bluuebunny/crossref_metadata_2025 huggingface dataset:
Claudian (Claudius Claudianus)
Authors: Parkes Ruth
Published: September 2016

The poetry of Claudian dating from the 4th century and the early years of the 5th century ce, has won admirers from its first reception to the 21st century. The corpus of the poet, a native Greek speaker, is bilingual; however, the majority of his extant works are in Latin, produced after his move to the West. Most of these aim to promote the deeds and ambitions of his patron Stilicho, the power behind the throne of the young emperor Honorius. His talent was recognized by the general following his apparent debut at Rome in 395 ce with a panegyric for the consuls-elect Olybrius and Probinus. Claudian was skillful at turning his pen to best serve the political interests of the court and Stilicho against a fast-moving, complex political backdrop. He was adept at exploiting in an innovative fashion his knowledge of rhetorical theory and classical literature. His oeuvre is marked by variety of style, form, length, and content. It ranges from the obviously political poems, such as consular panegyrics lauding Honorius and Stilicho and the epics prompted by contemporary events, to his three-book mythological epic, the De Raptu Proserpinae.
Ontology of Art
Authors: Rohrbaugh Guy
Published: September 2016

Ontological questions are questions about existence: Which things are truly existent? Into which fundamental categories do they fall? One seeks, not just an inventory of reality, but a map of it, one that could help to structure and navigate one’s other philosophical concerns. In the case of art ontology, we seek to understand where artworks fit into this wider organization of reality. We might wish to know, for example, whether they are just material things, or mental in some way, or even abstract entities of some sort. Such questions have a clear bearing on the epistemology of their appreciation, which is often our central aesthetic-philosophical concern. The category of art is, however, wildly heterogeneous. It includes paintings, musical theater, films, improvisations, earth-works, novels, poems, pottery, dance, videos, installations, conceptual art of various stripes, and much more besides. It appears that art is not itself an ontology category, but a status achieved by items from a variety of ontological categories. Definitions of “art” attempt to clarify this status, but are not a properly ontological investigation. The work left to ontologists involves characterizing those items that achieve this status, identifying commonalities and differences in the kinds of objects that form the media of different arts. There is interest both in finding whether all artworks belong to one, two, or more fundamental categories, and in identifying what makes the objects of the individual arts different from one another. The former, “fundamental” question has centered on the phenomenon of repeatability. While works in some arts, like painting, appear to be particular individuals, work in other arts, those like classical music, theater, and printmaking, involve multiple performances or prints or, more generally, occurrences. Since each occurrence cannot be the work, a real puzzle about the ontological character of the work itself emerges. Perhaps for idiosyncratic reasons, Western classic music has been the central case of this sort under discussion. Musical examples have also driven the latter, applied investigations, although here attention has often been drawn to musical practices that differ, in some important regard, from the classical cases so often found at the middle of disputes about the fundamental ontology.
Hate Crime Legislation
Authors: Wiedlitzka Susann
Published: September 2016

Hate crime is a problem in many countries around the world. Scholars define hate crimes as unlawful conduct directed at different target groups, which can include violent acts, property damage, harassment, and trespassing (see Hate crime: An emergent research agenda. Annual Review of Sociology 27.1 [2001]: 479–504). Hate crime perpetrators target their victim’s race, religion, ethnicity, sexual orientation, gender, or disability, but also a variety of other characteristics. Several social movements (e.g., the civil rights movement, women’s movement, and LGBT movement) laid the foundation for anti-violence movements and placed the hate crime discourse on the political and legislative agenda. One way to better understand hate crime is to explore how governments in different parts of the world address the issue of crimes motivated by hate or prejudice. Targeted laws and policies transformed hate violence from ordinary to extraordinary crime (see Hate crime policy in western Europe: Responding to racist violence in Britain, Germany, and France. American Behavioral Scientist 51.2 [2007]: 149–165). Different countries implemented hate crime legislation in order to condemn crime committed due to prejudice or bias against an individual or group of people, introducing such legislation during different periods in time. The United States emerged as the leader of hate crime policy approaches, implementing legal responses to prejudice and bias in the early 20th century. The United States was also the first country to circulate the term “hate crime” during the 1980s (see Hate crime: An emergent research agenda. Annual Review of Sociology 27.1 [2001]: 479–504). Europe and the Asia-Pacific region followed suit in implementing their own responses to hate crime. The diversity of hate crime legislation in different countries makes it difficult to combine the legislative contexts under a common framework. A controversial debate exists around the need for a separate set of hate crime legislation. Scholars dispute the seriousness of the hate crime offense, the possibilities of proving motivational aspects of the hate crime, criminalizing hate, and introducing more severe punishments. They also debate the utilization of the civil versus the criminal code, the inclusion of different protected categories under hate crime legislation, the symbolic character of hate crime, and the social and political impact of hate crime legislation. This bibliography reviews key resources on hate crime legislation, including its historical context, its globalization, and the socio-criminological debate around hate crime legislation.
Fugger Family
Authors: Häberlein Mark
Published: September 2016

From the late fifteenth to the early seventeenth centuries, the Fuggers of Augsburg were among the leading merchant-bankers of Europe. As the term merchant-bankers suggests, the family firm combined long-distance trade and financial services. The key to the Fuggers’ wealth was the marketing of Tyrolean and Hungarian copper and silver in return for loans to the rulers of the mining areas. The company operated a far-flung network of agencies and offices in major commercial cities such as Venice, Antwerp, Lisbon, and Seville; provided credit and banking services to the Habsburg emperors, the popes, and other European princes; and established sporadic ties with India and the New World. As information brokers, they collected newsletters from all over Europe and supplied relatives and princely clients with up-to-date information on political and military events. As Augsburg’s wealthiest mercantile family, the Fuggers also influenced the social and cultural life of the imperial city in various ways: They commissioned some of the earliest Renaissance buildings and artworks north of the Alps and initiated a major social housing project that is still in existence 500 years after its founding. As stalwart Catholics in a city that had largely turned Protestant during the Reformation, they ensured the survival of Catholicism by exerting their political influence and supporting religious orders, especially the Jesuits. The Fuggers’ influence also extended to neighboring territories: they not only extended loans to the Dukes of Bavaria, but also advised them on artistic matters and played an important role in the transfer of the aesthetic tastes of the Italian Renaissance to South German courts. Finally, the Fuggers exemplify the possibilities for social mobility in Renaissance Germany. Descendants of a rural weaver who had moved to Augsburg in 1367, they not only entered the highest echelon of urban society, the patriciate, in 1538, but even rose into the ranks of the imperial nobility, becoming hereditary counts in 1530, forming marital alliances with Bavarian and Austrian noble families, and purchasing extensive stretches of landed property. On the eve of the Thirty Years’ War, their territories comprised more than one hundred villages in eastern Swabia. While the Fuggers are frequently mentioned in textbooks and general overviews of the Renaissance and Reformation, scholarship is largely confined to German-language works. This article reflects the preponderance of literature in German while giving due credit to the works of French, British, and American scholars and to translations.
Insurance
Authors: Farber Hannah
Published: September 2016

The insurance of oceangoing vessels and their cargoes, known as marine or maritime insurance, underpinned the commerce of the Atlantic world. Emerging in recognizably modern form during the Italian Renaissance, marine insurance was adopted by large numbers of Atlantic merchants over the seventeenth and eighteenth centuries. These merchants paid, or bound themselves to pay, premiums to their insurers to insure specific vessels or cargoes. If the insured property was lost, damaged, or destroyed in transit, the merchants’ insurers reimbursed them for their losses. As the volume and value of Atlantic commerce increased, marine insurance became big business, attracting more capital, more customers, and more political attention. At the same time, other forms of insurance took root. Evolving ideas about risk, society, and commercial enterprise accompanied experimentation with a wide variety of risk-reduction initiatives. Insurance projects, broadly defined, proliferated in the financializing port cities at the edge of the Atlantic Ocean and within empires competing for control of the Americas. The state was deeply involved in some insurance projects: modernizing European states chartered large corporations to sell insurance against the risk of fire, for example, and launched “tontines” that offered a form of annuity tied to an individual’s life. Other forms of insurance were essentially gambling: individuals could, for periods of time, “insure” against the occurrence of specific, unpredictable events. Still other forms of insurance, such as mutual aid societies, allowed people of humbler backgrounds to ameliorate one another’s risks. While in some respects these projects had little in common, the Atlantic insurance business itself brought wildly diverse stakeholders into conversation with one another. Atlantic merchants communicated with speculators, who read the works of political economists, who made their opinions known to governments, which increasingly made their marks on the lives of working people. During the nineteenth and twentieth centuries, new forms of insurance (life, accident, property) grew to prominence in what had become a formidable global industry. The legacy of Atlantic insurance includes, but is not limited to, these modern forms of business. Contemporary conversations about risk, security, the government/business nexus, and the value of human life also owe a great deal to the insurers and insurance buyers of the Atlantic age.
International NGOs
Authors: Sundstrom Lisa McIntosh
Published: September 2016

International nongovernmental organizations (NGOs or INGOs) are studied from a wide range of academic disciplinary perspectives, and the perspectives and literature are diverse and growing rapidly. This article approaches the topic from a political science perspective and, in particular, from the perspective of the international relations field in political science. It also includes a range of sources from helpful instructional readings to more sophisticated works that have been influential among scholars in the field. The list incorporates both some of the newest work of theoretical and empirical importance and older works that have been important to the development of this topic of study. The scholars who study international NGOs use a variety of conceptual categories for their analysis. Hence, anyone searching for literature on this topic will find fruitful results by searching for a number of terms, including, for example: “transnational civil society,” “transnational advocacy networks,” “transnational social movements,” and “global civil society.” NGOs are also variously called “civil society organizations,” “social movement organizations,” or “nonprofit organizations.” In European literature they are often discussed as “interest groups.”
Politics of Anti-Americanism
Authors: Datta Monti Narayan
Published: September 2016

Academic, popular, and political inquiry into the nature, origins, and consequences of anti-Americanism rose after the terrorist attacks against the United States on 11 September 2001. Prior to 9/11, anti-Americanism had received attention from scholars and policymakers, but not consistently, and not in a manner readily available to the public. The US State Department, for instance, had commissioned polls and published reports on foreign attitudes toward the United States beginning in the 1950s, but many of these documents remain hard to access outside the US National Archives. Following 9/11, however, a flood of polls was widely disseminated for free by several organizations, including the Pew Research Center. News media also generated significant coverage on anti-Americanism, and it became a topic of discussion among world leaders, particularly surrounding the outbreak of the Iraq War in 2003. Critical investigation of anti-Americanism therefore surged after 2001, with a crest in scholarship at the close of the decade, and something of a resurgence after the election of US president Donald J. Trump. Central to this scholarship are five questions: How is anti-Americanism defined and measured? Does anti-Americanism originate from what the United States is, from its values and culture? Or does it originate from what the United States does, from its policies and actions abroad? What effect, if any, does anti-Americanism have for the United States and other actors? Lastly, what is the nature and origin of anti-Americanism within the United States, looking at home-grown movements and ideologies? These questions have been explored using increasingly complex social science research methods and data from polling organizations, such as Pew. Because these polling organizations have hisorically focused predominately on European and Middle Eastern publics, however, there has been comparatively little on other parts of the globe. At the same time, most polls focus predominately on attitudes toward the United States among foreign publics, not foreign elites. Yet scholars and policymakers require a better sense of what foreign elites think and feel to understand more clearly how foreign governments interact with the United States. Moreover, given that the study of anti-Americanism tends to be episodic (e.g., it soared after 9/11, subsided under Barack Obama, and then increased following the election of Donald Trump), longitudinal studies are needed to interpret complexities over time. Additionally, although survey data are relatively abundant on foreign perceptions of the United States, another step forward in this research agenda would be to include a systematic comparative analysis of global attitudes not just toward America, but also other great powers, like China, India, Brazil, and Russia. This would herald a larger field of study that explores not only anti-American sentiment, but also “anti–great power” sentiment.
Emotion and Racial Attitudes in Contemporary American Politics
Authors: Banks Antoine
Published: September 2016

The debate on race in American politics—past and present—has stimulated strong emotions. Scholars have recently begun to study the influence discrete emotions have on Americans’ attitudes and opinions about race. Understanding the effect emotions have on racial attitudes is of practical importance. For example, studies have demonstrated that the emotional rhetoric in American politics can increase hostility toward racial and ethnic minorities. The research on emotion and racial attitudes in American politics is interdisciplinary and includes political scientists, psychologists, sociologists, communication scholars, and others.
Implicit Racial Bias in Medical School Admissions
Authors: Capers Quinn , Clinchot Daniel , McDougle Leon , Greenwald Anthony G.
Published: September 2016

Problem

Implicit white race preference has been associated with discrimination in the education, criminal justice, and health care systems and could impede the entry of African Americans into the medical profession, where they and other minorities remain underrepresented. Little is known about implicit racial bias in medical school admissions committees.

Approach

To measure implicit racial bias, all 140 members of the Ohio State University College of Medicine (OSUCOM) admissions committee took the black–white implicit association test (IAT) prior to the 2012–2013 cycle. Results were collated by gender and student versus faculty status. To record their impressions of the impact of the IAT on the admissions process, members took a survey at the end of the cycle, which 100 (71%) completed.

Outcomes

All groups (men, women, students, faculty) displayed significant levels of implicit white preference; men (d = 0.697) and faculty (d = 0.820) had the largest bias measures (P < .001). Most survey respondents (67%) thought the IAT might be helpful in reducing bias, 48% were conscious of their individual results when interviewing candidates in the next cycle, and 21% reported knowledge of their IAT results impacted their admissions decisions in the subsequent cycle. The class that matriculated following the IAT exercise was the most diverse in OSUCOM’s history at that time.

Next Steps

Future directions include preceding and following the IAT with more robust reflection and education on unconscious bias. The authors join others in calling for an examination of bias at all levels of academic medicine.
Benchmarking Sepsis Gene Expression Diagnostics Using Public Data*
Authors: Sweeney Timothy E. , Khatri Purvesh
Published: September 2016

Objective:

In response to a need for better sepsis diagnostics, several new gene expression classifiers have been recently published, including the 11-gene “Sepsis MetaScore,” the “FAIM3-to-PLAC8” ratio, and the Septicyte Lab. We performed a systematic search for publicly available gene expression data in sepsis and tested each gene expression classifier in all included datasets. We also created a public repository of sepsis gene expression data to encourage their future reuse.

Data Sources:

We searched National Institutes of Health Gene Expression Omnibus and EBI ArrayExpress for human gene expression microarray datasets. We also included the Glue Grant trauma gene expression cohorts.

Study Selection:

We selected clinical, time-matched, whole blood studies of sepsis and acute infections as compared to healthy and/or noninfectious inflammation patients. We identified 39 datasets composed of 3,241 samples from 2,604 patients.

Data Extraction:

All data were renormalized from raw data, when available, using consistent methods.

Data Synthesis:

Mean validation areas under the receiver operating characteristic curve for discriminating septic patients from patients with noninfectious inflammation for the Sepsis MetaScore, the FAIM3-to-PLAC8 ratio, and the Septicyte Lab were 0.82 (range, 0.73–0.89), 0.78 (range, 0.49–0.96), and 0.73 (range, 0.44–0.90), respectively. Paired-sample t tests of validation datasets showed no significant differences in area under the receiver operating characteristic curves. Mean validation area under the receiver operating characteristic curves for discriminating infected patients from healthy controls for the Sepsis MetaScore, FAIM3-to-PLAC8 ratio, and Septicyte Lab were 0.97 (range, 0.85–1.0), 0.94 (range, 0.65–1.0), and 0.71 (range, 0.24–1.0), respectively. There were few significant differences in any diagnostics due to pathogen type.

Conclusions:

The three diagnostics do not show significant differences in overall ability to distinguish noninfectious systemic inflammatory response syndrome from sepsis, though the performance in some datasets was low (area under the receiver operating characteristic curve, < 0.7) for the FAIM3-to-PLAC8 ratio and Septicyte Lab. The Septicyte Lab also demonstrated significantly worse performance in discriminating infections as compared to healthy controls. Overall, public gene expression data are a useful tool for benchmarking gene expression diagnostics.
Information-Seeking Behavior of Greek Nursing Students
Authors: Intas George , Kostagiolas Petros , Zavras Dimitris , Chalari Eleftheria , Stergiannis Pantelis , Toylia Georgia , Niakas Dimitris
Published: September 2016

The aim of this study was to investigate factors influencing the use of electronic journals by nursing students through identification of information needs, information resources used, and barriers to seeking information. A cross-sectional study was conducted using a specially designed structured questionnaire. Of 600 nursing students, 505 agreed to participate, indicating a response rate of 84.2%. Participants sought out nurses and doctors, printed materials, scholarly databases/e-journals, and seminars as information resources. Participants reported that they searched for information for themselves, parents, and inpatients. Most searched for information for diet or special nutrition needs and for specific diseases. The obstacles faced included lack of time and cost. Training in information literacy is important to enhance the skills of nursing students.
Oxytocin, cortisol and 3,4-methylenedioxymethamphetamine: neurohormonal aspects of recreational ‘ecstasy’
Authors: Parrott Andrew C.
Published: September 2016

Most research into 3,4-methylenedioxymethamphetamine (MDMA) has debated its psychobiological effects in relation to neurotransmission. This article debates the contributory roles of the neurohormones oxytocin and cortisol for their psychobiological effects in humans. The empirical literature on these neurohormones is reviewed and suggestions for future research outlined. Acute MDMA or ‘ecstasy’ can generate increased levels of oxytocin and cortisol, and these neurohormonal changes may be important for its mood-enhancing and energy-activation effects in humans. However, an initial finding of enhanced sociability correlating with oxytocin levels has not been replicated. Potential reasons are debated. There may be dynamic interactions between the two neurohormones, with greater activation under cortisol, facilitating stronger positive feelings under oxytocin. Chronic regular use of MDMA can adversely affect cortisol in several ways. Regular users show increased cortisol in 3-month hair samples, changes to the cortisol awakening response, and indications of greater daily stress. Furthermore, these cortisol findings suggest changes to the hypothalamic–pituitary–adrenal axis. The effects of chronic MDMA usage on oxytocin still need to be investigated. It is concluded that the neurohormones oxytocin and cortisol contribute in various ways to the psychobiological effects of recreational ecstasy/MDMA.
Influence of Genotype on Warfarin Maintenance Dose Predictions Produced Using a Bayesian Dose Individualization Tool
Authors: Saffian Shamin M. , Duffull Stephen B. , Roberts Rebecca L. , Tait Robert C. , Black Leanne , Lund Kirstin A. , Thomson Alison H. , Wright Daniel F. B.
Published: September 2016

Background:

A previously established Bayesian dosing tool for warfarin was found to produce biased maintenance dose predictions. In this study, we aimed (1) to determine whether the biased warfarin dose predictions previously observed could be replicated in a new cohort of patients from 2 different clinical settings, (2) to explore the influence of CYP2C9 and VKORC1 genotype on predictive performance of the Bayesian dosing tool, and (3) to determine whether the previous population used to develop the kinetic–pharmacodynamic model underpinning the Bayesian dosing tool was sufficiently different from the test (posterior) population to account for the biased dose predictions.

Methods:

The warfarin maintenance doses for 140 patients were predicted using the dosing tool and compared with the observed maintenance dose. The impact of genotype was assessed by predicting maintenance doses with prior parameter values known to be altered by genetic variability (eg, EC50 for VKORC1 genotype). The prior population was evaluated by fitting the published kinetic–pharmacodynamic model, which underpins the Bayesian tool, to the observed data using NONMEM and comparing the model parameter estimates with published values.

Results:

The Bayesian tool produced positively biased dose predictions in the new cohort of patients (mean prediction error [95% confidence interval]; 0.32 mg/d [0.14–0.5]). The bias was only observed in patients requiring ≥7 mg/d. The direction and magnitude of the observed bias was not influenced by genotype. The prior model provided a good fit to our data, which suggests that the bias was not caused by different prior and posterior populations.

Conclusions:

Maintenance doses for patients requiring ≥7 mg/d were overpredicted. The bias was not due to the influence of genotype nor was it related to differences between the prior and posterior populations. There is a need for a more mechanistic model that captures warfarin dose–response relationship at higher warfarin doses.
Comparative Study of a Novel Tool for Follicular Unit Extraction for Individuals with Afro-textured Hair
Authors: Umar Sanusi
Published: September 2016

Background:

Hair transplantation involving patients with tightly curled Afro-textured hair using follicular unit extraction (FUE) employing conventional rotary punches frequently leads to unacceptably high transection rates. These patients are unsuitable candidates for FUE hair transplantation. Transection rates were observed during FUE in a case series of 18 patients with tightly curled Afro-textured hair using different punches.

Methods:

Three different punches were sequentially used in patients to extract follicular units with several needle gauges until satisfactory transection rates occurred: conventional sharp and dull rotary punches, followed by a 2-pronged curved nonrotary punch.

Results:

In all instances, the curved nonrotary punch had the best transection rate of <5%. Sharp and dull rotary punches completely failed or had excessive transection rates in 8 patients. The dull rotary punch performed better than the sharp rotary punch in 9 patients in whom it was used with few restrictions compared to 5 patients in whom there were more restrictions.

Conclusions:

A curved nonrotary punch configured to accommodate the curliness of tightly curled Afro-textured hair can overcome high transection rates experienced using conventional sharp or dull rotary punches. Limitations of this study include it being a small, retrospective case series, and that the new technique that could require additional training by current FUE hair transplant practitioners.
An Update on the Acute Management of Shoulder Dystocia
Authors: GILSTROP MARISA , HOFFMAN MATTHEW K.
Published: September 2016

Shoulder dystocia continues to challenge obstetrical providers and therefore the management must evolve. The available literature demonstrates clear value in both simulation training and having a clear algorithmic approach. Similarly, the available literature suggests that delivery of the posterior arm should be prioritized. Several new techniques such as the Menticoglou maneuver, Gaskin’s maneuver, and the posterior axilla sling traction technique offer obstetrical choices after more traditional techniques have failed.
Direction of the Relationship Between Acceptance of Illness and Health-Related Quality of Life in Chronic Heart Failure Patients
Authors: Obiegło Monika , Siennicka Agnieszka , Jankowska Ewa A. , Danel Dariusz P.
Published: September 2016

Background:

This study provides an in-depth insight into the relationships between illness acceptance and health-related quality of life (HRQoL) of chronic heart failure (CHF) patients. Although HRQoL is a well-established endpoint in CHF, little is known on illness acceptance in this group.

Aims:

The aim of this study is to critically reconsider the direction of a relationship between HRQoL and illness acceptance in CHF patients.

Methods:

The study included 204 patients (160 men and 44 women; mean age, 63 ± 11 years) with at least 6-month clinical evidence of CHF corresponding to New York heart Association (NYHA) classes I to IV. All the patients were examined with the Minnesota Living With Heart Failure Questionnaire (MLHFQ) and Acceptance of Illness Scale (AIS).

Results:

Univariate analysis showed that the level of illness acceptance correlated inversely with patient age, and the level of HRQoL decreased with the severity of CHF (NYHA class). A relationship between illness acceptance and HRQoL was analyzed by structural equation modeling. Model 1 was based on the assumption that HRQoL is modulated by illness acceptance, and model 2 tested the opposite relationship. Both models included patient age and NYHA class as extrinsic determinants of AIS and MLHFQ scores, respectively. Model 2 proved to be well fitted (χ
2 [df = 2] = 3.22, P = .20, root-mean-square error of approximation = 0.055). Scores on the AIS correlated inversely with age (b
age->AIS = −0.15, SE = 0.05, P = .002) and HRQoL (b
QoL->AIS = −0.15, SE = 0.02, P < .001), and an increase in NYHA class was reflected by an increase in HRQoL scores (b
NYHA->QoL = 5.75, SE = 1.97, P = .004).

Conclusion:

Patients with CHF may not accept their disease due to deteriorated HRQoL. As a result, they may be uninvolved in the therapeutic process, which leads to exacerbation of CHF, further deterioration of HRQoL, and inability to accept the illness.
Causes and Outcomes of Esophageal Perforation in Eosinophilic Esophagitis
Authors: Runge Thomas M. , Eluri Swathi , Cotton Cary C. , Burk Caitlin M. , Woosley John T. , Shaheen Nicholas J. , Dellon Evan S.
Published: September 2016

Goals:

To characterize patients who suffer perforation in the context of eosinophilic esophagitis (EoE) and to identify predictors of perforation.

Background:

Esophageal perforation is a serious complication of EoE.

Materials and Methods:

We conducted a retrospective cohort study of the University of North Carolina EoE clinicopathologic database from 2001 to 2014. Subjects were included if they had an incident diagnosis of EoE and met consensus guidelines, including nonresponse to a PPI trial. Patients with EoE who had suffered perforation at any point during their course were identified, and compared with EoE cases without perforation. Multiple logistic regression was performed to determine predictors of perforation.

Results:

Out of 511 subjects with EoE, 10 (2.0%) had experienced an esophageal perforation. Although those who perforated tended to have a longer duration of symptoms before diagnosis (11.4 vs. 7.0 y, P=0.13), a history of food impaction (odds ratio, 14.9; 95% confidence interval, 1.7-129.2) and the presence of a focal stricture (odds ratio, 4.6; 95% confidence interval, 1.1-19.7) were the only factors independently associated with perforation. Most perforations (80%) occurred after a prolonged food bolus impaction, and only half of individuals (5/10) carried a diagnosis of EoE at the time of perforation; none occurred after dilation. Six patients (60%) were treated with nonoperative management, and 4 (40%) required surgical repair.

Conclusions:

Esophageal perforation is a rare but serious complication of eosinophilic esophagitis, occurring in ∼2% of cases. Most episodes are due to food bolus impaction or strictures, suggesting that patients with fibrostenotic disease due to longer duration of symptoms are at increased risk.
Effect of Chicory-derived Inulin on Abdominal Sensations and Bowel Motor Function
Authors: Azpiroz Fernando , Molne Laura , Mendez Sara , Nieto Adoración , Manichanh Chaysavanh , Mego Marianela , Accarino Anna , Santos Javier , Sailer Manuela , Theis Stephan , Guarner Francisco
Published: September 2016

Goal:

To determine the effect of a prebiotic chicory-derived inulin-type fructan on the tolerance of intestinal gas.

Background:

Subjects with gas-related complaints exhibit impaired handling of intestinal gas loads and we hypothesized that inulin would have a beneficial effect.

Study:

Placebo-controlled, parallel, randomized, double-blind trial. Subjects with abdominal symptoms and reduced tolerance of intestinal gas (selected by a pretest) received either inulin (8 g/d, n=18) or maltodextrin as a placebo (8 g/d, n=18) for 4 weeks. A gas challenge test (4 h jejunal gas infusion at 12 mL/min while measuring abdominal symptoms and gas retention for 3 h) was performed before and at the end of the intervention phase. Gastrointestinal symptoms and bowel habits (using daily questionnaires for 1 wk) and fecal bifidobacteria counts were measured before and at the end of the intervention.

Results:

Inulin decreased gas retention during the gas challenge test (by 22%; P=0.035 vs. baseline), while the placebo did not, but the intergroup difference was not statistically significant (P=0.343). Inulin and placebo reduced the perception of abdominal sensations in the gas challenge test to a similar extent (by 52% and 43%, respectively). Participants reported moderate gastrointestinal symptoms and normal bowel habits during baseline examination, and these findings remained unchanged in both groups during the intervention. Inulin led to a higher relative abundance of bifidobacteria counts (P=0.01 vs. placebo).

Conclusions:

A daily dose of inulin that promotes bifidobacteria growth and may improve gut function, is well tolerated by subjects with gastrointestinal complaints.
Growth Failure Due to Inadequate Protein Intake Is Common Among Small Preterm Infants
Authors: Ziegler Ekhard E. , Carlson Susan J.
Published: September 2016

Growth failure is common among premature infants and carries the risk of delayed cognitive development. Its immediate cause is almost always inadequate intake of protein. But the reason why protein intake is insufficient changes with time. In the first days of life, when nutrition is predominantly provided parenterally, hesitation to provide the necessary high intakes of amino acids for a sufficient length of time is the main cause. When feedings are provided enterally, frequent interruptions of feedings and insufficient protein fortification of human milk are the main causes. Close monitoring of growth alerts the neonatologist to impending growth failure and permits remedial action.
Youth Athletes
Authors: Rosenbloom Christine
Published: September 2016

Youth participation in individual and team sports is high, yet little is known about the nutritional needs of children or adolescents who compete in sports. Parents and volunteer coaches are responsible for nutrition and hydration advice for youth athletes and it can be woefully incorrect. There are no predictive equations for energy needs, and research on protein intake for muscle growth and repair is conducted on adults. Currently, the best we can do is adapt nutrition guidelines for adults to young athletes, using growth and development as a guide for monitoring success with the implementation of nutrition strategies. Hydration strategies are critical for young athletes as heat illnesses occur more frequently in this group compared with adults. Young athletes are not immune to messages on enhancing muscle development, and use of performance-enhancing substances is higher than previously thought. Strategies for nutrition education for young athletes are included, based on psychosocial development.
Bariatric Surgery or Conventional Medical Therapy?
Authors: Mayer Jennifer E. , Dwyer Johanna T.
Published: September 2016

This article explores the risks and benefits of 2 therapies for adults with severe or morbid obesity and type 2 diabetes: bariatric surgery (with special attention to the Roux-en-Y gastric bypass) or conventional medical therapy, which relies on nutrition, physical activity, lifestyle changes, and hypoglycemic medication. The Roux-en-Y gastric bypass remains the most advantageous surgically in terms of glycemic control and weight loss, with lesser adverse effects on nutrient absorption and non-weight related quality of life. Although bariatric surgery may be useful to varying degrees for achieving glycemic control and potential diabetes remission, patients still must adhere to elements of conventional medical therapy if gains in glycemic control are to continue postoperatively.
Strategic Planning for Research in Pediatric Critical Care
Authors: Tamburro Robert F. , Jenkins Tammara L. , Kochanek Patrick M.
Published: September 2016

Objective:

To summarize the scientific priorities and potential future research directions for pediatric critical care research discussed by a panel of experts at the inaugural Strategic Planning Conference of the Pediatric Trauma and Critical Illness Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Data Sources:

Expert opinion expressed during the Strategic Planning Conference.

Study Selection:

Not applicable.

Data Extraction:

Chaired by an experienced expert from the field, issues relevant to the conduct of pediatric critical care research were discussed and debated by the invited participants.

Data Synthesis:

Common themes and suggested priorities were identified and coalesced.

Conclusions:

Of the many pathophysiologic conditions discussed, the multiple organ dysfunction syndrome emerged as a topic in need of more study that is most relevant to the field. Additionally, the experts offered that the interrelationship and impact of critical illness on child development and family functioning are important research priorities. Consequently, long-term outcomes research was encouraged. The expert group also suggested that multidisciplinary conferences are needed to help identify key knowledge gaps to advance and direct research in the field. The Pediatric Critical Care and Trauma Scientist Development National K12 Program and the Collaborative Pediatric Critical Care Research Network were recognized as successful and important programs supported by the branch. The development of core data resources including biorepositories with robust phenotypic data using common data elements was also suggested to foster data sharing among investigators and to enhance disease diagnosis and discovery. Multicenter clinical trials and innovative study designs to address understudied and poorly understood conditions were considered important for field advancement. Finally, the growth of the pediatric critical care research workforce was offered as a priority that could be spawned in many ways including by expanded transdisciplinary and multiprofessional collaboration and diversity representation.
Pediatric Out-of-Hospital Cardiac Arrest Characteristics and Their Association With Survival and Neurobehavioral Outcome*
Authors: Meert Kathleen L. , Telford Russell , Holubkov Richard , Slomine Beth S. , Christensen James R. , Dean J. Michael , Moler Frank W.
Published: September 2016

Objective:

To investigate relationships between cardiac arrest characteristics and survival and neurobehavioral outcome among children recruited to the Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital trial.

Design:

Secondary analysis of Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital trial data.

Setting:

Thirty-six PICUs in the United States and Canada.

Patients:

All children (n = 295) had chest compressions for greater than or equal to 2 minutes, were comatose, and required mechanical ventilation after return of circulation.

Interventions:

Neurobehavioral function was assessed using the Vineland Adaptive Behavior Scales, Second Edition at baseline (reflecting prearrest status) and 12 months postarrest. U.S. norms for Vineland Adaptive Behavior Scales, Second Edition scores are 100 (mean) ± 15 (sd). Higher scores indicate better functioning. Outcomes included 12-month survival and 12-month survival with Vineland Adaptive Behavior Scales, Second Edition greater than or equal to 70.

Measurement and Main Results:

Cardiac etiology of arrest, initial arrest rhythm of ventricular fibrillation/tachycardia, shorter duration of chest compressions, compressions not required at hospital arrival, fewer epinephrine doses, and witnessed arrest were associated with greater 12-month survival and 12-month survival with Vineland Adaptive Behavior Scales, Second Edition greater than or equal to 70. Weekend arrest was associated with lower 12-month survival. Body habitus was associated with 12-month survival with Vineland Adaptive Behavior Scales, Second Edition greater than or equal to 70; underweight children had better outcomes, and obese children had worse outcomes. On multivariate analysis, acute life threatening event/sudden unexpected infant death, chest compressions more than 30 minutes, and weekend arrest were associated with lower 12-month survival; witnessed arrest was associated with greater 12-month survival. Acute life threatening event/sudden unexpected infant death, other respiratory causes of arrest except drowning, other/unknown causes of arrest, and compressions more than 30 minutes were associated with lower 12-month survival with Vineland Adaptive Behavior Scales, Second Edition greater than or equal to 70.

Conclusions:

Many factors are associated with survival and neurobehavioral outcome among children who are comatose and require mechanical ventilation after out-of-hospital cardiac arrest. These factors may be useful for identifying children at risk for poor outcomes, and for improving prevention and resuscitation strategies.
Wage Inequity: Within-Market Comparative Analysis of Salary for Public Health Nurses and Hospital Nurses
Authors: Issel L. Michele , Lurie Christine Fitzpatrick , Bekemeier Betty
Published: September 2016

The labor market perspective focuses on supply and demand for registered nurses (RNs) as employees. This perspective contrasts with beliefs in the public health sector that RNs working in local health departments (LHD) as public health nurses (PHNs) accept lower wages because of factors other than market demand. This study sought to describe the extent to which hourly wages of RNs working in LHDs are competitive with hospital RN wages within the same county market. A repeated measures survey design was used in collecting 2010 and 2014 data. The unit of analysis was the county, as an RN labor market for LHDs and hospitals. Survey questions captured factors common in human resources benefits and wage packages, such as differential pay, hourly rate pay based on years of experience, components of benefit packages (eg, sick and vacation leave), and reimbursement for education. Within each county, the LHD and all hospitals constituted a “market,” yielding a potential 12 markets in our study sample. Human resources representatives from each of the 12 LHDs and from all hospitals within those 12 counties were invited to participate. We conducted comparisons with survey data using t test of mean differences on mean RN wages across years of experience. On average, LHDs paid significantly less than hospitals in their markets, at all levels of RN experience, and this gap increased with RN experience in the sample markets. Salary compression was evident in 2010 and worsened for PHNs in 2014, when compared with hospital RNs. In 2014, 100% of the sample LHDs offered reimbursements for continuing education for PHNs compared with 89% of hospitals providing this benefit. This study contributes to our understanding of the human resources challenges faced by LHDs and provides evidence elucidating resources issues that need to be addressed in order to improve recruitment and retention of PHNs.
A New Approach for Reconstruction of Diabetic Foot Wounds Using the Angiosome and Supermicrosurgery Concept
Authors: Suh Hyun Suk , Oh Tae Suk , Lee Ho Seung , Lee Seung Hwan , Cho Yong Pil , Park Joong Ryul , Hong Joon Pio
Published: September 2016

Background:

Major vessels in the diabetic foot are often calcified and inadequate for use as recipient vessels. Thus, a supermicrosurgery technique using small branches or perforators from other collateral vessels with an adequate pulse may be an alternative method. This study evaluated outcome using the supermicrosurgery concept and the risk factors involved.

Methods:

Ninety-five cases of diabetic foot reconstruction were reviewed; the average patient age was 57 years; average follow-up was 43.5 months. Débridement was performed according to the angiosome concept, and reconstruction was performed with perforator flaps using the supermicrosurgery approach. Correlation between total flap loss and 16 preoperative risk factors (age, sex, diabetes mellitus type, smoking, immunosuppression, flap size, hemoglobin A1c, ankle-brachial index, preoperative transcutaneous partial pressure of oxygen, C-reactive protein, computed tomographic angiography, amputation history, peripheral artery disease, American Society of Anesthesiologists physical status, osteomyelitis, and chronic renal failure) were analyzed.

Results:

Of 95 cases, nine cases of total loss and 12 of minor complication were noted. Among the risk factors, the odds for failure after peripheral artery disease was 10.99 (p = 0.035), and that associated with a history of amputation was 9.44 (0.0006). Other factors had no correlation with flap loss, including cases with no or one major vessel. Flap survival rate was 90.5 percent, and the overall limb salvage rate was 93.7 percent.

Conclusions:

Despite the high risk of failure related to peripheral artery disease and history of amputation, the supermicrosurgery approach using a recipient vessel with good pulsation regardless of the source can achieve limb salvage. This approach extends the possibility for reconstruction in patients with severe ischemic diabetic foot.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.