Unusual Episode Research Articles

<i>Da la scheggia rotta usciva insieme parole e sangue:</i> an unusual case of bleeding and the metaphor of a clinical trial

In the Canto XIII of the Inferno, in the forest of suicides, Dante and Virgil encounter a damned soul who, though not revealing his name, is easily identifiable as Pier delle Vigne, a notary and right-hand man of the emperor Frederick II in Palermo. Among other achievements, Pier delle Vigne signed the Constitutions of Melfi and, in 1224, the founding act of the University of Naples. Later, due to court intrigues, he fell out of favor with the emperor and committed suicide. The suicides in Hell have lost their bodies, transformed into trees or bushes (“men we were, and now we are stumps”). The report of Dante, Virgil and Pier delle Vigne’s encounter follows a sequence that, more than 700 years earlier, mirrors the general path of modern scientific research, in particular of clinical trials: from the observation of an unusual episode of bleeding (a tree that speaks and from which words and blood flow together), to the formulation of a hypothesis, from the mentor-student relationship to the experiment without informed consent, from empathy with the patient to the definition of autoimmunity and inflammation, and finally to the publication of the case.

"Artificial Mothers" on Display: How Public Exhibits Shaped the Development of Incubators.

For the first four decades of the twentieth century, premature babies in the United States were primarily treated in infant incubators not in hospitals, but in a public setting-at the Coney Island amusement park. Although incubators are now an indispensable medical device, their origins lie in public exhibitions rather than a professional medical environment. This article uncovers the longer history behind this unusual episode in neonatal care and technology. Offering the first comprehensive account of the early history of the infant incubator, it traces how these devices were first developed and showcased at exhibition sites across Europe in the 1890s. A comparative study of these exhibitions in Europe and the United States from 1890 to 1943 highlights significant differences in how industry, science, education, and spectacle interacted in each country. Moreover, it examines the changing relationship between public displays and professional medicine during this period, illustrating how technology developed in public spaces before transitioning into the professional medical domain.

Whole-genome analysis of circulating influenza A virus (H3N2) strains in Shanghai, China from 2005 to 2023.

Seasonal influenza A virus subtype H3N2 (A/H3N2) circulates globally and has been linked to higher hospitalization rates and summer outbreaks in temperate regions. Here, A/H3N2 circulation in Shanghai, China was systematically studied using data and materials generated by the Shanghai influenza surveillance network from 2005 to 2023. Time-series analysis of incidence and subtyping data showed that A/H3N2 co-circulated with other (sub)types and dominated in multiple seasonal influenza peaks, preferentially in summer. Whole genomes of 528 representative strains were sequenced, and spatiotemporal phylodynamic analysis using these and GISAID-archived sequences demonstrated that in the years before the COVID-19 pandemic, phylogenetically similar strains were circulating locally and elsewhere. However, clade 1a.1 (within 3C.2a.1b.2a), circulated in and only in Shanghai and domestically in 2022, while the sibling clade 2 predominated in other regions. Interestingly, clade 1a.1 was swiftly and completely replaced by clade 2, mostly 2a.3a.1, at the start of 2023. In hemagglutination inhibition and neutralization assays, sera from healthy donors collected in 2022 displayed higher or similar reactivity against 2a.3a.1 compared to 1a.1. By contrast, transcription and replication competence of 2a.3a.1 in MDCK cells was higher than 1a.1. These results indicated that instead of antigenicity differences enabling evasion of pre-existing immunity, higher replicative capability more likely contributed to 2a.3a.1 viruses achieving dominance in China. In addition to summarizing patterns of A/H3N2 local circulation in Shanghai, this work revealed an unusual episode in A/H3N2 global circulation and evolution dynamics in connection to the COVID-19 pandemic and explored possible mechanistic explanations.

3045 An Unusual Episode of Acute Diverticulitis Despite Concurrent Antibiotic Therapy

INTRODUCTION: Diverticulosis occurs when weak spots in the outer layer of colonic muscle weaken giving way to an inner layer of protruding pouches. The progression to diverticulitis occurs when these protruding pouches become inflamed and infected which may ultimately progress to systemic symptoms that include fever, pain, malaise, constipation and vomiting. It is estimated that 50% of the population develops diverticulosis by age 50 and 65% by age 80. Additionally, an estimated 15-20% of the population with diverticulosis will go on to develop diverticulitis. Mild cases of diverticulitis are treated with oral antibiotics and a liquid diet whereas severe cases are treated with IV antibiotics and bowel rest. Here, we present a case of a diverticulitis episode that developed while a patient was already being treated with antibiotics. CASE DESCRIPTION/METHODS: A 64 year old female with a history of endometrial cancer who presented to the hospital for one day history of abdominal pain associated with loose bowel movements. She stated she has had loose bowel movements since starting H. pylori antibiotics that included amoxicillin and clarithromycin 2 weeks prior to presentation. She had an esophagoduodenoscopy 3 months prior that revealed chronic gastritis without dysplasia as well as biopsy proven H. pylori. Her colonoscopy at the same time showed internal hemorrhoids and a single hyperplastic polyp. Her vital signs were unremarkable and she was afebrile. Her white blood cell count on presentation was 13.9. She had a CT scan of the abdomen and pelvis that revealed acute sigmoid diverticulitis and cholelithiasis without evidence of acute cholecystitis. She was subsequently admitted to the hospital and treated with rocephin and flagyl as well as bowel rest. Blood cultures, stool cultures and clostridium difficile cultures were negative. Patient recovered over the next couple of days with resolution of her symptoms and her WBC count. DISCUSSION: This purpose of this case is to highlight the current management and treatment options for diverticulitis. Current guidelines recommend antibiotics and bowel rest during acute episodes of diverticulitis. However, this case represents an unusual scenario where a patient develops acute diverticulitis despite concurrent treatment with antibiotics for ongoing H. pylori infection. Further randomized-controlled trials may help delineate treatment modalities for acute diverticulitis as current treatment guidelines may result in breakthrough diverticulitis episodes.

A Igreja Universal do Reino de Deus em Angola: faces da nova cartografia religiosa global

The Universal Church of the Kingdom of God was established in Angola since 1992, but its presence in the country has become uncertain from an unusual episode: in December 2012, in a vigil to the end of the year, 6 people were killed and 120 were injured. This scenario triggered a set of facts and political speeches regarding this religious institution, which questioned the influence of the UCKG in that country. This communication proposal takes this historical fact as an analytical motto to understand the performance of the Brazilian Pentecostal churches in Africa, in particular the Universal Kingdom of God Church in Angola. We aim to question whether that presence should be understood an an instrument that promotes Brazilian imperialism in that country, interfering with the traditional habits of the Angolan culture or, whether, from another perspective, this religious presence should be seen as an agent of integration between Brazil and Angola. In order to conduct the analysis, we start from the reports about the episode in question and go forward with the theoretical and methodological aid of sociology, anthropology and international relations. Keywords: Religion, Pentecostalism, Universal Church of the Kingdom of God, Angola.

The sign switch effect of macroeconomic news in foreign exchange markets

We examine an unusual episode in the behavior of the euro, pound and yen exchange rate markets when the dollar appreciated (depreciated) against the three major currencies, in response to unfavorable (favorable) US growth news during the global financial crisis. Contrary to the previous findings, we show that, for each currency pair, only a small subset (about a third) of the most significant macro news effects reversed sign, primarily announcements regarding consumption, credit, labor and housing markets. Our results reveal that announcement chronology within a month matters, in that specifically the earliest releases within an indicator category exhibit sign asymmetry.

A Retrospective Look at Rescuing and Restructuring General Motors and Chrysler

The rescue of the US automobile industry amid the 2008–2009 recession and financial crisis was a consequential, controversial, and difficult decision made at a fraught moment for the US economy. Both of us were involved in the decision process at the time, but since have moved back to academia. More than five years have passed since the bailout began, and it is timely to look back at this unusual episode of economic policymaking to consider what we got right, what we got wrong, and why. In this article, we describe the events that brought two of the largest industrial companies in the world to seek a bailout from the US government, the analysis that was used to evaluate the decision (including what the alternatives were and whether a rescue would even work), the steps that were taken to rescue and restructure General Motors and Chrysler, and the performance of the US auto industry since the bailout. We close with general lessons to be learned from the episode.

The principal – agent problem between the Pope and God: how the printing press saved the papacy

Purpose – The purpose of this paper is to discuss a unique principal–agent dilemma, one that is very much off the beaten track. The relationship of the Popes pre-1500 and God was one full of emptiness and strain. The Catholic Church was saved by a positive externality of the printing press (technology) that guided the Papacy to act more ethically and, thus, we presume in the best interest of God. Design/methodology/approach – We utilize a historical and an economic analysis to probe the phenomenon that the goals of the principal and the agent are not always congruent. How the former entices the latter to do his bidding is an issue on which economists have long focused. We apply it to an unusual historical episode. Findings – There were numerous corrupt popes during the medieval times of the Catholic Church and the number seemed to lessen and then even approach zero asymptotically after the printing press was invented. The Protestant reformation was a driving force, and this too, we argue, would have been nearly impossible were it not also for the printing press. Originality/value – This is a contribution to the economic subfield of the economics of religion. It explores how the dismal science can make a contribution to our understanding of matters of faith. It looks at religion not from a theological point of view, the more usual departure, but from the perspective of economics.

Chronic Headache with Unusual Episode: A Case of Cerebral Venous Sinus and Extracranial Venous Thrombosis in Antiphospholipid Syndrome

Cerebral venous sinus thrombosis (CVST) with concomitant extracranial venous thrombosis is not a common clinicopathological entity. Extensive venous thrombosis involving head and neck affects young adult and female gender with isolated CVST contributing about 75% of the cases. The clinical features of CVST are nonspecific and can mimic various conditions. The neuroimaging investigation especially CT, MR angiography and venography are used to establish the diagnosis. This case highlights the awareness of the diagnostic difficulties, identifying the etiology and initiating effective treatment. The diagnosis of head and neck venous thrombosis is by having a high index of suspicion based on the clinical context and early recognition to lower the associated morbidity and mortality thus improving clinical outcomes in this condition.

The Sign Switch Effect of Macroeconomic News in Foreign Exchange Markets

We examine an unusual episode in the behavior of the euro, pound and yen exchange rate markets when the dollar appreciated (depreciated) against the three major currencies, in response to unfavorable (favorable) US growth news during the global financial crisis. Contrary to the previous findings, we show that, for each currency pair, only a small subset (about a third) of the most significant macro news effects reversed sign, primarily announcements regarding consumption, credit, labor and housing markets. Our results reveal that announcement chronology within a month matters, in that specifically the earliest releases within an indicator category exhibit sign asymmetry. We explore possible sources of the switch in the exchange rate reaction during this period and find that fluctuations in market risk and carry trade returns explain most of the variation in the news response coefficient signs.

Multiorgan Failure in a Patient Treated With the 5-Fluorouracil, Leucovorin, Oxaliplatin, and Irinotecan Regimen

Introduction FOLFOXIRI (5-fluorouracil [5-FU], leucovorin, oxaliplatin, and irinotecan) combines elements of both the FOLFOX (5-FU, oxaliplatin, leucovorin) and FOLFIRI (5-FU, irinotecan, and leucovorin) regimens. FOLFOXIRI is used to treat patients with gastrointestinal malignancies. It is well tolerated and associated with few grade 3 adverse events (AE). We report a patient treated with FOLFOXIRI who developed an unusual episode of multisystem organ failure. We reviewed the literature on serious AEs associated with these irinotecanand oxaliplatin-containing regimens.

Beyond the tabula rasa: Gordon Stephenson and urban renewal in Kingston, Ontario

Gordon Stephenson conducted some of Canada's first urban renewal studies for Halifax (1957), Kingston (1958-60) and London (1960). Stephenson's Kingston study, done in collaboration with George Muirhead, was an unusual episode in Canadian planning history. Most urban renewal studies from the 1940s and 1950s suggested extensive clearance of ‘obsolete’ neighbourhoods. This report was one of the earliest in North America to suggest widespread renovation of historic buildings and selective infill with new construction. This approach was recommended for several neighbourhoods, the downtown and the central waterfront. Stephenson's report set the stage for extensive heritage preservation in Kingston.

Changes in Gene Expression Associated with Reproductive Maturation in Wild Female Baboons

Changes in gene expression during development play an important role in shaping morphological and behavioral differences, including between humans and nonhuman primates. Although many of the most striking developmental changes occur during early development, reproductive maturation represents another critical window in primate life history. However, this process is difficult to study at the molecular level in natural primate populations. Here, we took advantage of ovarian samples made available through an unusual episode of human–wildlife conflict to identify genes that are important in this process. Specifically, we used RNA sequencing (RNA-Seq) to compare genome-wide gene expression patterns in the ovarian tissue of juvenile and adult female baboons from Amboseli National Park, Kenya. We combined this information with prior evidence of selection occurring on two primate lineages (human and chimpanzee). We found that in cases in which genes were both differentially expressed over the course of ovarian maturation and also linked to lineage-specific selection this selective signature was much more likely to occur in regulatory regions than in coding regions. These results suggest that adaptive change in the development of the primate ovary may be largely driven at the mechanistic level by selection on gene regulation, potentially in relationship to the physiology or timing of female reproductive maturation.

Forecasting the European Credit Cycle Using Macroeconomic Variables

ABSTRACTWe question the ability of macroeconomic data to predict risk appetite and ‘flight‐to‐quality’ periods in the European credit market using a model inspired by the Markov switching literature. This model allows for a direct mapping of exogenous variables into state probabilities. We find that various surveys and transformed hard data have a forecasting power. We show that despite its depth, the 2008–2009 crisis should not be regarded as an unusual episode that would have to be modelled by an additional state. Finally, we show that our model outperforms a pure Markov switching model in terms of forecasting accuracy, thus clearly indicating that economic figures are helpful in forecasting the credit cycle. Copyright © 2011 John Wiley & Sons, Ltd.

Closing the 49th Parallel: An Unexplored Episode in Canadian Economic and Political History

We draw attention to, and begin to consider the implications of, the severe restrictions on emigration by Canadians to the United States introduced under the US Immigration Act of 1965. These restrictions came into effect in 1968 and lasted until mobility began to increase to some extent under the free trade agreements in the early 1990s. This is an unusual episode in Canadian history, the implications of which for the Canadian economy and for Canadian public policy appear to have received little attention. We assemble evidence that suggests that the near closing of the border led toward uncoupling of Canadian and US labour markets and to a decrease in the elasticity of labour supply in Canada. Implications for Canadian fiscal policy of a decline in labour elasticity are then derived using a model of equilibrium fiscal structure. We show that these predictions, including heavier taxation of labour income and an increase in the overall size of the public sector, are consistent with what occurred over the two decades after the near closing of the US border, as well as with the partial reopening following the free trade agreements. The analysis continues by acknowledging additional factors that determine the structure and size of the public sector, and by considering the near closing of the border in a broader historical context. We conclude with a prediction about the future course of Canada-US migration policy that follows from our analysis.

Forecasting the European Credit Cycle Using Macroeconomic Variables

We question the ability of macroeconomic data to predict risk appetite and flight-to-quality periods in the European credit market using a model inspired by the Markov Switching (MS) literature. This model allows for a direct mapping of exogenous variables into states probabilities. We find that various survey and transformed hard data have a forecasting power. We show that despite its depth, the 2008-2009 crisis should not be regarded as an unusual episode that would have to be modelled by an additional state. Finally, we show that our model outperforms a pure MS model in terms of forecasting accuracy, thus clearly indicating that economic figures are helpful in forecasting the credit cycle.

Closing the 49th Parallel: An Unexplored Episode in Canadian Economic and Political History

We draw attention to, and begin to consider the implications of, the severe restrictions on emigration by Canadians to the United States introduced under the US Immigration Act of 1965. These restrictions came into effect in 1968 and lasted until mobility began to increase to some extent under the free trade agreements in the early 1990s. This is an unusual episode in Canadian history, the implications of which for the Canadian economy and for Canadian public policy appear to have received little attention. We assemble evidence that suggests that the near closing of the border led toward uncoupling of Canadian and US labour markets and to a decrease in the elasticity of labour supply in Canada. Implications for Canadian fiscal policy of a decline in labour elasticity are then derived using a model of equilibrium fiscal structure. We show that these predictions, including heavier taxation of labour income and an increase in the overall size of the public sector, are consistent with what occurred over the two decades after the near closing of the US border, as well as with the partial reopening following the free trade agreements. The analysis continues by acknowledging additional factors that determine the structure and size of the public sector, and by considering the near closing of the border in a broader historical context. We conclude with a prediction about the future course of Canada-US migration policy that follows from our analysis.

Clofarabine as a potential stimulant of alloreactivity

DLI is a treatment option for malignancy relapses occurring after allogeneic hematopoietic SCT (HSCT).1, 2 The graft-versus-tumor effect of DLI results from donor T-cell alloreactivity directed against recipient antigens, and correlates with GVHD development. Most patients with relapse after HSCT primarily need to receive conventional chemotherapy to reduce tumor burden before DLI. In HSCT patients exhibiting GVHD clinical manifestations at the time of relapse, the primary use of chemotherapy is quasi-constantly associated with donor T-cell alloreactivity reduction, as assessed by GVHD improvement or even disappearance. In contrast, GVHD elicitation by chemotherapy administration represents an unexpected event. We report such an unusual episode of acute GVHD occurring in an allo-transplanted patient after salvage chemotherapy of leukemia relapse using clofarabine, a second-generation purine analog that has proven efficacy in patients with relapsed leukemia.3, 4

Impact of open sea deep convection on sediment remobilization in the western Mediterranean

The northwestern Mediterranean is known to be a privileged area of deep water formation via dense shelf water cascading and offshore convection. The impact of the former in the sedimentary dynamics of the deep basin has been highlighted in recent years, while open sea convection has been solely studied from a hydrological perspective. Particle fluxes and hydrodynamics were monitored at the DYFAMED site (Ligurian Sea, western Mediterranean) at 200, 1000 m and near the seafloor (2350 m depth) during winter 2005–2006. From February to April 2006, and in coincidence with an unusual episode of deep water formation, a notable intensification of currents was observed in the entire water column and near‐bottom particle flux increased up to two orders of magnitude. These observations suggest that offshore convection must be taken into account together with cascading as a major driving force for sedimentary dynamics in the deep western Mediterranean.

Spring “bleaching” among Pocillopora in the Sea of Cortez, Eastern Pacific

A mild bleaching event was observed among Pocillopora spp. in the southern Gulf of California in the spring of 2006. Uniform bleaching occurred in numerous colonies on the upper portions of their branches. Most (∼90%) colonies that exhibited bleaching contained a species of endosymbiotic dinoflagellate, Symbiodinium C1b-c, which differed from the Symbiodinium D1 found inhabiting most unbleached colonies. Analysis of chlorophyll fluorescence, indicated a decline in photosystem II photochemical activity, especially among colonies populated with C1b-c. By early August, most affected colonies had recovered their normal pigmentation and fluorescence values were once again high for all colonies. No mortality was observed among tagged bleached colonies nor did symbiont species composition change during recovery. This unusual episode of bleaching did not appear to be a response to thermal stress, but may have been triggered by high levels of solar radiation during a period of unseasonally high water clarity in the early spring.