bluuebunny/crossref_metadata_2025 huggingface dataset:
Poetics and subjectivities between classicism and Romanticism
Authors: Kahn Andrew , Lipovetsky Mark , Reyfman Irina , Sandler Stephanie
Published: May 2018

In the context of Sentimentalism in the 1770s, literary culture opened up to representations of human subjectivity. The chapter considers genres of poetry devoted to the themes of pleasure, death, and posterity. It also considers the spaces of poetry and modes of exchange, whether through the album, the salon, and the verse epistle. Two case studies explore the use of different literary forms in the further development of identity, individual and also authorial. The first looks at Radishchev’s experiment in writing a fictional diary as a psychological exercise. The second examines the tradition of imitation of Horace’s Monument poem in Russian poetry in the eighteenth century as well as by later poets, such as Pushkin and Brodsky. The case study shows how these Russian versions express changing ideas about imitation and originality as well as poets’ concern with posterity.
The poetics of language
Authors: Kahn Andrew , Lipovetsky Mark , Reyfman Irina , Sandler Stephanie
Published: May 2018

The chapter analyzes language-oriented poets and movements, showing how different conceptions of the poetic word emerged and influenced writing and performance throughout the period. The chapter follows the ramifications of avant-garde experiment, expressed in manifestos, public gestures, and performances. These innovations continued to influence the artistic practices of the 1920s and were revived later in the 1960s–80s. They comprised a legacy for concrete and Conceptualist poetry and, later, Metarealism. The chapter discusses the connection of these groups to underground culture, and shows how the inherited tropes of the avant-garde join up with postmodernist poetics and narratives in the post-Soviet period.
Catastrophic narratives
Authors: Kahn Andrew , Lipovetsky Mark , Reyfman Irina , Sandler Stephanie
Published: May 2018

The chapter considers how, beginning with the Revolution and continuing across the centry, new narrative forms in prose and poetry fashion a discourse of national destiny. As narratives conceptualize historical change and convey the meanings of catastrophe, they develop new plotlines, metaphoric systems and mythological visions. The chapter argues that Russian literature on the Great Terror, collectivization, and Gulag achieves a focus on historical and personal trauma comparable to Holocaust literature. Soviet narratives of World War II also form an important trend from the 1940s through twenty-first century, serving simultaneously as the source of social criticism and the sustained attempt to redefine national identity.
Intelligentsia narratives
Authors: Kahn Andrew , Lipovetsky Mark , Reyfman Irina , Sandler Stephanie
Published: May 2018

The chapter explores how narratives about the intelligentsia and its cultural identity unfold the experience and ideology of this significant group in parallel with catastrophic narratives about revolution, terror and war. Central texts include major Russian novels of the twentieth century, such as Gorky’s Life of Klim Samgin, Olesha’s Envy, Bulgakov’s The White Guard and The Master and Margarita, and Pasternak’s Doctor Zhivago. Also important are the genres of autobiography, memoir, and oral history, and a case study of a single lyric poem, by Osip Mandelstam, further demonstrate the capacity of poetry to engage with the theme of the responsibility of the intelligentsia in a time of terror. The chapter shows how literary texts captured the conflicted and far from passive role of the intelligentsia as a beleaguered moral authority in a state organized around a central political idea.
Truth and Belief
Authors: Rowett Catherine
Published: May 2018

The first part of the chapter explores the relations between knowledge and truth and between knowledge and belief. It challenges a number of muddles in the literature concerning propositional attitudes, particularly the idea that while belief is a propositional attitude, knowledge is not. Second, it explores ancient words for ‘truth’, and how truth and being are related in ancient thought, including the so-called veridical sense of the verb einai. It argues that truth is (both for Plato, and in truth) first a property of things, and is then derivatively found in likenesses, such as reflections, pictures, and descriptions, where it comes in degrees according to the representation’s faithfulness to the truth. Finally, it connects this to the iconic method in Plato, whereby he uses such images as a means of accessing the truth that cannot be seen.
Knowing What Virtue is in Plato’s Meno
Authors: Rowett Catherine
Published: May 2018

Noting the distinction between Plato and his character Socrates, I show that the failure of the Socratic project early in the Meno serves as the catalyst for the character to try out new methods to cope with concepts that lack any unitary definition. As the dialogue proceeds, Socrates uses (i) a method of ‘looking and pointing’ (in the geometry episode) whereby the slave identifies an indefinable length on a diagram, and (ii) a hypothetical method allowing consideration of other questions while keeping a disjunction of possible answers to an earlier question still unresolved. Although the hypothetical method is perfect for the Meno’s task, Socrates applies it incompetently, and the results are disappointing, in Plato’s drama. Nevertheless, the dialogue undermines Socrates’ initial assumption that one must find a definition before continuing the enquiry. It shows Plato recognizing that some ordinary concepts are not definable, and responding with appropriate procedures.
Introduction and Summary for Part III: Plato’s Republic
Authors: Rowett Catherine
Published: May 2018

The chapter provides a short non-specialist explanation and summary of the work on Plato’s Republic that follows in Chapters 7 and 8. The main points that are sketched here concern the organization of Plato’s Republic, including the fact that Republic 1 engages in a fruitless search for a definition, which is designed as a salutary lesson about the failure of the Socratic project and the need for a new method in the later books, which do not seek a definition but rather an iconic imaginary city in which to find a case of justice to think about. Second, it sketches the consequences of a correct understanding of the project in Books 2 to 10 of the Republic, and the way in which correcting our understanding of the method can help to escape from the dominant concerns associated with recent literature, including the concern that there are ‘fallacies’ in Plato’s reasoning.
Introduction
Authors: Lurie Peter
Published: May 2018

This introduction orients this book’s argument surrounding history’s visibility. It points to a tradition of visualizing history initiated by D. W. Griffith’s infamous Birth of a Nation and suggests links between it and a later critical tradition of falsely presuming history’s accessibility. It takes up recent challenges to politicized cultural scholarship and identifies the book’s investment in examining the terms on which so-called American art and culture have been defined. Edgar Allan Poe’s Pym and Herman Melville’s “Benito Cereno” offer templates for the later discussions of writers’ and filmmakers’ choice to eschew direct representations of history. It links these moves to New Formalist methodology and places the study’s approach within this field, describing the book’s moves from treating modernist writers to discussing the postmodern cinema of Stanley Kubrick and the Coen brothers. It takes up a tenet of modernist scholarship that questions notions of a putatively transcendent, disembodied subject.
Behçet’s disease as a causative factor of cerebral venous sinus thrombosis: subgroup analysis of data from the VENOST study
Authors: Uluduz Derya , Midi Ipek , Duman Taskin , Colakoglu Sena , Tüfekci Ahmet , Bakar Mustafa , Nazliel Bijen , Tascilar Nida , Goksan Baki , Sungur Mehmet Ali , Kozak Hasan Huseyin , Demir Serkan , Misirli Cemile Handan , Kucukoglu Hayriye , Cinar Nilgun , Domac Fusun Mayda , Ozturk Serefnur , Yayla Vildan , Karahan Ali Yavuz , Afsar Nazire , Goksu Eylem Ozaydin , Mengulluoglu Necdet , Aytac Emrah , Yesilot Nilufer , Ince Birsen , Yalin Ozgur Osman , Oruc Serdar , Demirci Seden , Senol Mehmet Guney , Yilmaz Arda , Gokce Mustafa , Yilmaz Kusbeci Özge , Uzuner Gulnur , Batur Caglayan Hale Zeynep , Acikgoz Mustafa , Zeydan Burcu , Ozdag Fatih , Baybas Sevim , Ekmekci Hakan , Cabalar Murat , Yaman Mehmet , Yurekli Vedat Ali , Tekeli Hakan , Genc Hamit , Utku Uygar , Ucan Tokuc Firdevs Ezgi , Uzuner Nevzat , Bektas Hesna , Kablan Yuksel , Goksel Basak K , Milanlioglu Aysel , Necioglu Orken Dilek , Aluclu Ufuk
Published: May 2018

Objective

This study was performed to determine the rate of cerebral venous sinus thrombosis (CVST) among cases of Behçet’s disease (BD) included in a multicentre study of cerebral venous sinus thrombosis (VENOST).

Methods

VENOST was a retrospective and prospective national multicentre observational study that included 1144 patients with CVST. The patients were classified according to aetiologic factors, time of CVST symptom onset, sinus involvement, treatment approach and prognosis.

Results

BD was shown to be a causative factor of CVST in 108 (9.4%) of 1144 patients. The mean age of patients in the BD group was 35.27 years and 68.5% were men, whereas in the non-BD CVST group, the mean age was 40.57 years and 28.3% were men (P < 0.001). Among the aetiologic factors for patients aged 18–36 years, BD was predominant for men, and puerperium was predominant for women. The onset of symptoms in the BD group was consistent with the subacute form. The transverse sinuses were the most common sites of thrombosis, followed by the superior sagittal sinuses. The most common symptom was headache (96.2%), followed by visual field defects (38%).

Conclusions

BD was found in 9.4% of patients in our VENOST series. Patients with BD were younger and showed a male predominance. The functional outcome of CVST in patients with BD was good; only 12% of patients presenting with cranial nerve involvement and altered consciousness at the beginning had a poor outcome (modified Rankin Score ⩾2).
The Role of Social Ties in Factor Allocation
Authors: Beck Ulrik , Bjerge Benedikte , Fafchamps Marcel
Published: May 2018

We investigate whether social structure helps or hinders factor allocation using unusually rich data from the Gambia. Evidence indicates that land available for cultivation is allocated unequally across households; and that factor transfers are more common between neighbors, co-ethnics, and kinship-related households. Does this lead to the conclusion that land inequality is due to flows of land between households being impeded by social divisions? To answer this question, a novel methodology that approaches exhaustive data on dyadic flows from an aggregate point of view is introduced. Land transfers lead to a more equal distribution of land and to more comparable factor ratios across households in general. But equalizing transfers of land are not more likely within ethnic or kinship groups. In conclusion, ethnic and kinship divisions do not hinder land and labor transfers in a way that contributes to aggregate factor inequality. Labor transfers do not equilibrate factor ratios across households. But it cannot be ruled out that they serve a beneficial role, for example, to deal with unanticipated health shocks.
Clues to an Evolutionary Mystery: The Genes for T-Toxin, Enabler of the Devastating 1970 Southern Corn Leaf Blight Epidemic, Are Present in Ancestral Species, Suggesting an Ancient Origin
Authors: Condon Bradford J. , Elliott Candace , González Jonathan B. , Yun Sung Hwan , Akagi Yasunori , Wiesner-Hanks Tyr , Kodama Motochiro , Turgeon B. Gillian
Published: May 2018

The Southern corn leaf blight (SCLB) epidemic of 1970 devastated fields of T-cytoplasm corn planted in monoculture throughout the eastern United States. The epidemic was driven by race T, a previously unseen race of Cochliobolus heterostrophus. A second fungus, Phyllosticta zeae-maydis, with the same biological specificity, appeared coincidentally. Race T produces T-toxin, while Phyllosticta zeae-maydis produces PM-toxin, both host-selective polyketide toxins necessary for supervirulence. The present abundance of genome sequences offers an opportunity to tackle the evolutionary origins of T- and PM- toxin biosynthetic genes, previously thought unique to these species. Using the C. heterostrophus genes as probes, we identified orthologs in six additional Dothideomycete and three Eurotiomycete species. In stark contrast to the genetically fragmented race T Tox1 locus that encodes these genes, all newly found Tox1-like genes in other species reside at a single collinear locus. This compact arrangement, phylogenetic analyses, comparisons of Tox1 protein tree topology to a species tree, and Tox1 gene characteristics suggest that the locus is ancient and that some species, including C. heterostrophus, gained Tox1 by horizontal gene transfer. C. heterostrophus and Phyllosticta zeae-maydis did not exchange Tox1 DNA at the time of the SCLB epidemic, but how they acquired Tox1 remains uncertain. The presence of additional genes in Tox1-like clusters of other species, although not in C. heterostrophus and Phyllosticta zeae-maydis, suggests that the metabolites produced differ from T- and PM-toxin.
The Impact of Postpartum Hemorrhage on Hospital Length of Stay and Inpatient Mortality: A National Inpatient Sample-based Analysis
Authors: Marshall A.L. , Durani U. , Bartley A. , Hagen C.E. , Ashrani A. , Rose C. , Go R.S. , Pruthi R.K.
Published: May 2018

(Am J Obstet Gynecol. 2017;217(3):344.e1–344.e6)

Postpartum hemorrhage (PPH) has an estimated prevalence of 6% to 11% worldwide and has increased during the 1990s and 2000s in several countries including the United States. PPH is the leading worldwide cause of maternal morbidity and mortality. While the association between PPH and maternal mortality is well established, there is a need for further population-based observational studies to strengthen the epidemiologic evidence for PPH. This study aimed to examine the association between PPH and the outcomes of hospital length of stay (LOS) and inpatient mortality by using a large sample of hospital-based deliveries.
Reassessing the Duration of the Second Stage of Labor in Relation to Maternal and Neonatal Morbidity
Authors: Grantz K.L. , Sundaram R. , Ma L. , Hinkle S. , Berghella V. , Hoffman M.K. , Reddy U.M.
Published: May 2018

(Obstet Gynecol. 2018;131(2):345–353)

Prolonged second stage of labor is associated with an increased risk of postpartum hemorrhage, maternal febrile morbidity, infection, perineal trauma, and neonatal morbidities. Previously, the Society for Maternal-Fetal Medicine and American College of Obstetricians and Gynecologists in an effort to reduce an initial cesarean section in patients receiving epidural analgesia, recommended that second-stage arrest be redefined by the addition of 1 hour: 4 versus 3 hours for nulliparous women with an epidural, and 3 versus 2 hours for multiparous women with an epidural. In the present study, the authors calculated the likelihood of vaginal birth without serious maternal or neonatal morbidity or mortality compared with birth with morbidity or mortality, so as to better inform clinical decision-making.
Antidepressant Use During Pregnancy and Psychiatric Disorders in Offspring: Danish Nationwide Register-based Cohort Study
Authors: Liu X. , Agerbo E. , Ingstrup K.G. , Musliner K. , Meltzer-Brody S. , Bergink V. , Munk-Olsen T.
Published: May 2018

(BMJ. 2017;358:j3668)

Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), are prescribed during pregnancy and are considered safe. Recent studies have raised concerns regarding the long-term neurodevelopmental effects, such as autism and attention-deficit/hyperactivity disorder, of these medications on the offspring. However, gaps exist in the knowledge of antidepressant use during pregnancy and risk of psychiatric disorders in the offspring. This population-based cohort study was performed to investigate the association between in utero antidepressant exposure and overall risk of psychiatric disorders in children.
Lessons Learned From a Single Institution’s Retrospective Analysis of Emergent Cesarean Delivery Following External Cephalic Version With and Without Neuraxial Anesthesia
Authors: Ainsworth A. , Sviggum H.P. , Tolcher M.C. , Weaver A.L. , Holman M.A. , Arendt K.W.
Published: May 2018

(Int J Obstet Anesth. 2017;31:57–62)

External cephalic version (ECV) has widely variable rates of success (30% to 80%), but, if successful, can prevent cesarean deliveries required due to breech presentation. Previously, the success rate of ECV has been shown to increase by up to 60% with the use of neuraxial anesthesia (NA) during the procedure. Randomized clinical trials comparing ECV with and without NA have reported increased rates of successful ECVs without an increase in emergency cesarean deliveries when NA is used. However, during reviews of internal data, the current authors noted a higher rate of cesarean delivery following ECVs performed with NA versus without at their institution. This retrospective study evaluated whether the randomized clinical trials reflected the realities of clinical practice at their institution.
Risk of Neonatal Drug Withdrawal after Intrauterine Coexposure to Opioids and Psychotropic Medications: Cohort Study
Authors: Huybrechts K.F. , Bateman B.T. , Desai R.J. , Hernandez-Diaz S. , Rough K. , Mogun H. , Kerzner L.S. , Davis J.M. , Stover M. , Bartels D. , Cottral J. , Patorno E
Published: May 2018

(BMJ. 2017;358:j3326)

Neonatal abstinence syndrome is a recognized complication of intrauterine exposure to opioids. Neonatal abstinence syndrome can manifest in a number of different ways, from difficulty feeding and sleeping to more severe complications such as impaired thermoregulation, seizures, failure to thrive, and respiratory distress. Because pregnant women who are using an opioid often also use psychotropic medications, there are concerns about potential interactions between the opioid and psychotropic drugs leading to an increase in the occurrence and severity of neonatal drug withdrawal from. However, not much is known about how this risk varies by type of psychotropic medicine or about the risks associated with psychotropic polypharmacy. These investigators undertook the present study to determine whether the risk of neonatal drug withdrawal in newborns exposed in utero to one or more psychotropic medications in addition to opioids is greater and more severe than those exposed to opioids alone.
Labor Induction and Cesarean Delivery: A Prospective Cohort Study of First Births in Pennsylvania USA
Authors: Kjerulff K.H. , Attanasio L.B. , Edmonds J.K. , Kozhimannil K.B. , Repke J.T.
Published: May 2018

(Birth. 2017;44(3):252–261)

The rate of induced labor in the United States has risen from 9.6% in 1990 to 23.3% in 2012. Cesarean delivery is associated with higher rates of maternal and neonatal morbidity, and labor induction has been associated with increased risk for cesarean delivery. It is unclear, however, whether this association between labor induction and cesarean delivery is due to intrapartum factors that commonly occur in association with or after labor induction, or if it is due to maternal characteristics or indicators leading to the decision to induce. This study aimed to determine why induced nulliparous women are more likely to deliver via cesarean delivery compared with nulliparous women who are not induced.
Optimal Intrathecal Hyperbaric Bupivacaine Dose With Opioids for Cesarean Delivery: A Prospective Double-blinded Randomized Trial
Authors: Onishi E. , Murakami M. , Hashimoto K. , Kaneko M.
Published: May 2018

(Int J Obstet Anesth. 2017;31:68–73)

Single-shot spinal anesthesia is one of the most common anesthetic techniques for cesarean delivery. When choosing the dose of hyperbaric bupivacaine to use for this procedure, one must balance the need for a dose that will achieve adequate anesthesia for the duration of the surgery while avoiding the complications such as hypotension associated with higher doses. In this prospective, randomized, double-blinded, dose-ranging trial conducted between 2010 and 2013 at a single hospital in Japan, the researchers goal was to identify the ideal dose of intrathecal hyperbaric bupivacaine, coadministered with opioids, for cesarean delivery.
Personal Growth Attributed by Nursing Students to a Diversity Class
Authors: Williams Ishan C. , Anderson Walter P. , Lopez-Baez Sandra I.
Published: May 2018

Although many nursing programs provide diversity training to enhance the understanding of cultural influences on health care, little is known about outcomes. This is due in part to a lack of consensus regarding definitions and measures. The purpose of this study was to examine a set of self-perceptions defined as personal growth, attributed by graduate nursing students (N = 41) to an eight-week diversity course. Participants reported modest levels of personal growth. Educators can adapt the instrument and method of this study to measure student attributions of growth to any aspect of nursing education.
The Use of a Lacrimal Probe in Closed Catheter Irrigation of Pyogenic Flexor Tenosynovitis
Authors: Haines Samuel C. , McCann Philip A.
Published: May 2018

Pyogenic flexor tenosynovitis is a destructive closed space infection of the flexor tendon sheath. Here, we describe an adjunct to its normal surgical treatment by ways of using a lacrimal probe.
Early onset of diffuse melanosis cutis under pembrolizumab therapy illustrates the limitations of anti-PD-1 checkpoint inhibitors
Authors: Thiem Alexander , Schummer Patrick , Ueberschaar Simon , Kerstan Andreas , Kneitz Hermann , Schrama David , Appenzeller Silke , Meierjohann Svenja , Schilling Bastian , Goebeler Matthias , Gesierich Anja
Published: May 2018

Anti-PD-1 targeted immunotherapies have revolutionized the treatment of advanced melanoma and other tumor entities, and long disease-free intervals have been reported in responding patients. However, a considerable number of patients still progress rapidly after the start of anti-PD-1 antibodies. Here, we document two patients, 78 and 85-year old, who suffered from advanced BRAF-V600 wild-type melanoma and received pembrolizumab 2 mg/kg every 3 weeks as the first systemic treatment. After only one, respectively, two infusions of pembrolizumab, both patients developed melanuria and diffuse melanosis cutis (DMC) on sun-exposed areas of their skin. Both also had liver metastases, which have been reported to be associated with DMC before. Pembrolizumab was stopped because of rapid tumor progression and both patients died within 2 months after manifestation of DMC. We conclude that DMC is a condition that may be a negative predictor of response to anti-PD-1 treatment. With respect to the very short survival, which is even shorter than that reported after conventional therapies, it needs to be evaluated whether immunotherapy may be a (relative) contraindication in DMC patients when another treatment option, that is targeted therapy, is available.
Concomitant Use of 1,550-nm Nonablative Fractional Laser With Low-Dose Isotretinoin for the Treatment of Acne Vulgaris in Asian Patients: A Randomized Split-Face Controlled Study
Authors: Xia Jun , Hu Guanglei , Hu Die , Geng Songmei , Zeng Weihui
Published: May 2018

BACKGROUND

Nonablative fractional laser (NAFL) has been shown to improve the appearance of inflammatory acne and acne scars. Isotretinoin is effective for the treatment of moderate-to-severe cases of recalcitrant acne. However, the recommended dose of isotretinoin can have profound effects.

OBJECTIVE

To investigate the clinical efficacy and safety of performing NAFL treatment in patients with moderate-to-severe acne vulgaris under treatment with low-dose oral isotretinoin.

METHODS AND MATERIALS

Eighteen patients who received 10-mg oral isotretinoin per day completed 3 sessions of NAFL treatment on one half of the face and presented for each scheduled follow-up appointment.

RESULTS

Low-dose isotretinoin was effective in managing papules and nodule lesions (p < .001). Comedo lesions were significantly improved on NAFL-treated half-faces, compared with untreated half-faces (p < .05) as well as on the appearance of atrophic boxcar scars (superficial boxcar scar, p < .05; deep boxcar scar, p < .01). The most common side effects of oral isotretinoin were xerostomia and cheilitis. The most common discomforts associated with NAFL treatment were mild transient erythema and edema in the treated area.

CONCLUSION

The combination of NAFL with low-dose isotretinoin is a safe and effective treatment for moderate-to-severe acne.
Cosmetic Dermatology Training During Residency: Outcomes of a Resident-Reported Survey
Authors: Champlain Amanda , Reserva Jeave , Webb Kirsten , Griffin Dana , Moy Lauren , Joyce Cara , Glaser Dee Anna , Lawrence Naomi , Lee Kachiu C. , Antonovich Diana D. , Duffy David M. , Kim Jenny , Ozog David , Sobanko Joseph , Alam Murad , Tung Rebecca C.
Published: May 2018

BACKGROUND

As the demand for cosmetic treatments increases, it is important for dermatology residents to be educated about and achieve proficiency in dermatologic cosmetic procedures.

OBJECTIVE

To assess dermatology residents' educational exposure to cosmetic dermatology.

MATERIALS AND METHODS

An anonymous 18-question survey was sent electronically to 1,266 dermatology residents requesting information about cosmetic dermatology training during residency.

RESULTS

Two hundred sixty-eight residents responded to the survey (21% response rate). Most residents receive didactic instruction (94%) and hands-on training (91%) on cosmetic dermatology topics during residency. Survey participants in residency programs perceived as supportive of cosmetic dermatology training are more frequently provided lectures (70% vs 31%, p < .001) and procedural training (100% vs 69%, p < .001) in cosmetic dermatology as compared to residents in unsupportive programs. Eighty-nine percent of respondents reported hands-on training as the most effective method for developing proficiency in cosmetic procedures.

CONCLUSION

Providing safe and competent patient care should serve as the impetus for expanding cosmetic dermatology education and training for residents.
Thyrotropin Receptor Antibodies—An Overview
Authors: Kotwal Anupam , Stan Marius
Published: May 2018

Purpose:

Thyroid autoimmunity affects approximately 5% of the population, and its investigation relies heavily on the use of autoantibodies. Thyroid stimulating hormone receptor (TSHR) autoantibodies (TRAb) play a central role in the evaluation of Graves disease (GD), Graves ophthalmopathy (GO) and pretibial myxedema (PTM). However, there is still controversy regarding overall TRAb assay diagnostic accuracy and their prognostic utility.

Methods:

We reviewed and analyzed the literature reporting TRAb assays and their clinical utility.

Results:

Current assays measure the overall TRAb titer in a competitive manner (TSH binding inhibiting immunoglobulin assay) or biologic activity of the stimulating TSHR autoantibodies (thyroid stimulating immunoglobulin assay). Both types of assays have improved over time with advances in sensitivity and specificity. TRAb are particularly relevant in hyperthyroidism cases where use of iodinated contrast is not an option (e.g., pregnancy or recent use of iodinated contrast) or in cases of euthyroid eye disease, suspicious for GO. Third generation TRAb assays are useful for therapy selection in GD, prognostic predictions in GO and risk prediction for fetal and neonatal thyrotoxicosis.

Discussion:

Given the pathogenic role of TRAb, we expect that the future will bring useful evidence regarding their predictive role with respect to efficacy of therapeutic modalities for GO and PTM. We also hope to better understand the role of blocking and neutral antibodies against TSHR, and harness that ability for modulation of thyroid function or therapy of differentiated thyroid carcinoma managed with TSH suppression.

Conclusions:

Thyroid autoimmune diseases have seen tremendous gains in understanding their pathophysiology, largely antibody mediated. Better TRAb testing is becoming a springboard for providing individualized patient care.
Peripherally restricted cannabinoid 1 receptor agonist as a novel analgesic in cancer-induced bone pain
Authors: Zhang Hong , Lund Dominique M. , Ciccone Haley A. , Staatz William D. , Ibrahim Mohab M. , Largent-Milnes Tally M. , Seltzman Herbert H. , Spigelman Igor , Vanderah Todd W.
Published: May 2018

Many malignant cancers, including breast cancer, have a propensity to invade bones, leading to excruciating bone pain. Opioids are the primary analgesics used to alleviate this cancer-induced bone pain (CIBP) but are associated with numerous severe side effects, including enhanced bone degradation, which significantly impairs patients' quality of life. By contrast, agonists activating only peripheral CB1 receptors (CB1Rs) have been shown to effectively alleviate multiple chronic pain conditions with limited side effects, yet no studies have evaluated their role(s) in CIBP. Here, we demonstrate for the first time that a peripherally selective CB1R agonist can effectively suppress CIBP. Our studies using a syngeneic murine model of CIBP show that both acute and sustained administration of a peripherally restricted CB1R agonist, 4-{2-[-(1E)-1[(4-propylnaphthalen-1-yl)methylidene]-1H-inden-3-yl]ethyl}morpholine (PrNMI), significantly alleviated spontaneous pain behaviors in the animals. This analgesic effect by PrNMI can be reversed by a systemic administration but not spinal injection of SR141716, a selective CB1R antagonist. In addition, the cancer-induced bone loss in the animals was not exacerbated by a repeated administration of PrNMI. Furthermore, catalepsy and hypothermia, the common side effects induced by cannabinoids, were measured at the supratherapeutic doses of PrNMI tested. PrNMI induced mild sedation, yet no anxiety or a decrease in limb movements was detected. Overall, our studies demonstrate that CIBP can be effectively managed by using a peripherally restricted CB1R agonist, PrNMI, without inducing dose-limiting central side effects. Thus, targeting peripheral CB1Rs could be an alternative therapeutic strategy for the treatment of CIBP.
Sexual Assault Nurse Examiner Forensic Examinations for Immigrant Victims: A Case Study
Authors: Payne Amanda
Published: May 2018

This case study examines how sexual assault nurse examiners (SANEs) in the United States are in a unique position to provide valuable medical forensic documentation for immigrant victims. In addition to providing evidence to solve crimes domestically, SANEs may help victims of persecution and human rights violations receive legally protected immigration status. Incorporating The Istanbul Protocol into practice provides SANEs with a tool to advocate for and protect the rights of immigrant victims both domestically and abroad.
Qualitative Research in Correctional Settings: Researcher Bias, Western Ideological Influences, and Social Justice
Authors: Wadams Morgan , Park Tanya
Published: May 2018

Within correctional settings, justice, health, and academic systems overlap for forensic nurse researchers. Within an environment that stresses social control, a researcher's implicit views, perspectives, and biases can lead to altering the authentic (re)presentation of a participant's experience. Researcher bias may be influenced by predominately western ideologies and societal discourses. Qualitative methods to mitigate and raise awareness around researcher biases include bracketing, unstructured interviews, diverse peer review, thinking inductively, investigator responsiveness, and critical reflexivity. In addition to these methods, a social justice perspective should be included within the ethical foundation, guiding theories, and worldview in the research design to mitigate western ideological influences on researcher bias. Finally, a forensic nurse researcher should consider how possible western influences on researcher bias impact their ethical and moral obligation to their participants, the research community, and their clinical practice.
Male Help-Seeking After Sexual Assault: A Series of Case Studies Informing Sexual Assault Nurse Examiner Practice
Authors: Porta Carolyn M. , Johnson Ellen , Finn Cris
Published: May 2018

Background

A series of three composite case studies of cisgender men who presented to an emergency department for care after experiencing a sexual assault are presented. These cases show common assault characteristics including substance use, force, and multiple perpetrators.

Methods

We describe the sexual assault nurse examiner (SANE) findings and treatment and provide legal details of specific cases when available.

Results

These case reports highlight common challenges to help-seeking and the primary reasons these male victims overcame the barriers to seek care.

Discussion

SANEs are encouraged to provide consistent care to all sexual assault patients, regardless of gender. SANEs have an obligation to educate peers and broader society about sexual assault prevention and to advocate for policies that encourage help-seeking when a sexual assault has occurred.
Endobronchial Ultrasound-guided Transbronchial Needle Aspiration Using 19-G Needle for Sarcoidosis
Authors: Balwan Akshu
Published: May 2018

Background:

Flexible bronchoscopy with endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is increasingly being used to obtain pathology specimens for diagnosis of sarcoidosis. There is wide variation in reported diagnostic yield in literature. New TBNA needles are available in the market but data are lacking about their diagnostic yield especially for sarcoidosis. This study reports the diagnostic yield of bronchoscopy with EBUS-TBNA using ViziShot FLEX 19-G needle in a series of patients with suspected sarcoidosis.

Methods:

This is a retrospective chart review for diagnostic yield of the 19-G EBUS-TBNA needle for suspected sarcoidosis.

Results:

Eighty-six EBUS bronchoscopies were performed, 15 were done with clinical suspicion of sarcoidosis. The 19-G needle was used for all cases of suspected sarcoidosis. The procedure was diagnostic of sarcoidosis in 14 (93.3%) patients by TBNA with 1 nondiagnostic bronchoscopy. Procedural diagnostic yield was 93.3%. Eighty-five percent (28/33) of sampled lymph nodes were positive for noncaseating granulomas. The yield of transbronchial lung biopsy (TBLB) and endobronchial lung biopsy was 38% (5/13) and 43% (6/14), respectively. TBLB and endobronchial lung biopsy did not add to the diagnostic yield of the procedure. No significant adverse events were noted.

Conclusion:

This series reports a higher diagnostic yield than most other published studies and opens platform for direct comparison of each available needle. It also adds to the safety data for this larger needle. In addition, it raises doubt into utility of TBLB for diagnosis of sarcoidosis, which can increase the procedural complications.
Systemic Chemotherapy for Advanced Rare Pancreatic Histotype Tumors
Authors: Brunetti Oronzo , Aprile Giuseppe , Marchetti Paolo , Vasile Enrico , Casadei Gardini Andrea , Scartozzi Mario , Barni Sandro , Delfanti Sara , De Vita Fernando , Di Costanzo Francesco , Milella Michele , Cella Chiara Alessandra , Berardi Rossana , Cataldo Ivana , Scarpa Aldo , Basile Debora , Mazzuca Federica , Graziano Giusi , Argentiero Antonella , Santini Daniele , Reni Michele , Cascinu Stefano , Silvestris Nicola
Published: May 2018

Objectives

Two issues were put forth by clinicians in the management of the advanced stages of rare variants of pancreatic ductal adenocarcinoma and other exocrine histotypes with peculiar clinical and pathological features: Do chemotherapy regimens recommended in pancreatic ductal adenocarcinoma patients have a clinical activity in rare pancreatic tumors? Or should other chemotherapy combinations be considered in this subset of patients?

Methods

We conducted a multicenter retrospective study that collected data from 2005 to 2016 at 14 Italian cancer centers with the aim to evaluate tumor response and time to progression for first- and second-line and overall survival.

Results

Of approximately 4300 exocrine pancreatic cancer patients, 79 advanced cases affected by rare histological types were identified, with pancreatic acinar cell cancer (n = 23), pancreatic adenosquamous cancer (n = 16), and mucinous cystic neoplasm with an associated invasive mucinous cystadenocarcinoma (n = 15) most represented. Survival analyses for each subgroup in relation with the different chemotherapy regimens showed the lack of statistical significance correlations.

Conclusions

Because of the lack of clinical trials in patients affected by these rare pancreatic histotypes, only their molecular classification would help clinicians in future therapeutic choice.
Vincristine-associated Neuropathy With Antifungal Usage: A Kaiser Northern California Experience
Authors: Nikanjam Mina , Sun Aida , Albers Mark , Mangalindin Kristine , Song Eyun , Vempaty Hyma , Sam Danny , Capparelli Edmund V.
Published: May 2018

The dose-limiting toxicity for vincristine is peripheral neuropathy which can be potentiated with concurrent usage of azole antifungals. The current retrospective study assessed the incidence of concurrent vincristine and azole antifungal usage to determine if it led to increased neurotoxicity for the Kaiser Northern California pediatric acute lymphoblastic leukemia (ALL) and Hodgkin lymphoma patient population. Data were obtained from the electronic medical record (2007 to 2014). In total, 130 subjects received at least one dose of vincristine for ALL or Hodgkin lymphoma (median age 9, 88% ALL, 58% male, 47% Caucasian). Thirty one percent of patients received concurrent antifungal usage (fluconazole, 78%; voriconazole, 10%; fluconazole/voriconazole, 12%); however, concurrent antifungal usage accounted for <15% of vincristine doses. Grade 2 or greater neuropathy occurred in 51% of patients; grade 3 neuropathy was present in 8% of patients. No difference in the incidence of grade 2 or greater neuropathy was observed with the concurrent use of antifungal therapy (P=0.35), sex (P=0.59), type of cancer (P=0.41), ethnicity (P=0.29), or age (P=0.39), but was higher with increasing amount of vincristine doses (P=0.004). These results suggest that concurrent azole antifungal usage with vincristine for patients with ALL and Hodgkin lymphoma was low in the Kaiser Northern California population and limited usage as needed may be reasonable and safe.
Emergency Department Chief Complaints Among Children With Cancer
Authors: Burcham Megan D. , Cochrane Anneli R. , Jacob Seethal A. , Carroll Aaron E. , Mueller Emily L.
Published: May 2018

Children with cancer have high emergency department (ED) utilization, but little is known about their chief complaints. A retrospective chart review of ED chief complaints for children with cancer (actively receiving therapy) at Riley Hospital for Children from January 2014 to December 2015 was performed. Proportions of visits and disposition for top 5 chief complaints were determined. Multivariate logistic regression analyzed factors associated with admission. There were 598 encounters by 231 children with cancer. About half (49%) had >1 complaint. The 5 most common primary chief complaints were: fever (60.2%), pain (6.5%), nausea/vomiting (5.0%), bleeding (3.9%), and abnormal laboratory values (3.3%). Admission rates varied, with the highest rates being for nausea/vomiting (66.7%). Risk factors for admission were: hospitalization in prior 4 weeks (odds ratio [OR], 2.67; confidence interval [CI], 1.77-4.02), chief complaint of fever (OR, 1.90; CI, 1.16-3.09). For each increase in number of chief complaints, odds increased by 1.45 (CI, 1.14-1.83). Black, non-Hispanic (OR, 0.44; CI, 0.22-0.88) as compared with white, non-Hispanic, younger age (OR, 0.53; CI, 0.29-0.99) or complaint of abnormal laboratory values (OR, 0.20; CI, 0.06-0.68) had lower odds of admission. Children with cancer present to the ED with multiple and varied complaints. Future interventions could aim to improve caregiver anticipatory guidance and ED visit preparedness.
Advanced Resuscitation Guidelines Improve Mortality Rates Among Cardiovascular Surgery Patients
Authors: Roberts Melanie
Published: May 2018

In this month’s Magnet® Perspectives column, Melanie Roberts, DNP, RN-BC, CNS, CCNS, CCRN, critical care clinical nurse specialist at Medical Center of the Rockies (MCR) and Poudre Valley Hospital, discusses her efforts to implement the state-ofthe-art European Resuscitation Council (ERC) guideline for resuscitation of cardiovascular (CV) surgery patients. Her evidence-based initiative has improved quality of care and mortality rates among the CV surgery population at MCR. Dr Roberts’ pioneering work earned her the 2017 National Magnet Nurse of the Year Award for Empirical Outcomes. She shares details of her innovative program and examines the value of implementing practice enhancements in a Magnet environment. She describes the importance of an interdisciplinary team effort to achieve success.
Repeat Human Immunodeficiency Virus Testing by Transmission Risk Group and Rurality of Residence in North Carolina
Authors: Billock Rachael M. , Samoff Erika , Cope Anna B. , Sampson Lynne A. , Hurt Christopher B. , Powers Kimberly A.
Published: May 2018

Background

Understanding of repeat human immunodeficiency virus (HIV) testing (RHT) is limited and the impact of rural residence as a potential barrier to RHT is unknown. Rural populations are of particular interest in the Southeastern United States because of their disproportionate HIV burden.

Methods

We used HIV surveillance data from publicly funded HIV testing sites in North Carolina to assess repeat testing by transmission risk group and residential rurality in a retrospective cohort study. Linear binomial regression models were used to estimate adjusted, 1-year cumulative incidences and cumulative incidence differences comparing RHT within transmission risk populations by level of rurality.

Results

In our total study population of 600,613 persons, 19,275 (3.2%) and 9567 (1.6%) self-identified as men who have sex with men (MSM) and persons who inject drugs (PWID), respectively. A small minority, 13,723 (2.3%) resided in rural ZIP codes. Men who have sex with men were most likely to repeat test (unadjusted, 1-year cumulative incidence after an initial negative test, 16.4%) compared with PWID (13.2%) and persons who did not identify as either MSM or PWID (13.6%). The greatest effect of rurality was within PWID; the adjusted, 1-year cumulative incidence of RHT was 6.4 (95% confidence interval, 1.4–11.4) percentage points higher among metropolitan versus rural PWID.

Conclusions

One-year cumulative incidence of RHT was low among all clients of publicly funded HIV testing sites in North Carolina, including MSM and PWID for whom annual testing is recommended. Our findings suggest a need for public health efforts to increase access to and support for RHT, particularly among rural PWID.
Genomic Fusions in Pigmented Spindle Cell Nevus of Reed
Authors: VandenBoom Timothy , Quan Victor L. , Zhang Bin , Garfield Erin M. , Kong Betty Y. , Isales Maria C. , Panah Elnaz , Igartua Catherine , Taxter Timothy , Beaubier Nike , White Kevin , Gerami Pedram
Published: May 2018

Recent molecular studies of spitzoid neoplasms have identified mutually exclusive kinase fusions involving ROS1, ALK, RET, BRAF, NTRK1, MET, and NTRK3 as early initiating genomic events. Pigmented spindle cell nevus (PSCN) of Reed is a morphologic variant of Spitz and may be very diagnostically challenging, having histologic features concerning for melanoma. Their occurrence in younger patients, lack of association to sun exposure, and rapid early growth phase similar to Spitz nevi suggest fusions may also play a significant role in these lesions. However, to date, there is little data in the literature focused on the molecular characterization of PSCN of Reed with next-generation sequencing. We analyzed a total of 129 melanocytic neoplasms with RNA sequencing including 67 spitzoid neoplasms (10 Spitz nevi, 44 atypical Spitz tumors, 13 spitzoid melanomas) and 23 PSCN of Reed. Although only 2 of 67 (3.0%) of spitzoid lesions had NTRK3 fusions, 13 of 23 (57%) of PSCN of Reed harbored NTRK3 fusions with 5′ partners ETV6 (12p13) in 2 cases and MYO5A (15q21) in 11 cases. NTRK3 fusions were confirmed with a fluorescent in situ hybridization break-apart probe. The presence of a NTRK3 fusion correlated with younger age (P=0.021) and adnexal extension (P=0.001). Other minor fusions identified in PSCN of Reed included MYO5A-MERTK (2), MYO5A-ROS1, MYO5A-RET, and ETV6-PITX3 leading to a total of 78% with fusions. Our study suggests that the majority of PSCN of Reed are the result of genomic fusions, and the most frequent and characteristic genomic aberration is an NTRK3 fusion.
Disappearing Digits: Analysis of National Trends in Amputation and Replantation in the United States
Authors: Reavey Patrick L. , Stranix John T. , Muresan Horatiu , Soares Marc , Thanik Vishal
Published: May 2018

Background:

Significantly fewer replantations have been performed at the authors’ institution in recent years, with similar trends observed across the United States. A study of three national databases was performed to evaluate this trend, its possible cause, and national health care implications.

Methods:

The National Electronic Injury Surveillance System, Bureau of Labor Statistics, and National Inpatient Sample databases were queried for cases with a diagnosis of finger amputation over available years from 2000 to 2011. Data were weighted and analyzed to give appropriate national estimates of amputations, replantations, and related clinical variables. Trend analysis was performed using modified Poisson regression.

Results:

Although workplace finger amputation rates decreased 40 percent from 2000 to 2010 (p < 0.0001), the overall finger amputation incidence did not change significantly (26,668 versus 24,215; p = 0.097). Compared with 930 replantations in 2001, only 445 were performed in 2011, more than a 50 percent decrease (p < 0.001). In all years, the majority of hospitals performing replantation performed only one (49.3 to 64.1 percent) each year, with a small minority (2.2 to 8.1 percent) performing more than 10 per year. In 2000, 120 hospitals (12.1 percent) performed at least one replantation, compared with only 80 hospitals (7.6 percent) in 2010, a 4.6 percent annual decline (p = 0.002).

Conclusions:

There has been a striking decline in digital replantations being performed, despite a relatively stable incidence of amputations. Apparently independent of declining work-related injuries, evolving clinical decision-making may be responsible for this trend. Decreasing replantation experience among hand surgeons lends credence to the development of specialized regional centers designed to treat these complex injuries.