bluuebunny/crossref_metadata_2025 huggingface dataset:
Machiavelli’s Camillus and the Tension Between Leadership and Democracy
Authors: McCormick John P.
Published: January 2020

This chapter challenges cynical understandings of Machiavelli’s conception of leadership, demonstrating the extent to which it fully comports with and uniquely enables both democratic politics and what he calls the “free way of life.” Through Machiavelli’s example of the ancient Roman statesman, Furius Camillus from the Discourses, this chapter delineates the salutary interactions between leaders and citizens that Machiavelli considered indispensable for the realization of liberty within democratic regimes. It demonstrates how the influence exerted and the prerogative enjoyed at key historical junctures by a political leader like Camillus does not constitute usurpations of popular deliberation but rather serve, in conjunction with popularly empowering institutions, as necessary complements to democratic judgment. Indeed, Machiavelli suggests that the most intimate bonds between leaders and citizens often form after the latter have angrily dismissed the former from office, or even exiled them from the polity, only subsequently to reappoint them or invite them back. Drawing upon classical humanistic sources—in particular, Livy and Plutarch—Machiavelli intimates that Camillus, Rome’s frequently appointed supreme magistrate, gained unprecedented trust and authority from the Roman people by accepting their decision to exile him, by faithfully returning to the city during a dire crisis when they summoned him back, and, on numerous subsequent occasions, by eagerly relinquishing command once he’d fulfilled his designated assignments.
The Gap Between Fairness and Law
Authors: Spolsky Ellen
Published: January 2020

This chapter explores the gap between the abstract ideal of fairness and the bodily materiality of retribution. The aim is to suggest how embodied versions of current cognitive science afford a helpful way of talking about the breach between abstractions, or thoughts of fairness, on one hand, and the judgments and punishments produced by actual legal systems on the other. It turns out to be remarkably easy for creatures with brains like ours to leap over the gap, to close the rift produced by evolved brain physiology between abstractions and their physical manifestations. The cognitive theory engaged here is the hypothesis that the grounds of morality and social decision-making—both the feeling of fairness and the institutionalized court systems—can be understood as produced by the structures and processes of human brains in their bodies. My inquiry rests on the co-occurrence of the highly popular revenge tragedies of late sixteenth and early seventeenth century (such as Hamlet) and the conflicts and arguments over the authority of the Chancery, or Equity Courts in London. Was equity, as John Selden later called it, “a roguish thing” that simply reflected the chancellor’s own feelings, in which case the judgments of the court were “above the law,” or was it, as Saint German claimed, grounded in sinderesis, the human mind’s natural understanding of right? The performances of revenge on stage, it is hypothesized, may have helped their audiences understand the direction of change that was needed.
Indigenous Law
Authors: Ablavsky Gregory , Deer Sarah , Richland Justin
Published: January 2020

Indigenous law is the category applied to the norms and legally binding practices of thousands of distinct indigenous communities spanning six continents. This chapter focuses on the content and construction of indigenous law within the borders of the present-day United States, equally marked by diversity among Native communities. Nonetheless, it identifies several important ways in which indigenous law broadly construed diverges from Euro-American legal systems. The chapter notes that indigenous communities have not drawn sharp distinctions between law and other methods for maintaining the proper ordering of society. And, while cautioning against essential accounts of Native justice, it also observes the ways in which Native dispute resolution focuses more on community and restoration than Anglo-American adversarial models. The chapter also recounts constructions of indigenous law by North America’s would-be European colonizers. It describes the long-standing practice by many colonizers of describing indigenous peoples as lawless. This language, the chapter argues, did important work in justifying colonization and the imposition of Anglo-American law. But it also traces the ways in which Native peoples forced Anglo-Americans to incorporate indigenous laws into US law. This incorporation happened both informally—as Anglo-Americans negotiating with Native nations adopted their rules to govern negotiations—and formally, as the body of law known as federal Indian law created a regime of legal pluralism that granted limited recognition to Native nations’ assertions of jurisdiction. The chapter concludes by noting the dangers of adopting the colonizers’ frame and defining indigenous law principally as a foil for Anglo-American law.
Property
Authors: Keenan Sarah
Published: January 2020

This chapter traces changing Anglo-European conceptions of property and their legal manifestations since John Locke, focusing on the common law world. Tracing this history of property requires an attentiveness to constructions of race. The chapter begins by outlining Locke’s concept of property and its relationship to seventeenth- and eighteenth-century British colonialism. Engaging with Cheryl Harris’s crucial insight that whiteness is property, it discusses conceptual and legal overlaps between having and being in dominant property regimes. The Lockean concept of property constructed land as an object essentially interchangeable with capital, a notion which found legal form in title registration and other legal initiatives which made land more alienable than it had previously been, thus assisting the colonial project of Indigenous dispossession. With the growth of the corporation and the credit economy since the nineteenth century, ownership has been divorced from control in ways that challenge the model of property put forward by Locke and other Anglo-European philosophers. In the culture of debt which pervades twenty-first-century capitalist economies, the subject of property is often also a debtor. This subject tends to be produced not through labor or metaphysical recognition but through increasingly algorithmic consumer surveillance and risk profiling which reproduces social categories including race. To understand property’s changing formations, there is a need for approaches that take seriously property’s white supremacist history and seek out alternative modes of having and being.
The Functions of Legal Literature and Case Reporting Before and After Stare Decisis
Authors: Bricker Andrew Benjamin
Published: January 2020

This chapter documents some of the diverse functions of legal literature and case reporting prior to the emergence of the modern doctrine of stare decisis in the mid-nineteenth century. In examining the historical variability of legal literature, this chapter attempts to open up new avenues of research for scholars working between law and the humanities. By acknowledging and trying to make sense of that diversity, scholars might find in legal literature useful archival objects that could serve as evidence for phenomena beyond the recording of decisions and the transmission of precedents. This chapter briefly tracks the shifting functions of legal literature in late-medieval and early modern England to suggest how scholars might use such sources. The remainder of the chapter focuses on a transitional period in the history of stare decisis: the eighteenth and nineteenth centuries, when legal practitioners began fully to grapple with a much more modern notion of precedent as fully binding. Even during this period, however, case reporting served a variety of ends beyond the transmission of precedent, and social historians and literary scholars in particular have used legal literature in creative ways to track both societal shifts and literary forms. The goal here is to expand how scholars working at the intersections of law and the humanities might use legal literature and to suggest new ways to think about case reports: not solely as narrow objects for the transmission of precedent but as archival resources for a variety of superficially non-legal subjects.
Video as Text/Archive
Authors: Capers Bennett
Published: January 2020

This chapter focuses on a few issues related to video evidence and law, especially with respect to American law. The first issue is the history of the use of video evidence in court. The second issue involves constitutional protections regarding the state’s use of surveillance cameras. The chapter then turns to the Supreme Court case Scott v. Harris to raise concerns about the use of video evidence as not just proof but “truth.” These are of course just a sampling of the issues that the topic of video evidence could raise. The hope is that this chapter will spur further inquiry on the part of the reader.
Trials and the Impressionism of Advocacy
Authors: Ferguson Rex
Published: January 2020

Trials have often been written about as narrative events: the standard claim being that at trial one narrative is pitted against another with the verdict proclaiming the winner. This is a connection which privileges a certain view of narrative that is defined by the coherence and closure produced by its plot and which is embodied, in literature, by realist fiction. While admitting the validity of this position, this chapter is intent upon extending it by examining the connection between trials and a different understanding and example of narrative fiction. Taking the Literary Impressionism of Joseph Conrad as a cue (and through an analysis of materials such as Scott Turow’s Presumed Innocent (1987) and the 2014 podcast Serial) the chapter claims that narrative’s capacity to contain non-sequential secrets, to convey latent messages, and to produce meaning from its seemingly peripheral constituents have, to date, been underanalyzed in the context of a narrative understanding of trials. In conclusion, the chapter argues that the impossibility of divorcing narrative from its instantiation in language has far-reaching consequences for how we might understand the narrative battle between prosecution and defense.
Legal Codes as Cultural Products
Authors: Pihlajamäki Heikki
Published: January 2020

Legal codes have served multiple purposes. From early on, they have served as symbols of power, drawing their legitimacy from ancient roots. When observed historically, the practical importance of the codes has often been meager. Although the symbolic significance of the codes has never disappeared, from the nineteenth century onward their importance for practical legal life has been undisputable. The traditional view of looking at the codification history through the lens of nineteenth-century history of continental law is, however, in many ways misleading and in need of revision. Codes need to be considered in the context of other forms of normativity, such as normative ethics, as cultural products, and as export products.
Legal Materiality
Authors: Kang Hyo Yoon , Kendall Sara
Published: January 2020

This chapter presents legal materiality as a distinct approach within law and humanities scholarship. Legal materiality is concerned with the conditions of possibility in and through which law arises, rather than taking law’s materiality to be self-evident, as when it is regarded as a form of material culture or when objects are taken as symbols of law. It distinguishes between matters and materials: if matters are problematizations or “matters of concern” to law, materials are the attributes or properties that are enlisted in acts of interpretation. Rather than addressing materials as inert physical elements that are acted upon by law, legal materiality is concerned with how materials come to matter by being engaged in the production of legal meaning through interpretive and representational practices. Section 2.2 situates this approach in relation to a broader inheritance of materialism and materiality in the Western tradition. It considers different understandings of “materialism,” such as “new materialisms” and historical materialism, that inform but also diverge from legal materiality. Section 2.3 engages with different uses of “materiality” in recent legal scholarship, followed by a detailed discussion of its meaning in two works of legal theory that have sought to articulate a conception of legal materiality. The concluding section discusses the potentials of this approach for law and humanities scholarship to understand how materials are directly implicated in the making of legal difference rather than serving solely as law’s objects.
Invertebrate Models of Nociception
Authors: Hesselson Daniel , Walker Denise S. , Massingham Joshua Neil , Schafer William R. , Neely G. Gregory , Chew Yee Lian
Published: January 2020

Chronic pain is a significant public health problem, affecting 20–25% of the global population, and there is a clear need for more specific and effective therapeutics. To achieve this, a comprehensive understanding of the underlying mechanisms and molecular machinery driving pain-related diseases is required. The definition of pain as an “unpleasant sensory and emotional experience” associated with tissue injury is innately anthropomorphic, the emotional element being difficult to reconcile in nonhuman organisms. Even simple invertebrates are nevertheless capable of nociception, the neural processing of noxious stimuli. With the significant advantages of simpler nervous systems, experimental tractability, and a high level of conservation, they have a major role to play in advancing our understanding. This chapter reviews our current molecular- and circuit-level understanding of nociception in two of the most widely used invertebrate experimental models, the nematode Caenorhabditis elegans and the fly Drosophila melanogaster. In particular, it summarizes the molecules, cells, and circuits that contribute to nociception in response to diverse noxious stimuli in these model organisms and the behavioral paradigms that we can harness to study them. The chapter discusses how mechanistic insights gained from these experimental systems can improve our understanding of pain in humans.
Introduction
Authors: Skrodzka Aga
Published: January 2020

The Oxford Handbook of Communist Visual Cultures expands and enriches the field of Visual Culture Studies primarily through its global scope—a result of the project’s focus on communist visual cultures, which brings together disparate and broadly understood visual texts, produced in different places and moments in time—nevertheless, texts connected by the mobilization of looking employed in processes of social transformation and political action. Interdisciplinary in method, the book allows the reader to think about visual culture beyond representation, as something embedded in everyday life, a rich fabric of visual communication with specific, collective and individual, sites of meaning. Ultimately, the coming together of different fields of visual culture in this book will facilitate a rethinking of the visual within particular disciplines, lifting the conceptual restrictions imposed by ideas related to taste, function, visibility, dissemination, and appropriation, which are used to stake out disciplinary boundaries.
Humanism and the Human
Authors: Winters Joseph
Published: January 2020

This chapter engages humanism and its fundamental assumptions by working through critical theory, black feminism, and black studies. It contends that there is a tension at the heart of humanism—while the ideal human appears to be the most widespread and available category, it has been constructed over and against certain qualities, beings, and threats. To elaborate on this tension, this chapter revisits the work of authors like Karl Marx and Michel Foucault. Marx acknowledges that the human is a site of conflict and antagonism even as his thought betrays a lingering commitment to progress and humanism. Foucault goes further than Marx by underscoring the fabricated quality of man and the ways in which racism functions to draw lines between those who must live and those who must die. In response to Marx and Foucault’s tendency to privilege Europe, this chapter engages black feminism and Afro-pessimism—Sylvia Wynter, Hortense Spillers, and Frank Wilderson—who show how the figure of the human within humanism is defined in opposition to blackness.
Humanism and the Visual Arts
Authors: Elwell J. Sage
Published: January 2020

The Renaissance marked the emergence of scientific naturalism. Implicit in this naturalism was the replacement of supernatural explanations of the cosmos with the belief that the world could be known and represented through first-hand rational investigation. This in turn inspired the tools and techniques necessary for rendering the visible world with accuracy. One of those techniques was single-point perspective. Single-point perspective placed the individual at the center of a knowable and accurately representable cosmos. For over half a millennia single-point, or linear, perspective and the primacy of the individual perceiver dominated Western art. This is the clearest convergence of humanism and the visual arts. However, beginning in the nineteenth century that primacy began to be challenged as art moved away from the demand for perspectival accuracy and the myth of the autonomous, sovereign subject was dispelled.
Humanism and Race
Authors: Cameron Christopher
Published: January 2020

Academic studies of humanism often ignore questions of race and both the existence and significance of non-white humanists. At the same time, scholarship on race and religion fails to consider humanist traditions. Through an analysis of work by literary critics, intellectual historians/philosophers, scholars of religious studies, and theologians this chapter calls for a greater attention to the intersection of race and humanism and posits three key points: scholars working in these fields must make greater use of archival sources and periodicals; explore the ideas and activism of white, black, Native American, and Latinx humanists; and carefully consider the influence of humanism throughout the African Diaspora on black humanism in the United States.
Aesthetic Responses to Architecture
Authors: Coburn Alexander , Chatterjee Anjan
Published: January 2020

Discussions of architectural beauty have largely taken place outside of empirical science. Over the past decade, however, neuroaesthetics has generated new insights into the neurobiological underpinnings of beauty and art. Now, scientists are also beginning to probe the intersection of neuroscience and architecture. The emerging field of neuroarchitecture aims to investigate the neural and psychological implications of architectural design and to inspire the construction of built environments that support psychological experiences and wellbeing. This chapter explores how neuroarchitecture might develop into an experimental science, drawing lessons from recent developments in neuroaesthetics along the way. An initial neural framework is outlined, the aesthetic triad, in order to contextualize past neuroscientific research on the built environment and to motivate future hypothesis-testing studies. Finally, the potential benefits and limitations of this area of research are discussed.
Glimpses of Organizations in the Act of Learning
Authors: Dixon Nancy M.
Published: January 2020

Although much has been written about the learning organization, there are few examples of specific practices that are implemented within learning organizations. In this chapter, the author provides authentic and descriptive glimpses of the learning practices in two organizations, one that has been a learning organization for over twenty years and one that is just three years into that journey. The practices in each are unique to their own mission, yet they are encompassed within the three blocks of a learning organization identified by Garvin, Edmondson, and Gino (2008): (1) a supportive environment, (2) concrete learning processes and practices, and (3) leadership behavior that provides reinforcement. What is common to both organizations is the fundamental belief that employees have both the intelligence and the will to act for the good of the whole which gives them the capability and the responsibility to fully participate in addressing their organization’s problems and guiding its strategy.
The Topicality of the Learning Organization: is the Concept Still Relevant Today?
Authors: Hoe Siu Loon
Published: January 2020

This chapter introduces the current level of interest in the learning organization and usefulness of the concept at the present time. It reviews authors who have recently and explicitly commented on the topicality of the learning organization, offers a qualitative content analysis of recent journal publications on learning organizations justifying the need for the concept, and uses quantitative research using print media indicators and Google Trends to identify the number of publications related to the learning organization over time. The results suggest that while the level of interest in the learning organization among scientific researchers has grown, the level of interest among casual researchers has declined. There is also relatively more interest in the concept outside of the United States and among healthcare and education organizations. The justifications for the usefulness of the concept today are mainly based on its role in improving organizational culture, performance, and innovation capacity.
The Learning Organization Survey: Validation of an Instrument to Augment Research on Organizational Learning
Authors: Edmondson Amy C. , Gino Francesca , Healy Patrick J.
Published: January 2020

Many scholars have proposed factors that inhibit or facilitate organizational learning, yet few of these claims have been tested empirically. To measure differences in learning across organizations or work units within the same organization, this chapters draws on existing perspectives in the organizational learning literature to create and test a Learning Organization Survey (LOS) in two studies. The LOS presents ten constructs in three clusters – learning environment, processes, and leadership. Study 1 examines the reliability and validity of the ten theory-based constructs comprising the learning organization. Study 2 provides further validation that the LOS is a reliable, stable instrument containing items that suit the theoretical criteria for components of learning organizations. Implications for research and practice are discussed.
Suggestions for Future Research on the Learning Organization
Authors: Örtenblad Anders Ragnar
Published: January 2020

This chapter suggests some areas for further research on the learning organization. The suggestions, which in one way or another all are connected to the need for a discussion on what the learning organization actually means/how it is and should be defined, are presented under four sub-headings: “defining the learning organization,” “demarcating the learning organization,” “concretizing the learning organization through action research,” and “paradigm shift?” The chapter ends with a list of some less developed research suggestions. One of the most important research areas that is suggested in the chapter is figuring out whether there is reason to try to give the learning organization one definition that all could agree upon and accept, or whether it would be more reasonable to construct some kind of overview definition, which could include several somewhat different definitions and make these comparable.
Garvin’s Learning Organization: A Process Perspective on Learning for Implementation, Improvement, and Innovation
Authors: Healy Patrick J.
Published: January 2020

This chapter summarizes David A. Garvin’s model of the learning organization and compares and contrasts Garvin’s perspective with those of other scholars. The chapter begins by presenting Garvin’s original definition of the learning organization, the processes learning organizations excel at managing, and ways to measure whether an organization is a learning organization. Next, the chapter describes Garvin’s revisions to his model over time, including changes to his definition, an increased emphasis on enablers of organizational learning, and additional ways to assess learning organizations. The chapter then positions Garvin’s perspective within the broader literature on the learning organization, identifying his focus on learning processes as a distinctive contribution. Finally, it assesses the impact of Garvin’s definition on both research and practice and speculates on the relevance of Garvin’s learning organization to present and future organizations.
Personal Paradoxes in Learning to Design “the Learning Organization”
Authors: Garratt Robert
Published: January 2020

This chapter is a personal reflection on the development of the author’s thinking over a period of forty years on the issues of learning in organizations. Starting with “live project” education in the Architectural Association School, London he traces the start-up of the London and Manchester Business Schools and the role of learning in both. From there his work with Ulster College, Belfast and the General Electric Company’s “Developing Senior Management” programs led to the publication of The Learning Organization, thought to be the first book in this area of study. This led to his growing interest in the lack of learning and development of boards of directors and to the publication of his Learning Board model in The Fish Rots from the Head. His work has been influential in developing business and organizational learning in China, South Africa, South East Asia, Australia and the Caribbean, as well as Europe.
Senge’s Learning Organization: Development of the Learning Organization Model
Authors: Bui Hong T. M.
Published: January 2020

Despite a number of critics, Senge’s The Fifth Discipline: The Art and Practice of the Learning Organization is one of the best-selling books on management of all time. This chapter revisits Senge’s learning organization by looking at how the idea has been conceptualized since its publication. Consequently, it aims to further develop a more holistic model of Senge’s learning organization philosophy that can enable systematic evaluation of the process of creating a learning organization. In detail, it attempts to develop all possible antecedents for the five disciplines of a learning organization, namely personal mastery, mental models, team learning, shared vision, and systems thinking mainly based on what has been developed in the literature so far. This conceptual framework is expected to assist both practitioners and researchers in building learning organizations.
Actin Filament Disruption Alters Phragmoplast Microtubule Dynamics during the Initial Phase of Plant Cytokinesis
Authors: Maeda Keisho , Sasabe Michiko , Hanamata Shigeru , Machida Yasunori , Hasezawa Seiichiro , Higaki Takumi
Published: January 2020

Plant growth and development relies on the accurate positioning of the cell plate between dividing cells during cytokinesis. The cell plate is synthetized by a specialized structure called the phragmoplast, which contains bipolar microtubules that polymerize to form a framework with the plus ends at or near the division site. This allows the transport of Golgi-derived vesicles toward the plus ends to form and expand the cell plate. Actin filaments play important roles in cell plate expansion and guidance in plant cytokinesis at the late phase, but whether they are involved at the early phase is unknown. To investigate this further, we disrupted the actin filaments in cell cycle-synchronized tobacco BY-2 cells with latrunculin B (LatB), an actin polymerization inhibitor. We observed the cells under a transmission electron microscope or a spinning-disk confocal laser scanning microscope. We found that disruption of actin filaments by LatB caused the membrane vesicles at the equatorial plane of the cell plate to be dispersed rather than form clusters as they did in the untreated cells. The midzone constriction of phragmoplast microtubules also was perturbed in LatB-treated cells. The live cell imaging and kymograph analysis showed that disruption of actin filaments also changed the accumulation timing of NACK1 kinesin, which plays a crucial role in cell plate expansion. This suggests that there are two functionally different types of microtubules in the phragmoplast. Together, our results show that actin filaments regulate phragmoplast microtubules at the initial phase of plant cytokinesis.
Greybody factor for a rotating black hole with quintessential energy
Authors: Sharif M , Ama-Tul-Mughani Qanitah
Published: January 2020

This paper is devoted to deriving an analytic expression of the greybody factor for a rotating black hole surrounded by quintessence. Primarily, we transform the radial part of the Klein–Gordon equation into the standard Schrödinger equation through the tortoise coordinate to analyze the profile of the effective potential. Asymptotic solutions are obtained in two distinct regions, namely, the black hole and cosmological horizons determined by the quintessential field. We then extrapolate these solutions and match them smoothly in an intermediate region to extend the viability over the whole radial regime. To elaborate the significance of the analytical solution, we evaluate the emission rates and absorption cross-section for the massless scalar fields. It is found that the accelerated expansion of the universe corresponding to smaller values of the state parameter minimizes the effective potential and consequently increases the emission process of the scalar field particles.
Equal rights in autoimmunity: is Sjögren’s syndrome ever ‘secondary’?
Authors: Kollert Florian , Fisher Benjamin A
Published: January 2020

Sjögren’s syndrome (SjS) accompanied by other systemic autoimmune rheumatic connective tissue diseases has historically been termed ‘secondary’ in contrast to ‘primary’ SjS as a standalone entity. However, it is a matter of a long-standing debate whether the prefixes ‘primary’ and ‘secondary’, including a temporal component, are obsolete in the terminology of SjS. We review the history and the pathophysiological, chronological, genetic, histological and clinical data underlying the concept of ‘secondary’ SjS. There are important unintended consequences of the nomenclature; notably ‘secondary’ SjS has been much less researched and is often excluded from clinical trials. We argue for further research, a change in terminology and more stringent classification. Further we highlight possible opportunities for trials in SjS and other systemic autoimmune diseases that might contribute to an advance in care for all patients with SjS.
Adrenal insufficiency in prednisolone-treated patients with polymyalgia rheumatica or giant cell arteritis—prevalence and clinical approach
Authors: Borresen Stina W , Thorgrimsen Toke B , Jensen Bente , Hilsted Linda , Bartels Else M , Feldt-Rasmussen Ulla , Locht Henning
Published: January 2020

Objectives

Glucocorticoid treatment is fundamental in polymyalgia rheumatica (PMR) and giant cell arteritis (GCA), but carries a risk of glucocorticoid-induced adrenal insufficiency. Adrenal insufficiency can cause reluctance to stop glucocorticoid treatment after disease remission as symptoms can resemble PMR/GCA flare. We aimed to determine the prevalence of adrenal insufficiency in prednisolone-treated patients with PMR/GCA.

Methods

We included 47 patients with PMR (n = 37), GCA (n = 1) or both (n = 9), treated with prednisolone for ≥5.4 months, current dose 2.5–10 mg/day. Adrenal function was evaluated using a corticotropin (Synacthen®) stimulation test following 48 h prednisolone pause. Two years’ clinical follow-up data are provided.

Results

Seven patients (15%) had adrenal insufficiency, 4 (11%) of the 37 patients with PMR alone, and 3 (30%) of the 10 patients with GCA. Corticotropin-stimulated P-cortisol was significantly associated with current prednisolone dose, mean daily dose the last 3 and 6 months before testing, and basal P-cortisol, but not with total dose or treatment duration. Adrenal insufficiency occurred with all current prednisolone doses (2.5–10 mg/day). Five (71%) of the glucocorticoid-insufficient patients could discontinue prednisolone treatment; two of them recovered glucocorticoid function, whereas three still needed hydrocortisone replacement 2 years later. Two patients experienced in total four acute hospital admissions with symptoms of adrenal crises.

Conclusion

Glucocorticoid-induced adrenal insufficiency occurred in 15% of patients with PMR/GCA. Mean prednisolone dose the last 3 months and basal P-cortisol were the best and simplest predictors of adrenal function. Most of the glucocorticoid-insufficient patients could discontinue prednisolone with appropriate treatment for adrenal insufficiency.
Guilt by Association: Ezokola’s Unfinished Business in Canadian Refugee Law
Authors: Bond Jennifer , Benson Nathan , Porter Jared
Published: January 2020

Guilt by association is an insufficient ground on which to deny international refugee protection. This was the finding in Ezokola v. Canada, a landmark case holding that Article 1F(a) of the Refugee Convention requires a “voluntary, knowing and significant contribution” to a crime or criminal purpose before a refugee claimant can be excluded from protection on the basis of alleged involvement in international crimes. However, the same kinds of underlying acts that were before the Supreme Court of Canada in Ezokola – and are routinely considered under the Article 1F(a) exclusion framework – are also assessed under a second, distinct part of Canada's refugee system called the inadmissibility framework. This article explores the relationship between exclusion and inadmissibility, and demonstrates critical differences in the scope of each framework. We ultimately conclude that Canada's inadmissibility provisions bar asylum seekers from refugee protection on grounds broader than those permitted under Article 1F(a). This renders Canada's refugee claims system fundamentally inconsistent with the Refugee Convention and means that the business started in Ezokola urgently needs to be finished.
Occupational aspects of irritable larynx syndrome
Authors: Denton Eve , Hoy Ryan
Published: January 2020

Purpose of review

The aim of this article is to provide an update on occupational aspects of irritable larynx syndrome (ILS).

Recent findings

It is being increasingly recognized that ILS is common amongst certain occupations. This is particularly true of occupations that require frequent voice use such as teachers; where there is exposure to workplace irritants such as World Trade Center responders; or mechanical factors that cause laryngeal dysfunction such as elite athletes. Work associated ILS impacts on quality of life but responds to speech and language therapy focusing on education, vocal hygiene, and laryngeal exercises that reduce cough and treat acute laryngeal obstruction episodes.

ILS may be caused or exacerbated by many occupational exposures, causes significant symptoms, and impacts on quality of life. It is potentially treatable and may well be preventable. More research in this important area is required.
Characteristics of Academic-Affiliated Health Systems
Authors: Niedzwiecki Matthew J. , Machta Rachel M. , Reschovsky James D. , Furukawa Michael F. , Rich Eugene C.
Published: January 2020

Purpose

Changing market forces increasingly are leading academic medical centers (AMCs) to form or join health systems. But it is unclear how this shift is affecting the tripartite academic mission of education, research, and high-quality patient care. To explore this topic, the authors identified and characterized the types of health systems that owned or managed AMCs in the United States in 2016.

Method

The authors identified AMCs as any general acute care hospitals that had a resident-to-bed ratio of at least 0.25 and that were affiliated with at least one MD- or DO-granting medical school. Using the Agency for Healthcare Research and Quality 2016 Compendium of U.S. Health Systems, the authors also identified academic-affiliated health systems (AHSs) as those health systems that owned or managed at least one AMC. They compared AMCs and other general acute care hospitals, AHSs and non-AHSs, and AHSs by type of medical school relationship, using health system size, hospital characteristics, undergraduate and graduate medical education characteristics, services provided, and ownership.

Results

Health systems owned or managed nearly all AMCs (361, 95.8%). Of the 626 health systems, 230 (36.7%) met the definition of an AHS. Compared with other health systems, AHSs included more hospitals, provided more services, and had a lower ratio of primary care doctors to specialists. Most AHSs (136, 59.1%) had a single, shared medical school relationship, whereas 38 (16.5%) had an exclusive medical school relationship and 56 (24.3%) had multiple medical school relationships.

Conclusions

These findings suggest that several distinct types of relationships between AHSs and medical schools exist. The traditional vision of a medical school having an exclusive relationship with a single AHS is no longer prominent.
Role of Ilizarov external fixator in the treatment of long-standing knee flexion deformity in adults: A prospective cohort study
Authors: Meselhy Mohammed Anter , Elhammady Adel Samy
Published: January 2020

Background:

One of the major disabilities of the lower limb is fixed knee flexion deformity. Post-polio residual paralysis is the main etiology, but there are others. This study evaluated the outcome of treatment of long-standing fixed knee flexion deformity with the Ilizarov external fixator without soft-tissue intervention or osteotomy in a certain age group.

Methods:

Thirty patients (33 knees) with knee flexion deformity were enrolled in this study. There were 11 women and 19 men. Three patients had bilateral lower limb affection. The etiology was post-polio residual paralysis in 11 patients (14 knees), four patients had brain insult, eight patients had post infectious etiology, and seven patients had failure of open reduction and internal fixation of tibial plateau fractures. An Ilizarov fixator was applied in all patients for deformity correction with no soft-tissue release or osteotomies.

Results:

The mean age of the patients was 28.7 yr (18-55 yr), the mean preoperative flexion knee angle was 77.87 degrees (50-130 degrees). The mean preoperative arc of motion was 17.1 degrees (0-50 degrees), the mean time since the deformity was well established was 9.4 yr (4-30 yr), the mean time needed for correction of the deformity was 49.2 days (27-120 days) at the end of the procedure. All patients achieved full correction of the deformity.

Conclusions:

The Ilizarov external fixator is an effective tool in the treatment of severe long-standing fixed knee flexion deformity in adults with minimal complications and good outcomes.

Level of Evidence:

Level II.
The current use of Twitter in orthopaedic surgery departments: A cross-sectional analysis
Authors: Zitsch Bradford P. , Worley John R. , Cornell Georgeanne E. , Skelley Nathan W.
Published: January 2020

Background:

The extent to which individual clinical departments use Twitter™ is largely unknown. Further, impact of use has not been extensively studied. The purpose of this study was to identify and analyze Twitter™ utilization by orthopaedic surgery departments and to gauge the implications Twitter™ use has on the status of the department.

Methods:

We conducted a cross-sectional analysis of Twitter utilization for all Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic surgery training programs. Tweets between May 1 and December 1, 2018 were categorized and Tweet impact was assessed using public interaction. Program rankings, as measured by Doximity and US News and World Report (USNWR), were correlated with various Twitter variables. Correlations were calculated with Pearson’s correlation coefficient.

Results:

Of the 153 ACGME-accredited orthopaedic surgery departments, 24 (15.7%) had Twitter accounts. The departments averaged 1079.35±713.47 followers and a mean of 16.16±13.83 tweets per month. Most tweets were internally generated “unique” tweets. Unique tweets had a mean of 4.50±0.04 likes and 1.10±0.12 retweets per tweet. Twitter account profile data and tweet content demonstrated equal numbers of tweets categorized as “educational” and “other”. Both Doximity and USNWR had more favorable ranks with increasing variables of all Twitter categories, and there was a statistically significant correlation between greater number of post “likes” and a higher USNWR score.

Conclusions:

Twitter is underutilized by orthopaedic surgery departments and has a small correlation with the reputation of the department.

Level of Evidence:

Level IV.
The association between chronic pain and central sensitization following total knee replacement: A retrospective cohort study
Authors: Şen Baran , Engin Onur , Ellidokuz Hülya , Eken Mesude , Tatari Hasan , Akalin Elif
Published: January 2020

Background:

Pain still persists in 20% of patients who have had total knee replacement (TKR) surgery. It is important to investigate the reason for the persistent pain after surgery and related factors. This study aimed to elucidate any connection between central sensitization and ongoing pain after knee replacement surgery and other associated factors.

Methods:

The population was composed of 182 patients who had undergone TKR, and in follow-up visits from 1 mo to 2 yr after the operation, they were evaluated using the Pressure Pain Threshold (PPTs), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Central Sensitization Inventory (CSI), the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), the Beck Depression Inventory (BDI), and the painDETECT test.

Results:

The mean follow-up period was 6.84±4.10 (1-24) months. According to the postoperative LANSS score, neuropathic mechanisms were responsible for pain in 48.4% (88/182) of the patients. CSI showed central sensitization in 41.2% (75/182) of the patients (CSI score ≥40). Patients whose pain was not associated with neuropathic mechanisms (LANSS score <12 or painDETECT score<19) saw more benefit from surgery (P<0.001). Additionally, pain relief after TKR was more prevalent in patients whose CSI score was <40 points (P<0.001).

Conclusions:

This study showed that neuropathic mechanisms and central sensitization are important sources of persistent pain in patients who have had total knee replacement. Evaluation of central sensitization and neuropathic mechanisms may play an important role in management of pain.

Level of Evidence:

Level III.
Monoblock polyethylene radial head prosthesis for the treatment of unreconstructable acute radial head fractures with a minimum 1-year follow-up: A retrospective case series
Authors: Ucpunar Hanifi , Camurcu Yalkin , Altay Ridvan , Duman Serda , Cobden Adem , Sofu Hakan
Published: January 2020

Background:

Radial head arthroplasty is an alternative treatment for complex radial head fractures that are not appropriate for fixation. No study to date has reported the outcomes of monoblock ultrahigh molecular weight polyethylene (UHMW-PE) radial head prosthesis (RHP) for the treatment of radial head fracture. We aimed to evaluate the functional and radiographic outcomes of patients with unreconstructable acute radial head fractures treated with a monoblock UHMW-PE RHP.

Methods:

Patients who underwent UHMW-PE RHP placement for the treatment of radial head fracture were included in this retrospective case series. Patients who did not complete follow-up were excluded. Primary outcome measurements were the Mayo Elbow Performance Score (MEPS) and the Disabilities of Arm, Shoulder, and Hand (DASH) score. The latest follow-up physical examination and radiographs were evaluated for loosening, subluxation, and dislocation. Postoperative complications and need for further surgery were noted.

Results:

Eleven patients (four female and seven male patients) with a mean follow-up of 18.5 mo were evaluated. The mean MEPS was 79.5 (range, 65–100) at 3 mo postoperatively and 85.9 (range, 75–100) at the latest follow-up. The mean DASH score was 10.8 (range, 3–20) at 3 mo postoperatively and 8.7 (0–20) at the latest follow-up. No complications were encountered during follow-up.

Conclusions:

Radial head arthroplasty with a monoblock UHMW-PE RHP is safe and effective at short-term follow-up for treating acute unreconstructable radial head fractures with satisfactory functional and radiographic outcomes.

Level of Evidence:

Level IV.
Risk score for major complications after total hip arthroplasty: the beneficial effect of neuraxial anesthesia. A retrospective observational study
Authors: Elsharydah Ahmad , Li Fredrick C. , Minhajuddin Abu , Gabriel Rodney A. , Joshi Girish P.
Published: January 2020

Background:

Total hip arthroplasty (THA) is an effective treatment for symptomatic osteoarthritis after failed nonsurgical therapies. Minimizing perioperative complications is critical for faster recovery and shorter hospital stay. The primary aim of this study was to identify predictors of perioperative major complications (MC) and mortality after THA, and to use these predictors to develop a risk scoring system.

Methods:

The 2006-2016 National Surgical Quality Improvement Program (NSQIP) database was queried for adult patients who underwent primary elective THA performed under general or neuraxial anesthesia. Univariate and multivariate logistic regression and bootstrap analyses were used to select the strongest predictors for MC. A simple risk score was created based on the beta estimates for the selected predictors.

Results:

Included were 104,404 cases. The final model had five predictors for MC: age ≥65 yr, congestive heart failure, hypertension, creatinine ≥2 mg/dL, and diabetes mellitus. The model had a fair discrimination ability with an area under the curve (AUC) value of 0.67 on the training sample and 0.65 on the test sample. The model had good calibration for the data in both the training and test samples. Neuraxial anesthesia decreased the risk of MC (OR 0.54 [95% CL, 0.44–0.66], P<0.0001). Risk scores for MC ranged from 0 to 13. A risk score of 4 or greater was associated with a significant increase in MC.

Conclusions:

Neuraxial anesthesia is associated with decreased risk of MC after THA. The risk model developed may assist with preoperative decision-making regarding the choice of anesthesia, selection of outpatient cases, and postoperative care.

Level of Evidence:

Level III.
Rural health issues in rheumatology: a review
Authors: Lennep Day S. , Crout Teresa , Majithia Vikas
Published: January 2020

Purpose of review

Early access to rheumatology is imperative to achieve appropriate outcomes in rheumatologic diseases. But there seems to be a significant gap and disparity in the access to rheumatology care between urban and rural areas. This review was undertaken to analyze this issue.

Recent findings

A significant delay in diagnosis of rheumatic disorder has been correlated to the travel distance to rheumatologist. It is also clear that currently, a significant rheumatology workforce shortage exists and is projected to worsen significantly, thereby making this gap and disparity much bigger.

The scope of this gap and disparity in rheumatology care for rural patients remains incompletely defined and quantified. It is felt to be a significant issue and it is important to invest resources to obtain information about its scope. In addition, a number of solutions already exist which can be implemented using current network and infrastructure. These include relatively low-cost interventions such as patient navigator, remote rheumatology experts and if possible tele-rheumatology. These interventions can assist temporarily but a major improvement will require policy change at federal and state government level as well as involvement, buy-in, and incentivization of the providers and health networks providing rheumatology care.