bluuebunny/crossref_metadata_2025 huggingface dataset:
Recombinant Orthopoxvirus Primes Colon Cancer for Checkpoint Inhibitor and Cross-Primes T Cells for Antitumor and Antiviral Immunity
Authors: Kim Sang-In , Park Anthony K. , Chaurasiya Shyambabu , Kang Seonah , Lu Jianming , Yang Annie , Sivanandam Venkatesh , Zhang Zhifang , Woo Yanghee , Priceman Saul J. , Fong Yuman , Warner Susanne G.
Published: December 2020

Although it is known that oncolytic viruses can inflame and recruit immune cells to otherwise immunosuppressed tumor microenvironments, the influence of the antiviral immune response on antitumor immunity is less clear across viral platforms and tumor types. CF33 is a recombinant orthopoxvirus backbone effective against colon cancer. We tested derivatives of CF33 with and without immune-checkpoint inhibition (anti–PD-L1) in mouse models of colon cancer. Results showed that the efficacy of CF33 backbone with J2R deletion (single-deleted) against colon cancer is not altered by additional deletion of F14.5L in vitro or in vivo. CF33 infection upregulated PD-L1 expression on tumor cells and led to an increased influx of lymphocytes and macrophages in tumors. Also, the levels of active CD8+ (IFNγ+) T cells in the virus-treated tumors were higher than those in control-treated tumors. Furthermore, a combination of CF33 derivatives with anti–PD-L1 resulted in durable tumor regression and long-term survival, resistant to tumor rechallenge. Analysis of immune cells from the treated mice showed that tumor-specific T cell activation occurred more robustly in tumors treated with the virus and that T cells were more strongly activated against the virus than against tumor, in an MHC-I–dependent manner. Our findings warrant further studies on the role of cross-priming of T cells against viral and tumor antigens, in the overall success of viroimmunotherapy.
Personal Neoantigen Cancer Vaccines: A Road Not Fully Paved
Authors: Fritsch Edward F. , Burkhardt Ute E. , Hacohen Nir , Wu Catherine J.
Published: December 2020

Personal neoantigen–based cancer vaccines are designed to target antigens arising from tumor-specific mutations within individual cancers and present a tremendous opportunity to capitalize on their favorable and intrinsic properties of escape from central tolerance and exquisite tumor specificity. With the endpoint of creating an optimal T-cell army to attack a tumor, neoantigen-based vaccines have demonstrated the ability to coax naïve T-cell recruits against epitopes that do not induce spontaneous immunity to raise long-lasting T-cell responses against multiple tumor-specific epitopes and subsequently to extend the breadth of responses, as immunity begets immunity via epitope spreading. Importantly, on both preclinical and clinical fronts, the association of T-cell responses to neoantigens and favorable outcomes has been demonstrated time and time again. We recognize, however, that the path forward remains long and winding and requires the field to address several key challenges, particularly overcoming evolved tumor escape mechanisms and optimizing vaccine-induced immunity. Some challenges stem from gaps in science that enable in silico prediction of antigen presentation and recognition by T-cell receptors, whereas others stem from the logistical obstacles and cost of personalization. Nevertheless, with perseverance and innovative solutions, we have little doubt that the ability of neoantigen vaccination to induce potent cancer-specific T cells will fundamentally succeed in enabling greater effectiveness of a broad array of immunotherapies. We provide our perspective on the progress and the remaining challenges to realizing the opportunity of personal neoantigen cancer vaccines.
Sphingosine-1-Phosphate Receptor 3 Potentiates Inflammatory Programs in Normal and Leukemia Stem Cells to Promote Differentiation
Authors: Xie Stephanie Z. , Kaufmann Kerstin B. , Wang Weijia , Chan-Seng-Yue Michelle , Gan Olga I. , Laurenti Elisa , Garcia-Prat Laura , Takayanagi Shin-ichiro , Ng Stanley W.K. , Xu ChangJiang , Zeng Andy G.X. , Jin Liqing , McLeod Jessica , Wagenblast Elvin , Mitchell Amanda , Kennedy James A. , Liu Qiang , Boutzen Héléna , Kleinau Melissa , Jargstorf Joseph , Holmes Gareth , Zhang Yang , Voisin Veronique , Bader Gary D. , Wang Jean C.Y. , Hannun Yusuf A. , Luberto Chiara , Schroeder Timm , Minden Mark D. , Dick John E.
Published: December 2020

Acute myeloid leukemia (AML) is a caricature of normal hematopoiesis driven from leukemia stem cells (LSC) that share some hematopoietic stem cell (HSC) programs including responsiveness to inflammatory signaling. Although inflammation dysregulates mature myeloid cells and influences stemness programs and lineage determination in HSCs by activating stress myelopoiesis, such roles in LSCs are poorly understood. Here, we show that S1PR3, a receptor for the bioactive lipid sphingosine-1-phosphate, is a central regulator that drives myeloid differentiation and activates inflammatory programs in both HSCs and LSCs. S1PR3-mediated inflammatory signatures varied in a continuum from primitive to mature myeloid states across cohorts of patients with AML, each with distinct phenotypic and clinical properties. S1PR3 was high in LSCs and blasts of mature myeloid samples with linkages to chemosensitivity, whereas S1PR3 activation in primitive samples promoted LSC differentiation leading to eradication. Our studies open new avenues for therapeutic target identification specific for each AML subset.

Significance:

S1PR3 is a novel regulator of myeloid fate in normal hematopoiesis that is heterogeneously expressed in AML. S1PR3 marks a subset of less primitive AML cases with a distinct inflammatory signature and therefore has clinical implications as both a therapeutic target and a biomarker to distinguish primitive from mature AML.

See related commentary by Yang et al., p. 3.

This article is highlighted in the In This Issue feature, p. 1
Transcatheter Mitral Valve Repair in Patients with Heart Failure: A Meta-Analysis
Authors: Vallakati Ajay , Hasan Ayesha K , Boudoulas Konstantinos Dean
Published: December 2020

Background: Severe secondary mitral regurgitation (MR) is associated with poor prognosis in heart failure patients with left ventricular systolic dysfunction. Few observational and randomized controlled studies demonstrated the efficacy of transcatheter mitral valve repair in heart failure patients with significant MR. A meta-analysis of published studies was performed to evaluate the role of transcatheter mitral valve repair using the MitraClip device in heart failure patients with significant secondary MR. Methods: A literature search was performed using PubMed, Cochran CENTRAL, and Embase databases using the search terms “percutaneous mitral valve repair” or “transcatheter mitral valve repair” and “heart failure.” Studies that compared medical therapy plus transcatheter mitral valve repair using MitraClip to medical therapy alone in heart failure patients with significant secondary MR were included for pooled analysis. A random-effects model with the Mantel-Haenszel method was used to analyze the data. Results: Four studies, 2 randomized controlled and 2 nonrandomized studies met the criteria for analysis. Pooled analysis included a total of 1,421 patients, of which 746 patients underwent transcatheter mitral valve repair and 675 patients received medical therapy alone. When compared to medical therapy, transcatheter mitral valve repair significantly decreased all-cause mortality (OR 0.58, 95% CI 0.37–0.91; p = 0.02). A trend toward significant reduction in rehospitalizations (OR 0.35, 95% CI 0.12–1.00; p = 0.05) was also observed. Periprocedural complications ranged from 7.5 to 12.6%. Conclusion: Evidence from pooled analysis suggests that transcatheter mitral valve repair using MitraClip on top of medical therapy, in appropriately selected symptomatic heart failure patients with significant secondary MR, provides survival benefit and may decrease hospitalizations when compared with guideline-directed medical therapy alone.
Personalized Medicine and Cervical Screening: Development of Individualized Quantitative Risk Assessments for Cervical Adenocarcinoma and Adenocarcinoma in situ
Authors: Jones Terri E. , Onisko Agnieszka , Austin R. Marshall
Published: December 2020

Introduction: Cervical screening has decreased the incidence of cervical carcinoma around the world primarily by preventing cervical squamous carcinoma, with significantly less measurable protective benefits in prevention of cervical adenocarcinoma. In this study, we apply Bayesian modeling of cervical clinical, screening, and biopsy data from a large integrated health system to explore the feasibility of calculating personalized risk assessments on screened system patients for subsequent histopathologic diagnoses of invasive cervical adenocarcinoma (AdCa) or cervical adenocarcinoma in situ (AIS). Materials and Methods: Diagnoses of cervical AIS or AdCa rendered between 2005 and 2018 were identified in our large health system database with 1,053,713 cytology results, 354,843 high-risk (hr) human papillomavirus (HPV) test results, and 99,012 cervical histopathologic results. Using our continuously updated Bayesian cervical cancer screening model which includes clinical data, cervical screening results, and cervical biopsy results, we projected quantitative estimates of patients’ 5-year cumulative risk for cervical AIS or AdCa. Results: 161 patients were identified with AIS (ages 17–75, mean 37 years), and 99 patients had diagnoses of cervical AdCa (ages 26–91, mean 48 years). Quantitative Bayesian 5-year cumulative risk projections for diagnoses of cervical AdCa or AIS in patients with different cervical screening test and biopsy histories were determined. The highest patient risk projections for subsequent cervical AdCa and/or AIS histopathologic diagnoses were associated with prior cervical screening test results of HPV-positive atypical glandular cells. Prior squamous cytologic abnormalities were associated with lower risk estimates. Prior histopathologic diagnoses of squamous abnormalities also influenced quantitative risk. A prior histopathologic diagnosis of AIS was associated with a very low risk of subsequent AdCa, consistent with effective excisional treatment. AdCa risk was greatest in women aged 30–65 years with prior CIN3 biopsy results, whereas AIS risk was greatest in women <30. Conclusion: Prevention of cervical AdCa in screened patients remains a major challenge for cervical screening. Individualized risk projections for cervical glandular neoplasia reflecting patient age, prior cervical screening test results, and prior cervical biopsy history are feasible using Bayesian modeling of health system data.
The Phenomenon of Dynasties of Jewish Doctors in the Mamluk Period (1250–1517)
Authors: Mazor Amir , Lev Efraim
Published: December 2020

This article discusses the phenomenon of dynasties of Jewish physicians in the Late Middle Ages in Egypt and Syria. Based on Muslim Arabic historiographical literature on the one hand, and Jewish sources such as Genizah documents on the other, this paper reconstructs fourteen dynasties of Jewish physicians that were active in the Mamluk Sultanate (1250–1517). Examination of the families reveals that the most distinguished dynasties of court physicians were of Jewish origin, and had to convert to Islam during the Mamluk period. Moreover, the office of the “Head of the Physicians” was occupied mainly by members of these convert Jewish dynasties. This situation stands in stark contrast to the pre-Mamluk period, in which dynasties of unconverted Jewish court physicians flourished. However, Jewish sources reveal that dynasties of doctors who were also communal leaders continued to be active also during the Mamluk period.
ONSTAGE, the Online Data System of Theatre in Amsterdam from the Golden Age to Today
Authors: Blom Frans R. E. , Nijboer Harm , van der Zalm Rob
Published: December 2020

ONSTAGE is the data repository for Amsterdam’s first and most prominent public theatre venue: the Schouwburg. In theatre history, the Amsterdam Schouwburg has a fairly unique place due to its rich body of extant account books, programs and administrative records of annual play lists, and registers of expenses and revenues. These sources, as a most sensitive finger on the theatre’s pulse, can be used as analytical tools that provide access to the theatre’s artistic business, from its foundation in 1638 until today. This data paper is an assessment of the new ONSTAGE data system, in terms of its structure, the nature of the data and enrichment, and the research potential. The paper also explores future growth in linked data systems.
South Korea's Scramble for Africa: Complexities and Implications
Authors: Curry Mark
Published: December 2020

South Korea had recently made agreements to secure large-scale deals in Tanzania, among other places, to secure cheap, long term agriculture supplies. Having limited experience in Africa, the potential for problems with Korea’s partners is great. The feasibility, desirability and legitimacy of such projects must be examined to forestall difficulties. Africa’s volatility and Tanzania’s complex historical context likewise need to be understood alongside Korea’s own history of colonization of Tanzanian indigenous people’s land. Also, Korea’s geopolitical standing and emergency as a developed county are implicated by such ventures. Significantly, securing future food resources by controlling large territories in distant continents is relevant to any discussion of Korea’s security and international relations.
Dynamic Asset Allocation under Mispricing, Predictability and Portable Alpha
Authors: Kang Hyoung-Goo
Published: December 2020

The existing literature about portfolio management has investigated how to update a portfolio allocation, conditional on the information that possibly predicts asset returns and volatilities. We add several innovations to fill the lacuna of prior research in the contexts of global asset allocation. First, we suggest a simple method of how to rebalance portfolios automatically and dynamically in order to exploit potential market inefficiencies. The existing literature has not developed such a strategy. Out-of-sample tests demonstrate that our strategy dominates both static allocation and dynamic strategies that do not account for possible mispricing. Thus, our strategy can contribute not only to academia, but also to practical portfolio managers who endeavour to beat markets. Second, we elaborate portable alpha strategies using the new dynamic strategy. Once we add an alpha strategies using the new dynamic strategy. Once we add an alpha portfolio to existing portfolios, then they perform better in terms of mean and risk. Thus, it makes our alpha portfolio portable, i.e., we can apply the alpha portfolio to any fund and can enhance its performance. Third, our dynamic strategy implies a convenient method to estimate a conditional mean and covariance matrix as functions of predictive information matrix without consuming much computational risk managers and traders who need to control the risks of large target portfolios on a real time basis.
Phanuromyia ricaniae Nam, Lee & Talamas sp. n. (Hymenoptera: Scelionidae) reared from the eggs of Ricania shantungensis Chou & Lu (Hemiptera: Ricaniidae) in Asia
Authors: NAM SANGHYEOK , CHEN HUA-YAN , TALAMAS ELIJAH J. , LEE GWAN-SEOK , DONG WEI , SUN LI-JUAN , LEE SEUNGHWAN
Published: December 2020

The genus Phanuromyia in the subfamily Telenominae (Hymenoptera: Scelionidae) consists of 60 described species, for which host records indicate they are egg parasitoids of lanternflies and planthoppers (Hemiptera: Auchenorrhyncha). In this study, we describe a new species of the genus, P. ricaniae sp. n., reared from the eggs of a planthopper, Ricania shantungensis Chou & Lu (Hemiptera: Ricaniidae). This planthopper has been considered as a serious invasive pest in South Korean agriculture. Ricania shantungensis has a wide host range, including economically important crops such as apple, peach, and pear. Phanuromyia ricaniae therefore has the potential to be a biological control agent against ricaniid planthoppers.
The first phylogenetic study of sword-tail crickets from China inferred from COI, 18S and 28S genes, with the establishment of two new genera and description of one new species (Orthoptera: Grylloidea: Trigonidiidae)
Authors: HE ZHU-QING , SHEN CHU-ZE , WU XUE
Published: December 2020

The phylogenetic tree of Chinese Trigonidiinae species was reconstructed based on one mitochondrial fragment (COI) and two nuclear ribosomal loci (18S and 28S). According to the concatenated trees, we define four genus groups with high nodal supports. The subgenus Paratrigonidium should be upgraded to genus status. A new genus Abstrigonidium He gen. nov. is established and Paratrigonidium chloropodum is selected as type species (A. chloropodum comb. nov.). Amusurgus (Paranaxipha) fujianensis is moved to genus Sectus as S. fujianensis comb. nov. A new species named as Emerasoma curvicerca He gen. et sp. nov. is reported. It differs from other genera by asymmetric genitalia, and lacking stridulatory files and mirror. The type specimens are deposited in Museum of Biology, East China Normal University (ECNU).
“Bad hombres” at the Southern US border? White nationalism and the perceived dangerousness of immigrants
Authors: Kulig Teresa C , Graham Amanda , Cullen Francis T , Piquero Alex R , Haner Murat
Published: December 2020

As a candidate and as president, Donald Trump heightened the salience of immigration, portraying those crossing the nation’s Southern border as “bad hombres” and advocating building a wall blocking their access to the United States from Mexico. Based on a 2019 MTurk study of 465 White adults, the current study found that a clear majority of respondents rejected this stereotype of Southern immigrants as “bad hombres,” judging them to be just as law-abiding as Americans. Importantly, however, the analysis revealed that two innovative measures—Hispanic resentment and, in particular, White nationalism—were consistently related to perceptions of immigrants as criminogenic. Given the growing demographic diversity of the United States, future research should consider the increasing influence of racial/ethnic resentment and White group identity on public opinions about immigration and other justice issues.
Investigating Open-access Booking in New Brunswick Occupational Therapy
Authors: Speed David , Fyffe Shelley
Published: December 2020

Background.

Open-access booking (OAB) describes administrative changes to improve system efficiency. However, OAB studies have focused on GP practices and have not applied OAB to other health care services.

Purpose.

The purpose of the study was to investigate the associations between OAB and administrative outcomes in the Saint John region.

Method.

Evaluators compared three years of pre-OAB data against two years of post-OAB data using an interrupted-time series design (February 2014–January 2019).

Findings.

OAB was associated with a 12% jump in the likelihood of being discharged within three months even though clients received an equivalent level of service. OAB was not associated with more missed appointments (∼8% vs. ∼7%). While OAB was not associated with reduced wait times, the post-OAB period handled a larger number of client referrals, which may explain the null finding.

Implications.

OAB shows potential for improving administrative outcomes, but further research is needed.
Bilateral Eagle Syndrome
Authors: Dabrowski Dominik S. , Ghali Ghali E. , Cotelingam James D.
Published: December 2020

Significance Statement

Unilateral Eagle Syndrome is relatively rare and highlights important concepts in anatomy and pathophysiology. Bilateral Eagle Syndrome is exponentially more rare and has only been mentioned several times in the literature. Understanding the impact this can have on the human body and the severity of symptoms and sequelae is valuable for several types of specialists that treat this disorder.
A spike in the scientific output on social sciences in Vietnam for recent three years: Evidence from bibliometric analysis in Scopus database (2000–2019)
Authors: Pham-Duc Binh , Tran Trung , Trinh Thao-Phuong-Thi , Nguyen Tien-Trung , Nguyen Ngoc-Trang , Le Hien-Thu-Thi
Published: December 2020

Bibliometric analysis of 3105 publications retrieved from the Scopus database was conducted to evaluate bibliographic content of scientific output on social sciences in Vietnam, for the 2000–2019 period. Our main findings show that the number of publications on social sciences from Vietnam has increased significantly over the last two decades, and there was a spike in the scientific output for the recent three years when the number of publications accounted for 53.76% of the collection. The most productive authors came from a few public research institutes with strong resources as the top 10 institutions participated in 44.22% of the collection. Vietnamese scholars tend not to submit their works to high-ranking journals since five Q1 journals in the top 10 publishing journals published only 6.17% of the collection. For international collaboration, Australia and the United States ranked first and second based on the number of publications and citations. Other countries in top 10 mostly located in Europe and Asia. Research topics were diverse focusing on gender, poverty, HIV, higher education and sustainable development. We suggest that supporting policies and funding need to be provided to help Vietnamese scholars improve their works, and to boost their scientific production in the future.
The Design of the RAND Health Insurance Experiment: A Retrospective
Authors: Newhouse Joseph P.
Published: December 2020

This article, prepared as part of a special issue on multiarmed experiments, describes the design of the RAND Health Insurance Experiment, paying particular attention to the choice of arms. It also describes how the results of the Experiment were used in a simulation model and, looking back, how the design might have differed, and how the results apply today, 4 decades after the Experiment was conducted.
Comparative effects on pain arising from injury to the knee meniscus in adults: A systematic review and network meta-analysis
Authors: Zhang Yongni , Cao Wuting , Cao Qin , Zhu Yi
Published: December 2020

Objective:

To identify the most effective pain management method for meniscus injuries by comparing pain relief observed with several common interventions including combined different combinations of surgery and exercise, surgery alone, supervised exercise alone and home exercise alone.

Methods:

PubMed, Embase, CINAHL, Cochrane Library, Web of Science, SportDiscus, and PEDro were searched from database inception through October 15, 2020. Randomized controlled trials investigating the effect of surgery and exercise for meniscus injuries by using the visual analogue scale (VAS) assessment were eligible for inclusion. Primary outcome was mean change in VAS score from baseline. Comparisons between interventions were made through use of random-effects network meta-analysis over the short-term (three months) and mid-term (12 months). Relative ranking of therapies was assessed by the surface-under-the-cumulative ranking possibilities. All reference lists of included studies were hand-searched.

Results:

We investigated six RCTs (total n = 796 patients). No significant difference was found between different treatments of pain control in three months and 12 months. The surface under the cumulative ranking curves suggested that supervised exercise combined with surgery was considered most likely to overshadow other treatments in reducing short-term pain (surface under cumulative ranking curve (SUCRA) values: 98.1; mean ranks: 1.1) and mid-term pain (SUCRA values: 97.2; mean rank: 1.1).

Conclusion:

There is not sufficient evidence to identify any preferred or more effective surgical and/or exercise-based treatment program.
Impact of neurotrophic factors combination therapy on retinitis pigmentosa
Authors: Yin Xiaobei , He Ting , Chen Rui , Cui Hui , Li Genlin
Published: December 2020

Objective

We aimed to determine the location of neurotrophic receptors tropomyosin receptor kinase (Trk)B, TrkC, and ciliary neurotrophic factor receptor (CNTFR)α in the retina of retinal degeneration ( rd) mice and to explore the dynamic changes of B-cell lymphoma-2 (Bcl-2), Bcl-2-associated X-protein (Bax), and microtubule-associated protein light chain 3 (LC3) expression and ultrastructure in the retina of rd mice intravitreally injected with neurotrophic factors.

Methods

Rd mice aged 2 and 3 weeks post-natally (PN) received intravitreal injections of neurotrophic factors. Two weeks later, their retinas were harvested for the detection of Bax, Bcl-2, and LC3 mRNA and protein expression.

Results

TrkB and TrkC expression levels were lower at 3 weeks PN compared with 0, 1, and 2 weeks PN, but CNTFRα expression was still detected in certain layers. The three receptors were expressed in different retinal layers at the same timepoint. Bax expression was downregulated in, rhBDNF + rhCNTF, rhBDNF + rhNT-3, groups 2 weeks after intravitreal injection; Bcl-2 expression was upregulated in the rhBDNF + rhCNTF + rhNT-3 group at PN-4w; and LC3 expression was upregulated in rhBDNF + rhCNTF + rhNT-3 groups.

Conclusions

The combined use of neurotrophic factors had a more significant effect on Bax, Bcl-2, and LC3 expression than the same factors used alone.
Can Patient-Reported Outcomes Predict the Need for Secondary Surgeries After Hip Arthroscopy?
Authors: Shapira Jacob , Bheem Rishika , Kyin Cynthia , Rosinsky Philip J. , Meghpara Mitchell B. , Maldonado David R. , Lall Ajay C. , Domb Benjamin G.
Published: December 2020

Background:

Patient-reported outcomes (PROs) capture the postoperative period and reflect the patient’s perspective of one’s own recovery. However, it is unknown if PROs can reflect and predict the need for secondary surgeries after a primary hip arthroscopy.

Purpose:

To examine if PROs at 3 months and 1 year after primary hip arthroscopy were correlated with future reoperations and determine the critical thresholds for significant PROs utilizing a multivariate logistic regression analysis and receiver operator characteristic (ROC) analysis.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

Data on consecutive patients who underwent primary hip arthroscopy between February 2008 and August 2018 was retrospectively reviewed. Patients were included for analysis if they had the following PROs preoperatively and at 3 months and 1 year postoperatively: modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and visual analog scale (VAS) for pain. Patients were split into 2 groups: those who underwent secondary surgery and those who did not. Patient variables, intraoperative labral treatment, preoperative PROs, and postoperative PROs were compared between the 2 groups. A multivariate logistic regression analysis and ROC analysis were deployed to evaluate the correlation between PROs and the need for future surgery.

Results:

A total of 911 primary arthroscopy cases were included in this study. While age, body mass index, labral treatment, and 3-month and 1-year follow-up mHHS, NAHS, and VAS were significant in the bivariate analysis, the multivariate logistic regression analysis only found 1-year mHHS to be significant in the final model ( P < .05). The ROC curve for 1-year mHHS demonstrated acceptable discrimination between patients requiring secondary surgery and patients not requiring secondary surgery with an area under the curve of 0.73. Using the Youden index, a threshold of 80.5 was determined for the 1-year mHHS.

Conclusion:

The risk for secondary procedures may be evaluated with mHHS at 1 year after primary hip arthroscopy. Surpassing a score of 80.5 may be associated with a 74.4% reduction in risk for either a revision hip arthroscopy or a conversion to hip replacement.
International Negotiations and Domestic Change in the EU’s Eastern Neighborhood: Deconstructing Antidiscrimination Reforms in Moldova
Authors: Axyonova Vera , Cenuşa Denis , Gawrich Andrea
Published: December 2020

Democratic reforms, or lack thereof, in countries addressed by the European Union’s (EU’s) Eastern Partnership initiative (EaP) have attracted considerable scholarly attention. Yet many studies approach these countries’ political and policy developments through the lens of external actors’ (especially the EU and Russia’s) engagements. While accounting for international influences, this article lends agency to the domestic actors by scrutinizing the antidiscrimination reform process in Moldova, one of the EaP countries with closer relations to the EU, against the background of their negotiations. In doing so, the article explains the outcome of the reform and makes a case for applying Robert Putnam’s (1988) Two-Level-Game approach to an analysis of a controversial reform process surrounded by international and domestic pressures in a nonconsolidated democracy. In addition to its empirical contribution, the article seeks to advance the applicability boundaries of the Two-Level-Game theory beyond classical Foreign Policy Analysis in a democratic context and enhance the scholarly debate on the external–domestic interplay in policy change and norm adoption.
Enacting sabotage in siblings’ conflicts: Desired objects and deceptive bodies
Authors: Zotevska Emilia , Cekaite Asta , Evaldsson Ann-Carita
Published: December 2020

The present study examines sibling’ conflict trajectories with a specific focus on acts of sabotage – deliberate obstruction or destruction of activities with an object. Multimodal interaction analysis is used to understand how siblings’ conflicts are organised through multiple (verbal and embodied) practices. We further draw on childhood studies that focuses on children’s material practices and use the term enactment to better understand human-nonhuman relations. The study found that children put considerable time and energy into configuring deceptive bodies that both organised and disrupted their local moral orders.
A systematic approach towards implementing value-based health care in heart failure: Understandings from retrospective analysis methods in South London
Authors: Burnhope Emma , Waring Michael , Guilder Andrew , Malhotra Bharti , Cardoso Jorge M , Razavi Reza , Carr-White Gerald
Published: December 2020

Background

Value-Based Health Care (VBHC) is an evolving model of healthcare delivery aimed at achieving better patient outcomes at lower costs to the healthcare provider. The practise of VBHC requires efficient information systems with good reporting capability and subsequent outcome measuring. Information systems within the National Health Service (NHS) are often multiple and not necessarily integrated to one another. We therefore developed a systematic approach to collecting, validating and analysing data from multiple sources and information systems, with the aim of designing and endorsing an automatic system to capture health outcomes data in heart failure to support future VBHC models.

Methods

A retrospective cohort of heart failure patients with reduced ejection fraction undergoing Implantable Cardioverter Defibrillator (ICD) or Cardiac Resynchronization Therapy (CRT) procedures within a limited geographical area in South London were evaluated. A purpose built database was created to integrate, transform and validate health care data from multiple information systems.

Results

Validation analysis shows that our implemented methodology has produced a robust dataset. Our limited cohort of 134 patients does not allow for any complex statistical analysis however has identified some important themes related to outcomes and costs.

Conclusion

We have created a validated database specific to our Trust that can be upscaled locally with ease and transferred to other health diseases. Due to variations in local procedure from one Trust to another, this methodology now requires implementation across multiple sites to understand differences in transformation of data and outcome measuring.
Enhancement of air entrainment in ejector-diffuser using plate guidance at slots to reduce infrared emission
Authors: Singh L , Singh SN , Sinha SS
Published: December 2020

Ejector-diffuser reduces infrared emissions and are installed in combat aircraft to counter the threat of heat-seeking missile. The specific role of an ejector-diffuser is to reduce the heat emissions without substantially affecting the engine performance. The present study investigates a new design of ejector-diffuser wherein straight-plates and hybrid-straight-plates are installed at each slot for improving the ejector-diffuser performance. The evaluation criteria of an ejector-diffuser is specified in terms of air entrainment through the slots, thermal characteristics, and recovery of pressure. This work is carried out in two stages. In the first part, the orientation of the plate at the slot is investigated by varying the angle between the slot and diffuser axis over the range [Formula: see text]. The overall mass entrainment increases from 2.88 to 4.04 with the increase in plate angle. Further, the thermal characteristics also improves with increase in plate angle, but the pressure recovery decreases from 0.701 to 0.155. In the second part, the straight-plate at the slots are partially/fully replaced by hybrid-plate. Two configurations are proposed by first introducing a hybrid-plate at the first slot and straight-plate at the other slots, and subsequently by introducing hybrid-plate at all the slots. It is found that the pressure recovery in both the cases shows a significant improvement compared to the straight-plate case, the value being close to 0.75 for both the cases. However, the cumulative mass entrained by the first configuration of the hybrid-plate is better than the second configuration and is similar to the straight-plate guidance of 28°. Thus, the current study proposes an IRSS device having the hybrid-plate at the first slot and the straight-plate guidance at the remaining slots which reduces infrared emissions with minimum loading on the engine.
Preliminary parameters design for a long endurance unmanned helicopter with low rotor-disc loading
Authors: Zhao Hong , Li Jian-Bo , Wang Yuan , Wang Zhi-Gang
Published: December 2020

This paper investigates the design of a long-endurance unmanned helicopter (LEUH) with low rotor disc loading (LRDL) and low rotor speed (LRS). Due to the flaws in flying qualities caused by the LRDL and the LRS, this paper establishes a flying quality evaluation model in which handling qualities (FQs) and flight control (FC) are introduced into the distributed multi-objective collaborative optimization (DMOCO) of the helicopters. The comprehensive design optimization on preliminary parameters of the LEUH in wind shear is also carried out. Numerical simulation results show that the LRDL and the LRS technologies are successfully applied to LEUH, with the FQs and the flight performance considered. Compared with A160 LEUH, the payload load ratio is significantly improved.
Disseminated nocardiosis in an immunosuppressed patient with systemic lupus erythematosus and neuromyelitis optica spectrum disorder
Authors: Terebelo Sima , Sharif Sara , Chaudhry Zeshan A , Ginzler Ellen
Published: December 2020

Opportunistic infections are an ongoing concern in patients with autoimmune disease who are being treated with immunosuppressive agents. Nocardiosis is an uncommon opportunistic infection which has been reported in association with immunosuppressed patients and autoimmune disease. It is challenging to diagnose and can have multisystem manifestations. Failure to diagnose and appropriately treat can result in significant mortality. We present a 49 year old woman with systemic lupus erythematosus and neuromyelitis optica spectrum disorder who was treated with mycophenolate mofetil, prednisone and recent plasmapheresis. She developed acute onset of shortness of breath and fevers and was ultimately diagnosed with disseminated nocardiosis with lung, brain and muscle abscesses.
Effects of transcutaneous electrical acupuncture point stimulation on peripheral capillary oxygen saturation in elderly patients undergoing colonoscopy with sedation: a prospective randomized controlled trial
Authors: Chen Yongming , Gong Yin , Huai Xiaorong , Gu Xiyao , Su Diansan , Yu Weifeng , Xie Hong
Published: December 2020

Introduction:

This study investigated whether transcutaneous electrical acupuncture point stimulation (TEAS) at PC6 can reduce the proportion of elderly patients experiencing a drop of ⩾4% in peripheral capillary oxygen saturation (SpO2) while undergoing colonoscopy under sedation.

Methods:

A total of 32 elderly patients (aged ⩾ 65 years) scheduled for colonoscopy were randomly assigned in a 1:1 ratio to receive either real or sham TEAS (treatment or control groups, respectively). Each patient received oxygen (2 L/min) delivered routinely via nasal cannula. The treatment group was given TEAS at PC6 for 20 min at 2 Hz frequency and 6 mA intensity; the control group underwent the same procedures but with zero frequency/intensity. SpO2 and other physiological parameters were measured prior to sedation and colonoscopy (baseline) and at seven other timepoints through departure from recovery. Depth of anesthesia was measured using a Narcotrend monitor.

Results:

Significantly fewer patients in the treatment group experienced a ⩾4% decrease from baseline SpO2 (2/16) than patients in the control group (10/16; p = 0.004). The two groups were comparable with regard to respiratory rate, systolic and diastolic blood pressures, mean arterial pressure, and heart rate.

Conclusion:

TEAS applied at PC6 with 2 Hz frequency was feasible and may be helpful in reducing the rate of hypoxia in elderly patients during colonoscopy. Trial registration number: NCT03775122 (ClinicalTrials.gov).
A woman with fever and confusion
Authors: Hsu Hung-Lin , Lee Wei-Jing
Published: December 2020

A 37-year-old HIV-positive woman presented to the emergency department with fever, headache, confusion, and seizures for 3 days. Computed tomography of the head with contrast demonstrated multiple ring-enhancing masses. An eccentric mural nodule in ring-enhanced mass characterizes eccentric target sign, which is pathognomonic for cerebral toxoplasmosis. The patient received anti-toxoplasmic therapy and had marked clinical improvement.
Factor Structure of the Vocational Identity Status Assessment (VISA) in University, Liberal Arts, and Community College Students
Authors: Weigold Arne , Weigold Ingrid K. , Gregor Margo A. , Thornton Emily M.
Published: December 2020

The Vocational Identity Status Assessment (VISA) measures vocational identity development in adolescents and emerging adults. Although the initial six-factor structure has been confirmed, there have not yet been studies assessing other plausible factor structures. Additionally, the VISA has not previously been examined in some major types of institutions of higher education in the United States. The current study assessed five potential factor structures for the VISA in three college student samples: 857 from a large public university, 196 from a small, private, minority-majority liberal arts college, and 320 from a community college. The six-factor structure was the best-fitting model of the ones examined and showed evidence of multigroup invariance up to the strict level. There were notable latent mean differences across samples, as well as frequency differences for vocational identity statuses. These findings have implications for the appropriate modeling of the VISA and its use within diverse college student samples.
Quantifying cognition and fatigue to enhance the sensitivity of the EDSS during relapses
Authors: Morrow Sarah A , Conway Devon , Fuchs Tom , Wojcik Curtis , Unverdi Mahmut , Yasin Faizan , Pol Jeta , Eckert Sveltlana , Hojnacki David H , Dwyer Michael , Zivadinov Robert , Weinstock-Guttman Bianca , Benedict Ralph HB
Published: December 2020

Background:

Cognition is affected by relapses in persons with multiple sclerosis (PwMS), yet the Expanded Disability Status Scale (EDSS) does not readily detect cognitive changes.

Objective:

The objective of this study is to improve the detection of cognitive decline during relapses, by incorporating the Symbol Digit Modalities Test (SDMT) into the cerebral Functional System Score (CFSS) of the EDSS.

Methods:

This prospective study recruited PwMS from three dedicated MS centers. All subjects had EDSS, SDMT, and Fatigue Severity Scale (FSS) administered. Subjects experiencing a relapse were assigned to the relapse group (RG). Matched controls from the larger cohort were assigned to the stable group (SG). RG and SG subjects underwent the same evaluation at relapse and 3 months later. Our main outcomes were a modified CFSS (m-CFSS) and modified EDSS (m-EDSS), incorporating SDMT and FSS, accounting for cognitive performance and fatigue rating, during relapse.

Results:

The full cohort included 592 subjects; 80 qualified for RG and 72 were matched to the SG. The m-CFSS was significantly higher than CFSS at baseline (median = 2 vs. median = 0, p < 0.001) and relapse (median = 2 vs. median = 1, p < 0.001). The m-EDSS was higher than EDSS (median 3.0 vs. 2.5, p = 0.02) at relapse, where 35 RG subjects (43.8%) had higher m-EDSS than EDSS at relapse.

Conclusion:

This study demonstrates that incorporating the SDMT and FSS improves the accuracy of the EDSS, by accounting for cognitive changes, during relapse activity.
A novel ethical approach to moral distress during COVID 19 in New York
Authors: Dolgin Janet , McLeod-Sordjan Renee , Markowitz Walter , Sanmartin Maria
Published: December 2020

The initial surge of COVID19 patients in New York, created a surge of unprecedented numbers in the largest integrated hospital system of the New York City and surrounding Long Island region. Due to innovation and clinician ingenuity ventilator allocation was going to have an easier solution than alleviating the moral distress of overworked and understaffed clinicians. Through the innovative work of clinicians, leadership and the leadership of Governor Cuomo and hospital executives, the need for triaging ventilators did not become a reality. Yet the need for ethicists to support and aid clinicians in the discernment and need for escalation for scarce ICU resources and personnel was key. The transition from an allocation strategy of ventilators organically occurred as rapidly as the surge of COVID19 as it became clear that addressing clinician distress was imperative to maintain the level of human capital. An allocation strategy was envisioned that would assess the urgency of need for intensive care resources utilizing established decision aid calculators. In a mixed method quantitative and qualitative review, this article utilizes descriptive data to illustrate the lessons learned from utilizing ethics consultants to review pandemic decision making and alleviate clinician moral distress.
Gatekeepers in Gifted: A Case Study of the Disproportionality of Gifted Black Youth in Elementary Programs
Authors: Novak Angela M. , Jones Karen D.
Published: December 2020

Gifted identification and services, like many aspects of education, are inequitable and disproportionate in favor of White students. Obama Elementary School serves 421 students: 29% are Black and 58% are White; the school’s gifted program is 10% Black and 86% White. Rebecca Johnson, the gifted teacher, brings this to the attention of her principal, who has Rebecca present to the school improvement team. Rebecca receives pushback from a culturally unresponsive and equity-illiterate group. This case study provides teaching notes on gifted identification and services as well as cultural proficiency and equity literacy, and is framed in both gifted education and anti-racism.
Clinical trial monitoring effectiveness: Remote risk-based monitoring versus on-site monitoring with 100% source data verification
Authors: Yamada Osamu , Chiu Shih-Wei , Takata Munenori , Abe Michiaki , Shoji Mutsumi , Kyotani Eri , Endo Chiyo , Shimada Minami , Tamura Yuko , Yamaguchi Takuhiro
Published: December 2020

Background/Aims:

Traditional on-site monitoring of clinical trials via frequent site visits and 100% source data verification is cost-consuming, and it still cannot guarantee data quality effectively. Depending on the types and designs of clinical trials, an alternative would be combining several monitoring methods, such as risk-based monitoring and remote monitoring. However, there is insufficient evidence of its effectiveness. This research compared the effectiveness of risk-based monitoring with a remote monitoring system with that of traditional on-site monitoring.

Methods:

With a cloud-based remote monitoring system called beagle View®, we created a remote risk-based monitoring methodology that focused only on critical data and processes. We selected a randomized controlled trial conducted at Tohoku University Hospital and randomly sampled 11 subjects whose case report forms had already been reviewed by data managers. Critical data and processes were verified retrospectively by remote risk-based monitoring; later, all data and processes were confirmed by on-site monitoring. We compared the ability of remote risk-based monitoring to detect critical data and process errors with that of on-site monitoring with 100% source data verification, including an examination of clinical trial staff workload and potential cost savings.

Results:

Of the total data points (n = 5617), 19.7% (n = 1105, 95% confidence interval = 18.7–20.7) were identified as critical. The error rates of critical data detected by on-site monitoring, remote risk-based monitoring, and data review by data managers were 7.6% (n = 84, 95% CI = 6.2–9.3), 7.6% (n = 84, 95% confidence interval = 6.2–9.3), and 3.9% (n = 43, 95% confidence interval = 2.9–5.2), respectively. The total number of critical process errors detected by on-site monitoring was 14. Of these 14, 92.9% (n = 13, 95% confidence interval = 68.5–98.7) and 42.9% (n = 6, 95% confidence interval = 21.4–67.4) of critical process errors were detected by remote risk-based monitoring and data review by data managers, respectively. The mean time clinical trial staff spent dealing with remote risk-based monitoring was 9.9 ± 5.3 (mean ± SD) min per visit per subject. Our calculations show that remote risk-based monitoring saved between 9 and 41 on-site monitoring visits, corresponding to a cost of between US$13,500 and US$61,500 per trial site.

Conclusion:

Remote risk-based monitoring was able to detect critical data and process errors as well as on-site monitoring with 100% source data verification, saving travel time and monitoring costs. Remote risk-based monitoring offers an effective alternative to traditional on-site monitoring of clinical trials.
Personality’s cross-national impact across EU attitude dimensions
Authors: Curtis K. Amber , Nielsen Julie Hassing
Published: December 2020

Studies increasingly suggest that personal predispositions affect political attitudes, including those towards the European Union (EU). Yet little is known about the extent to which personality effects on EU support generalize across European countries or attitude domains. We use original survey data from five EU member states (Denmark, Germany, Poland, Sweden, and the United Kingdom) to investigate how the Big Five (B5) traits affect four different facets of public opinion toward the EU (support for further EU unification, views on EU membership, trust in EU institutions and support for using the euro). While we find that each of the B5 matters in at least one place, we find little consistency in personality’s effects across countries. Neither does any pattern emerge across most dimensions of EU support. Our results underscore the importance of isolating the contextual factors that might condition personality’s impact. They further call for greater theoretical development regarding why and how only certain national environments appear to lend themselves to personality effects. At a minimum, they suggest scholars should be wary of drawing conclusions about the B5’s impact from single cases.