptoms.
Implementation and Effectiveness of a Veterans Affairs–Based Comprehensive Lung Cancer Survivorship Program
Authors: Rabe Brian J. , Stafford Jordan W. , Hassinger Alisa D. , Swartzwelder Harry S. , Shofer Scott L.
Published: November 2021

Purpose:

Few programs exist to address persistent impairment in functional status, quality of life, and mental health in lung cancer survivors. We aimed to determine whether a 12-wk multimodal survivorship program imparts clinical benefit.

Methods:

Any patient at the Durham Veterans Affairs Medical Center with lung cancer and a Karnofsky score of ≥60 could participate. Chronic obstructive pulmonary disease medications were optimized at the enrollment visit. Participants with a Hospital Anxiety and Depression Scale (HADS) score of >8 were offered pharmacotherapy and mental health referral. Participants did home-based exercise with a goal of 1 hr/d, 5 d/wk. They were called weekly to assess exercise progress and review depression/anxiety symptoms. Participants were offered pharmacotherapy for smoking cessation.

Results:

Twenty-three (50%) of the first 46 enrollees completed the full 12-wk program. Paired changes from enrollment to completion (mean ± SD) were observed in 6-min walk test (73.6 ± 96.9 m, P = .002), BODE (Body mass index, airflow Obstruction, Dyspnea, and Exercise) index (−1.45 ± 1.64 points, P < .001), Duke Activity Status Index (3.84 ± 7.12 points, P = .02), Fried Frailty Index (−0.588 ± 0.939 points, P = .02), modified Medical Research Council dyspnea scale (−0.619 ± 1.284 points, P = .04), Functional Assessment of Cancer Therapy-Lung Emotional subscale score (1.52 ± 2.96 points, P = .03), HADS total score (−2.63 ± 4.34 points, P = .02), and HADS Anxiety subscale score (−1.47 ± 2.29 points, P = .01).

Conclusions:

A comprehensive Lung Cancer Survivorship Program provides clinically meaningful improvements in functional status, quality of life, and mental health.
Cross-sectional comparison of office and ambulatory pulse wave velocity by two methods, and their changes after lifestyle or medical interventions in hypertension
Authors: Batta Dóra , Körösi Beáta , Gyöngyösi Helga , Nemcsik-Bencze Zsófia , László Andrea , Tislér András , Cseprekál Orsolya , Nemcsik János
Published: November 2021

Objective:

Pulse wave velocity (PWV), the most accepted biomarker of arterial stiffening can be measured by different methods and in the past decade, its 24 h monitoring has also become available. The aim of our study was to compare office and ambulatory PWVs and in a proportion of patients to compare the changes of PWVs after the initiation of lifestyle modifications or antihypertensive medication.

Methods:

Office carotid–femoral PWV was measured with the tonometric PulsePen device (PP PWV), first hour and 24 h ambulatory oscillometric PWVs were evaluated with Mobil-O-Graph (MOB first hour PWV and MOB 24 h PWV, respectively). In new hypertensive patients, the measurements were repeated 3 months after the initiation of antihypertensive medication. In white-coat hypertensive patients after lifestyle modifications the measurements were repeated at 12 months.

Results:

One hundred and five participants were involved with 22 new hypertensive and 22 white-coat hypertensive (WhHT) patients. PP PWV [8.7 (7.3–9.9) m/s] differed from MOB first hour PWV [7.3 (6.5–8.8) m/s] and MOB 24 h PWV [7.4 (6.4–8.8) m/s] as well (P < 0.05). PP PWV significantly decreased both in hypertensive [by 0.9 (0.4–1.5) m/s, P < 0.05] and WhHT patients [by 0.3 (−0.1 to 1) m/s, P < 0.05]. MOB first hour PWV did not change neither in hypertensive patients, nor in WhHT patients. MOB 24 h PWV decreased only in hypertensive patients [by 0.2 (0–0.6) m/s], which was less pronounced compared with PP PWV (P < 0.05).

Conclusion:

The significant differences observed both in the cross-sectional and in the prospective parts of our study suggests that the two methods are not interchangeable.
The Switch From Paliperidone Long-Acting Injectable 1- to 3-Monthly
Authors: Mauri Massimo Carlo , Franco Gemma , Minutillo Alessandro , Paletta Silvia , Di Pace Chiara , Reggiori Alessandra , Baldelli Sara , Cattaneo Dario
Published: November 2021

Purpose/Background

The aim of the study was a preliminary evaluation of the maintenance of clinical efficacy and tolerability of paliperidone palmitate in patients with schizophrenia during the transition phase from 1-monthly paliperidone palmitate formulation (PP1M) to PP3M, with the evaluation of plasma levels of the drug.

Methods/Procedures

A prospective observational study was conducted for 13 months involving 22 outpatients, aged 18 to 66 years and clinically stabilized. Patients were affected by schizophrenia according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria. For each patient, clinical assessment, safety and tolerability, and drug plasma level determination were performed. Clinical efficacy was assessed by Brief Psychiatric Rating Scale, Positive and Negative Symptom Scale, and Hamilton Rating Scale for Depression. During the first 4 months of the study, once-monthly paliperidone palmitate was administered, and then during the following 9 months, the 3-monthly formulation was administered.

Findings/Results

The time course of the Brief Psychiatric Rating Scale total scores showed a statistically significant (P = 0.006) improvement from T0 to T8; Positive and Negative Symptom Scale scores showed a similar time course, with a statistically significant (P = 0.0016) reduction of the mean total score; Hamilton Rating Scale for Depression mean scores showed a statistically significant (P = 0.003) reduction with substantial maintenance of clinical stabilization of the patients. Only 1 patient dropped out after the first PP3M injection.

Implications/Conclusions

Our preliminary data currently confirm the maintenance of clinical stability shifting from PP1M to PP3M.
Liquid biopsies in pediatric oncology: opportunities and obstacles
Authors: Sundby R. Taylor , Pan Alex , Shern Jack F.
Published: November 2021

Purpose of review

Liquid biopsies have emerged as a noninvasive alternative to tissue biopsy with potential applications during all stages of pediatric oncology care. The purpose of this review is to provide a survey of pediatric cell-free DNA (cfDNA) studies, illustrate their potential applications in pediatric oncology, and to discuss technological challenges and approaches to overcome these hurdles.

Recent findings

Recent literature has demonstrated liquid biopsies’ ability to inform treatment selection at diagnosis, monitor clonal evolution during treatment, sensitively detect minimum residual disease following local control, and provide sensitive posttherapy surveillance. Advantages include reduced procedural anesthesia, molecular profiling unbiased by tissue heterogeneity, and ability to track clonal evolution. Challenges to wider implementation in pediatric oncology, however, include blood volume restrictions and relatively low mutational burden in childhood cancers. Multiomic approaches address challenges presented by low-mutational burden, and novel bioinformatic analyses allow a single assay to yield increasing amounts of information, reducing blood volume requirements.

Liquid biopsies hold tremendous promise in pediatric oncology, enabling noninvasive serial surveillance with adaptive care. Already integrated into adult care, recent advances in technologies and bioinformatics have improved applicability to the pediatric cancer landscape.
Nurses' Values and Perspectives on Medical Aid in Dying
Authors: Davidson Judy E. , Bojorquez Genesis , Upvall Michele , Stokes Felicia , Bosek Marcia Sue DeWolf , Turner Martha , Lee Young-Shin
Published: November 2021

The aim of this study was to describe the values and perspectives of nurses regarding medical aid in dying (MAiD). The values of nurses regarding this controversial topic are poorly understood. A cross-sectional electronic survey was sent to American Nurses Association nurse members; 2390 responded; 2043 complete data sets were used for analysis. Most nurses would care for a patient contemplating MAiD (86%) and less during the final act of MAiD (67%). Personally, 49% would support the concept of MAiD, and professionally as a nurse by 57%. Nurses who identified as Christian were less likely to support MAiD. Only 38% felt that patients should be required to self-administer medications; 49% felt MAiD should be allowed by advance directive. The study results provide new insight into the wide range of nurses' values and perceptions regarding MAiD. Health care policy and nursing standards need to be written to accommodate the wide variation in nurses' values.