The emergence and perils of polarization

We provide commentaries on the papers included in the Dynamics of Political Polarization Special Feature. Baldassarri reads the contribution of the papers in light of the theoretical distinction between ideological partisanship, which is generally rooted in sociodemographic and political cleavages, and affective partisanship, which is, instead, mostly fueled by emotional attachment and repulsion, rather than ideology and material interests. The latter, she argues, is likely to lead to a runaway process and threaten the pluralistic bases of contemporary democracy. Page sees the contribution of the many distinct models in the ensemble as potentially contributing more than the parts. Individual papers identify distinct causes of polarization as well as potential solutions. Viewed collectively, the papers suggest that the multiple causes of polarization may self-reinforce, which suggests that successful interventions would require a variety of efforts. Understanding how to construct such interventions may require larger models with greater realism.

Separatismul în spațiul post-sovietic, între seceră și ciocan / Separatism in the post-Soviet space, between the sickle and the hammer

This paper aims to present a comprehensive and complete analysis of the separatist movements from the ex-Soviet space, especially in the Republic of Moldova. The paper focuses on presenting both the national and international context immediately after the fall of the USSR, as well as the factors that determined the apparition of the separatist movements. Multiple causes and effects are paired and presented to expose the chronology that followed the unfolding of those historical events. The paper is split into three main topics: the Transnistrian conflict and its consequences, the Georgian conflict and its aftermath, and the ongoing conflicts between Armenia and Azerbaijan.

Secondary nipple reconstruction using two surgical techniques

Background Although the initial projection after primary nipple reconstruction is excellent, nipple projection gradually flattens in most cases due to multiple causes. Although various methods have been reported to rebuild the nipple after nipple flattening, the most effective method of secondary nipple reconstruction remains unknown. The aim of this study was to review our institution’s experiences with secondary nipple reconstruction.Methods We conducted a retrospective review from March 2012 to January 2019. We performed secondary nipple reconstruction if the primary reconstructed nipple height differed by more than 6 mm from the normal nipple height. We chose the method of nipple revision according to the degree of tissue scarring and the remaining nipple projection.Results We performed secondary nipple reconstruction on a total of 27 nipples, using pursestring sutures for 19 nipples and star flaps in eight nipples. The median follow-up period was 8 months (range, 6–19 months) after the final nipple reconstruction. Among the 19 nipples reconstructed using purse-string sutures, 10 (53%) demonstrated acceptable projection of more than 5 mm. Among the eight nipples reconstructed using star flaps, six (75%) showed acceptable projection of more than 5 mm. Most of the patients (73%) were satisfied (scores of 4 or 5) with the nipple reconstruction overall.Conclusions Few studies have presented favorable outcomes of secondary nipple reconstruction. When the star flap and purse-string suture methods were used depending on the remaining nipple height and scarring, appropriate projection could be achieved.

A neurologist’s rhombencephalitis after comirnaty vaccination. A change of perspective

Rhombencephalitis is an orphan disease of multiple causes that may manifest with facial palsy, limb ataxia and reduced consciousness. Up to now it is described after COVID-19 infection and in this (personal) case was found up to 8 weeks after Comirnaty vaccination. So far, we do not fully understand the pathophysiological characteristics of encephalitis associated with SARS-CoV-2. In rare cases, vaccination may cause an immunological reaction and delayed inflammation, the consequences of which we have not yet deciphered. Rhombencephalitis should be considered as a rare potential mRNA-associated vaccination side effect.

Impact of COVID-19 Pandemic on the Psychological Outcomes: Multiple Indicators and Multiple Causes (MIMIC) Modeling

Background: Due to the limited research examining the psychological impact of coronavirus disease 2019 (COVID-19), our study aims to investigate the effect of the COVID-19 pandemic on psychological outcomes and assess the differences between participants with and without post-traumatic stress disorder (PTSD) on the psychological outcomes as latent factors and items. Methods: An online survey was conducted on 999 participants. The Impact of Event Scale-Revised (IES-R) assessed the psychological impact, while outcomes were measured by Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder (GAD-7), and Insomnia Severity Index (ISI). A series of Confirmatory Factor Analysis (CFA), structural equation model (SEM), Multiple Indicators and Multiple Causes (MIMIC), and Differential Item Functioning (DIF) were conducted. Results: The IES-R has significant effects on the psychological outcomes. Participants with PTSD have a higher impact on latent factors (depression, anxiety, and insomnia) than those without PTSD. Among participants, 36.5% experienced moderate to severe symptoms of depression, and 32.6% had mild depressive symptoms. For anxiety, 23.7% of respondents experienced moderate to severe anxiety symptoms, and 33.1% had mild symptoms of anxiety. For the ISI, 51.5% of participants experienced symptoms of insomnia. Conclusion: the IES-R for COVID-19 has a significant impact on depression, anxiety, and insomnia at the level of latent constructs and observed variables.

Observational case studies of the effect of phage laden Ganga water on psoriasis

Water of Ganga river is reported to have more than 200 isolates of phages. This study has used the naturally available cocktail of phages in the Ganga water as a treatment for chronic Psoriasis. In the conventional Phage Therapy (PT) phages that are active against specific bacteria are first identified; then isolated, multiplied and administered to the patient. We have made a novel innovation of administering the naturally available cocktail of phages in the water of the Ganga river without first identifying the target bacteria and isolating specific phages that may be active against them. In doing so, we enable the large numbers of phages to self-identify the bacteria that are present and act against them. This approach shortcuts the tortuous process of conventional PT. Further, the phages act against a number of bacteria simultaneously and provide good results in psoriasis which has multiple causes.Patients who took Ganga water for only 2 weeks showed benefit but the benefit did not sustain after stoppage of the treatment and the disease relapsed to the pre-treatment levels. The same patients showed sustained benefit after they took Ganga water for four weeks. Conclusion is that Ganga water can be used for therapeutic purposes as long as the treatment is continued for at least four weeks. The study underscores the need to establish more robust protocol for treatment of dermatological and possibly other diseases with the cocktail of phages available in the waters of the Ganga river.

1000Quantifying multiple causes of death: A systematic review and audit of methods and practice

Background Mortality reporting and research are typically focused on a single underlying cause of death (UCoD) selected from multiple reported causes. The need to incorporate multiple causes of death (MCoD) in mortality statistics is now recognised internationally, but there is scant methodological work to guide analytical approaches. This review aims to identify and appraise current methods and practices used to analyse MCoD data. Methods The Web of Science, Medline, Pubmed and Scopus (from inception to December 2019) were queried. Studies reporting MCoD alone or in comparison with single UCoD were included. The review is supplemented by qualitative interview with international experts. Results 3491 studies were identified; 141 full texts were included in the review. The measures usually estimated when analysing MCoD can be broadly categorised into descriptive measures (n = 93 studies), measures of associations between diseases (n = 46 studies) and advanced statistical methods (n = 11 studies). Descriptive statistics commonly used include standardized ratio of multiple to underlying cause (SRMU) and mortality rates based on any mention of a disease. Approaches used to assess measures of associations between diseases include the Cause-of-Death Association Indicator (CDAI) and social network analysis. The advanced statistical methods include weighting MCoD and lethal defect-wear model of mortality. Audit results will be discussed. Conclusions This review provides a comprehensive and updated summary of methodological approaches used to analyse MCoD data. The merit of each analytical framework is discussed. Key messages More work is needed to develop methodological frameworks that could be used to support routine consideration of MCoD in practice.

896Quantifying cause-related mortality incorporating multiple causes: challenges and opportunities

Key contact person Dr Grace Joshy, Fellow, Research School of Population Health, Australian National University. Focus and outcomes for participants Mortality statistics are typically based on a single underlying cause of death (UCoD), derived from multiple conditions on the death certificate, and have provided critical evidence for policy and practice for over a century. There have been radical shifts in patterns of death in the past couple of decades; deaths in older ages are increasingly from chronic and degenerative diseases. The relevance of assuming that a single disease is causing the death is diminishing, especially with an aging population structure and increasing life expectancy. This symposium will enable participants to understand the complexities associated with mortality reporting/coding, strengths and limitations of available statistical methods for using multiple causes of death (MCoD) and the importance of quantifying mortality incorporating MCoD. Rationale for the symposium, including for its inclusion in the Congress The use of a single UCoD rather than MCoD means that vast amounts of potentially useful data are largely ignored, which is likely to bias mortality estimates (including under- and over-reporting of the importance of certain causes of death). Despite global recognition of the urgent need to better integrate data on MCoD into mortality statistics, use of these data are challenging and limited. Complexities arise from the way mortality information is reported on death certificates and coded to form mortality collections; limited understanding of available statistical methods also adds to the complexity. International Classification of Diseases 10th Revision (ICD-10) has been translated into 43 languages and it is being used by over 100 countries to report mortality data, a primary indicator of health status. The 2018 release of the 11th revision of the International Classification of Diseases, enriching data on multiple parameters including comorbidity, confers further urgency and a unique opportunity to optimise the use of MCoD in mortality reporting. The World Congress of Epidemiology 2020 will provide a unique platform for wider discussions on the challenges and opportunities for using MCoD data. The symposium will provide a deeper understanding and enhanced the use of MCoD data. The speakers are engaged in cutting-edge NHMRC-funded research on mortality incorporating MCoD and development of novel statistical methods. Presentation program The symposium will feature presentations from six speakers. Names of presenters James Eynstone-Hinkins, Lauren Moran, Saliu Balogun, Karen Bishop, Margarita Moreno-Betancur, Grace Joshy