bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of microchimerism following somatic cell nuclear transfer and natural pregnancies in goats
Authors: Gash Kirsten K , Yang Min , Fan Zhiqiang , Regouski Misha , Rutigliano Heloisa M , Polejaeva Irina A
Published: July 2019

Microchimerism is defined as the presence of a small population of cells or DNA in 1 organism originated from a genetically different organism. It is well established that this phenomenon occurs in humans and mice as cells are exchanged between mother and fetus during gestation. Currently, no information is available about the presence of maternal microchimerism in goats, and the only published study is limited to an evaluation of fetal and fetal–fetal microchimerism in blood samples following natural breeding. In order to determine whether bidirectional fetal–maternal cell or DNA trafficking occurs in goats, we assessed: 1) fetal microchimerism in surrogates that gave birth to somatic cell nuclear transfer (SCNT)-derived transgenic offspring (n = 4), 2) maternal microchimerism following natural breeding of SCNT-derived transgenic does with a nontransgenic buck (n = 4), and 3) fetal–fetal microchimerism in nontransgenic twins of transgenic offspring (n = 3). Neomycin-resistance gene (NEO) gene was selected as the marker to detect the presence of the αMHC-TGF-β1-Neo transgene in kidney, liver, lung, lymph node, and spleen. We found no detectable maternal or fetal–fetal microchimerism in the investigated tissues of nontransgenic offspring. However, fetal microchimerism was detected in lymph node tissue of one of the surrogate dams carrying a SCNT pregnancy. These results indicate occurrence of cell trafficking from fetus to mother during SCNT pregnancies. The findings of this study have direct implications on the use and disposal of nontransgenic surrogates and nontransgenic offspring.
Family-Based Consent and Motivation for Cadaveric Organ Donation in China: An Ethical Exploration1
Authors: Fan Ruiping , Wang Mingxu
Published: July 2019

This essay indicates that Confucian family-based ethics is by no means a stumbling block to organ donation in China. We contend that China should not change to an opt-out consent system in order to enhance donation because a “hard” opt-out system is unethical, and a “soft” opt-out system is unhelpful. We argue that the recently-introduced familist model of motivation for organ donation in mainland China can provide a proper incentive for donation. This model, and the family priority right that this model supports, is ethically justifiable in terms of Confucian family-based ethics.
20 Art. 20 GG: The Social State
Authors: Christian Bumke , Andreas Voßkuhle
Published: July 2019

This chapter discusses the principle of social state as articulated in Art. 20 of the Grundgesetz (GG). In contrast to the democracy principle, GG contains only a few provisions which can be assumed to be specific manifestations of the social-state principle. As a result, interpretation and application of the principle become problematic. As an objective right, the social-state principle requires the state to provide actual benefits. Art. 1 para. 1 GG, in combination with the social-state principle, justifies a claim ‘to the guarantee of a minimum livelihood in accordance with human dignity’. The chapter examines the Federal Constitutional Court's jurisprudence concerning individual social benefits that may be provided by the legislature to fulfill its obligations under the social-state clause, with particular emphasis on long-term care insurance, and the state's obligations under the social-state principle to create and maintain public social-welfare facilities.
22 Art. 20 GG: The Rule of Law
Authors: Christian Bumke , Andreas Voßkuhle
Published: July 2019

This chapter discusses the rule of law principle as articulated in Art. 20 of the Grundgesetz (GG). The rule of law may be formal or substantive. The formal conception of the rule of law applies primarily to technical and organisational safeguards which discipline state authority, such as separation of powers and the independence of courts. In contrast to the formal perspective, the idea of the ‘substantive’ rule of law principle also takes into account the substance and overall direction of state activity. The chapter first examines the Federal Constitutional Court's jurisprudence concerning the principle of separation of powers and the requirement of the rule of law principle that administrative agencies act according to statutory laws. It then considers the principle of proportionality (the prohibition of excessiveness) and the binding force of law and justice on the courts before concluding with an analysis of the principle of legal certainty.
27 Arts. 38 et seq. GG: Organs of the Federal Government
Authors: Christian Bumke , Andreas Voßkuhle
Published: July 2019

This chapter discusses the relevant provisions of Art. 38 et seq. of the Grundgesetz (GG) with regard to the following organs of the federal government: the Bundestag, the Bundesrat, the Federal President, the Federal Convention, and the Federal Government. It first examines the Federal Constitutional Court's jurisprudence regarding the Bundestag, the election of its members as well as their position, rights and duties, and committees (in particular, committees of inquiry). It then considers the Bundesrat and the question of whether it is a constitutional organ, along with the Federal President and the Federal Assembly. It also looks at the Federal Government, focussing on its powers in the context of deciding whether personnel affairs relating to civil servants belonged to its mandate, its information policy, whether commentary made by members of the Federal Government constitute permissible or impermissible political activity, and dissolution of the Bundestag.
Multiple Sclerosis
Authors: Birnbaum Gary
Published: July 2019

This chapter provides a broad overview of adult onset multiple sclerosis (MS), with the intent of providing a practical approach to diagnosis and treatments. It starts by looking at the epidemiology and demographics of MS, followed by a detailed discussion of the pathogenesis and pathology of MS. The chapter discusses the diagnosis, the various stages, and the symptoms of MS. Treatment of the disease, addressing both underlying pathology and symptoms, are discussed in detail. These include discussions of established therapies such as injectable and oral disease-modifying therapies, monoclonal antibodies, plasmapheresis or plasma exchange (PLEX), as well as new, and currently experimental therapies such as autologous stem cell transplants. Emphasis is especially directed at the often-underutilized management of MS-related symptoms.
Guillain-Barré Syndrome
Authors: Burford Matthew J. G. , Lewis Richard A.
Published: July 2019

This chapter begins by outlining the origin of Guillain-Barré syndrome (GBS). It looks at the epidemiology and antecedent events. It also considers clinical manifestations. The classic clinical scenario is one of acute, symmetric, progressive, ascending weakness, and areflexia, with or without sensory symptoms days to weeks after a preceding infection. Next differential diagnosis is examined. The differential diagnosis of GBS is quite broad and includes disorders leading to sudden onset of weakness. The general pattern of clinical involvement and medical history helps to hone the differential. Finally, the chapter looks at management of the syndrome and treatment options for various different groups, such as immune therapy.
Renal-limited vasculitis (RLV)
Authors: Glassock Richard J. , Nachman Patrick H
Published: July 2019

This chapter uses the term renal-limited vasculitis (RLV) to refer to disorders of widely different aetiology and pathogenesis having in common the development of destructive lesions of the glomerular capillaries often leading to segmental necrosis of the capillary wall and proliferation of cells within Bowman’s space (crescents) in the absence of any multi-system manifestations. The resulting accumulation of cells gives rise to a ‘crescent’ enveloping the glomerular tuft itself; polymerization of fibrinogen in Bowman’s space due to passage of fibrinogen through gaps in the damaged capillary wall, the elaboration of procoagulant factors by infiltrating monocytes, and impaired fibrinolysis all contribute to its pathogenesis. Quite often the crescentic lesions are extensive and involve a majority of glomeruli. Such patients frequently manifest rapid and progressive deterioration of renal function leading to the clinical syndrome of rapidly progressive glomerulonephritis. This chapter discusses the pathology, prognosis,,treatment options, and risk factors for RLV.
Other primary glomerular diseases
Authors: Ponticelli Claudio , Moroni Gabriella
Published: July 2019

This chapter covers the other primary glomerular diseases, including their pathologies, treatment options for their management, and risk factors. Some of these primary glomerular diseases are quite rare. This chapter covers fibrillary glomerulonephritis (FGN), collagenofibrotic glomerulopathy, thin basement membrane nephropathy (TBMN), lipoprotein glomerulopathy (LPG), ‘pure’ mesangial proliferative glomerulonephritis (MesPGN), IgM nephropathy, C1q nephropathy, idiopathic nodular glomerulosclerosis, and C4 glomerulopathy. It describes the use of light microscopy, immunofluorescence, electron microscopy, and immunochemistry where applicable. For each disease, the natural history, clinical presentation, pathogenesis, and pathology are described, and, where applicable, specific studies are discussed. Any specific treatments are outlined for each.
Prevention and management of violence and aggression
Authors: Price Alyson , Price David
Published: July 2019

The prevention and management of violence and aggression (PMVA) in mental health inpatient settings raises a number of issues for staff involved in this type of intervention. The aim of this chapter is to outline some of the issues pertinent to staff and review historical and current influences for physical restraint. It discusses the physical risks that may be posed by a restraint, including prone restraint concerns, and reviews the public health model in relation to care planning around the management of disturbed behaviour—looking at the use of primary, secondary, and tertiary level interventions. In addition, the chapter discusses risk assessment and the decision-making process involved in a restraint. Finally, before considering the future directions of PMVA, legislation relevant to restraint is reviewed within the UK setting.
People with personality disorders and developmental conditions on an inpatient ward
Authors: Pearce Steve , Critchlow Gail
Published: July 2019

This chapter reviews research and expert guidelines on inpatient management of personality disorder, autism spectrum disorder, and adult attention deficit hyperactivity disorder. It covers use of medication, milieu approaches, other psychosocial interventions, the impact of the ward environment, quality assurance mechanisms, and the impact of institutionalization. Ways in which formal therapeutic approaches can be implemented on inpatient wards are also addressed. The effect of risky and challenging behaviours on defensive practice and staff burnout is covered, and detailed advice on managing suicidal and high-risk patients who are difficult to discharge safely is included. The chapter details specific approaches to milieu management, use of observations, personalized care plans, and communication styles in borderline personality disorder, autism spectrum disorder, and attention deficit hyperactivity disorder. Patients with these diagnoses constitute an important group of inpatients, and with careful management, iatrogenic harms can be avoided.
Assessment and management of the risk of suicide
Authors: McLaughlin Sue , Bonner Gwen , Attard Caroline
Published: July 2019

Assessment and management of suicide risk within the inpatient setting can be particularly challenging for staff where a range of factors impact the decision-making process. Using an authentic, compassionate approach towards understanding risks with service users is important to support meaningful collaborative risk assessment, and involving carers wherever possible is recommended. Reflective peer review can be a helpful way to consider decision-making and enhance clinical skills, as well as providing valuable support to staff. Post-incident support can be equally important for staff and service users and the culture in which risk assessment is undertaken needs to be one of encouragement and positive learning across the team and the organization.
Working with relatives and friends
Authors: Moone Nicki
Published: July 2019

Working with relatives and carers on inpatient wards demands careful consideration and reflection on how best to adapt practice to meet their needs, working in partnership as stipulated by national policy and practice guidelines. Making all staff ‘carer aware’ means having a systematic approach to building on carers’ strengths and addressing their needs. The role of mental health practitioners in an acute inpatient ward requires a specific set of skills and values when working alongside carers and consideration of the impact that the caring role has had. Attention to best practice, guidance, and protocols go some way to addressing the need to be carer inclusive.
Psychological treatment on the acute ward
Authors: Barkataki Ian , Ross Louise
Published: July 2019

Psychological approaches to treatment on inpatient units have been increasingly valued both by staff and service users. Such approaches have been delivered by specialist psychologists and psychotherapists but also adopted and used by the wider multidisciplinary ward team as a framework for guiding treatment. This chapter outlines both direct interventions with service users, as well as broader, more indirect psychological working with staff, families, and other external stakeholders. It also outlines the key stages of psychological working including assessment, formulation, intervention, and evaluation, and provides an overview of the types of therapies commonly delivered. The importance of staff well-being, team working, clinical supervision, and reflective practice is discussed, as are the challenges of working psychologically within an inpatient context.
Acute inpatient care for children and adolescents
Authors: James Anthony
Published: July 2019

Inpatient treatment of children and adolescents forms an important part of modern psychiatric care. However, practices are changing with increasing demands for admission, and higher numbers of suicidal adolescents, with a greater degree of complexity and higher levels of violence and self-harm. There is also a drive for shorter admissions, partly driven by costs and resource limitations. Inpatient care is a complex activity, and understanding the dynamics and group dynamics of an inpatient unit is vital to any successful outcome. Child and adolescent units provide a variety of therapeutic approaches delivered by a multidisciplinary team. Integration of the therapeutic modalities is essential. In this age group, inpatient care is divided by age. Specialized services include eating disorder, forensic/secure, learning disability, and occasionally autism units. The outcome of inpatient care is favourable, although costly, and requires managed integration with outreach and community psychiatric services.
Dynamics of dusty vortices – I. Extensions and limitations of the terminal velocity approximation
Authors: Lovascio Francesco , Paardekooper Sijme-Jan
Published: July 2019

Motivated by the stability of dust laden vortices, in this paper we study the terminal velocity approximation equations for a gas coupled to a pressureless dust fluid and present a numerical solver for the equations embedded in the FARGO3D hydrodynamics code. We show that for protoplanetary discs it is possible to use the barycentre velocity in the viscous stress tensor, making it trivial to simulate viscous dusty protoplanetary discs with this model. We also show that the terminal velocity model breaks down around shocks, becoming incompatible with the two-fluid model it is derived from. Finally we produce a set of test cases for numerical schemes and demonstrate the performance of our code on these tests. Our implementation embedded in FARGO3D using an unconditionally stable explicit integrator is fast, and exhibits the desired second-order spatial convergence for smooth problems.
Full-3D relativistic MHD simulations of bow shock pulsar wind nebulae: emission and polarization
Authors: Olmi B , Bucciantini N
Published: July 2019

Bow shock pulsar wind nebulae are observed with a variety of complex morphologies at different wavelengths, most likely due to differences in the magnetic field strength and pulsar wind geometry. Here we present a detailed analysis, showing how these differences affect the observational properties in these systems, focusing on non-thermal synchrotron emission. By adopting different prescriptions for the local emissivity, on top of the magnetic and flow patterns taken from three-dimensional (3D) high-resolution numerical simulations in relativistic magnetohydrodynamics (MHD), and considering various viewing angles, we try to characterize the main features of the emission and polarization, to verify if and how these can be used to get information, or to put constraints, on known objects. We found, for example, that conditions leading to a strong development of the turbulence in the bow shock tail produce substantial differences in the emission pattern, especially in polarized light.
Detection of a slow H i bar in the dwarf irregular galaxy DDO 168
Authors: Patra Narendra Nath , Jog Chanda J
Published: July 2019

We examine the H i total intensity maps of the VLA LITTLE-THINGS galaxies and identify an H i bar in the dwarf irregular galaxy DDO 168 which has a dense and compact dark matter halo that dominates at all radii. This is only the third galaxy found to host an H i bar. Using the H i kinematic data, we apply the Tremaine–Weinberg method to estimate the pattern speed of the bar. The H i bar is found to have an average pattern speed of 23.3 ± 5.9 $\rm km \, s^{-1} \, kpc^{-1}$. Interestingly, for the first time, we find that the observed pattern speeds of the bar in the two kinematic halves are different. We identify the origin of this difference to be the kinematic asymmetry. This observed offset in the pattern speed serves to put a stringent constraint on the lifetime of the bar set by the winding time-scale. The lifetime of the bar is found to be 5.3 × 108 yr, which is two times the dynamical time-scale of the disc. We also find the H i bar in DDO 168 to be a weak bar with a strength of 0.2. If H i bar being weak can be easily disturbed, this could possibly explain why it is extremely rare to observe H i bars in galaxies. We estimate the bar radius to be 1 kpc and the dimensionless ratio, RL/Rb to be ≥2.1 indicating a ‘slow’ bar in DDO 168. Our results confirm the proposition that the dynamical friction with the halo slows down a rotating bar in a galaxy dominated by dark matter halo from inner radii.
Completion of LINE integration involves an open ‘4-way’ branched DNA intermediate
Authors: Khadgi Brijesh B , Govindaraju Aruna , Christensen Shawn M
Published: July 2019

Long Interspersed Elements (LINEs), also known as non-LTR retrotransposons, encode a multifunctional protein that reverse transcribes its mRNA into DNA at the site of insertion by target primed reverse transcription. The second half of the integration reaction remains very poorly understood. Second-strand DNA cleavage and second-strand DNA synthesis were investigated in vitro using purified components from a site-specific restriction-like endonuclease (RLE) bearing LINE. DNA structure was shown to be a critical component of second-strand DNA cleavage. A hitherto unknown and unexplored integration intermediate, an open ‘4-way’ DNA junction, was recognized by the element protein and cleaved in a Holliday junction resolvase-like reaction. Cleavage of the 4-way junction resulted in a natural primer-template pairing used for second-strand DNA synthesis. A new model for RLE LINE integration is presented.
The effects of youth labour market reforms: evidence from Italian apprenticeships
Authors: Albanese Andrea , Cappellari Lorenzo , Leonardi Marco
Published: July 2019

In this paper, we estimate the causal effects of the 2003 reforms to the Italian apprenticeship contract that increased its legal length, allowed on-the-job training and introduced a minimum floor to apprentices’ wages. Using administrative data, we implement a covariate balancing propensity score and a difference-in-differences estimator. We find that the new contract improves the chances of an apprentice obtaining a permanent job in the same firm five years after hiring; however, this occurs more frequently in large firms. We also find sizeable, long-run wage effects that extend well beyond the legal duration of the apprenticeship contract. These effects are compatible with increased human capital accumulation, possibly due to the reformed training provisions.
Select Committee Reform: Shifting the Balance and Pushing the Boundaries
Authors: Maer Lucinda
Published: July 2019

The departmental select committee system, established in 1979, is seen as increasingly powerful, with committees producing more work, engaging with more people, and doing more to scrutinise the actions of those with power than ever before. There have been two main periods of select committee reform over the past 40 years: the first following the 2001 general election, and the second in the run-up to the 2010 general election. More recently, select committees, strengthened by the election of their chairs and members, have pushed at the boundaries of their powers and remit. This article sets out the story of reform.
From Hólar to Lisbon: Middle English Literature in Medieval Translation, c.1286–c.1550
Authors: Byrne Aisling
Published: July 2019

This paper offers the first survey of evidence for the translation of Middle English literature beyond the English-speaking world in the medieval period. It identifies and discusses translations in five vernaculars: Welsh, Irish, Old Norse-Icelandic, Dutch, and Portuguese. The paper examines the contexts in which such translation took place and considers the role played by colonial, dynastic, trading, and ecclesiastical networks in the transmission of these works. It argues that English is in the curious position of being a vernacular with a reasonable international reach in translation, but often with relatively low literary and cultural prestige. It is evident that most texts translated from English in this period are works which themselves are based on sources in other languages, and it seems probable that English-language texts are often convenient intermediaries for courtly or devotional works more usually transmitted in French or Latin.
Why Does an IPO Affect Rival Firms?
Authors: Spiegel Matthew , Tookes Heather
Published: July 2019

IPO firms’ rivals tend to experience performance declines following an IPO in the industry. Why? We estimate a dynamic structural oligopoly model to distinguish between alternative theories that can explain an industry’s evolution post-IPO. We find that most changes in rivals’ performance are due to industry trends that also drive IPOs. However, we also find some “competitive” IPOs where the IPO enhances the IPO firm’s performance at the expense of competitors. These findings help reconcile prior evidence of average performance reductions of both IPO firms and their rivals with well-known cases in which firms have benefited from going public. (JEL G30, G32)

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
Significant association between clinical characteristics and immuno-phenotypes in patients with ANCA-associated vasculitis
Authors: Matsumoto Kotaro , Suzuki Katsuya , Yoshimoto Keiko , Seki Noriyasu , Tsujimoto Hideto , Chiba Kenji , Takeuchi Tsutomu
Published: July 2019

Objectives

To elucidate the association between clinical characteristics and immuno-phenotypes in patients with ANCA-associated vasculitis (AAV).

Methods

Peripheral blood from 36 patients with active AAV and 18 healthy controls was examined for numbers of circulating T cells, B cells, NK cells, dendritic cells, monocytes and granulocytes using flow cytometry. These immuno-phenotyping data were subjected to cluster analysis and principal components analysis to divide AAV patients into subgroups. Associated organ involvement or therapeutic prognosis were assessed for each subgroup.

Results

AAV patients had higher proportions of plasma cells, plasmablasts, activated T cells, CD14++ CD16+ monocytes, eosinophils and neutrophils than healthy controls. Immuno-phenotyping findings were similar between patients with microscopic polyangiitis, granulomatosis with polyangiitis and eosinophilic granulomatosis with polyangiitis. Cluster analysis indicated that AAV patients could be divided into three subgroups according to peripheral immune cell numbers: antibody production-related (n = 9), cytotoxic activity-related (n = 4) and neutrocytosis/lymphocytopenia-related (n = 23). The antibody production-related or cytotoxic activity-related group was associated with CNS involvement, and the neutrocytosis/lymphocytopenia-related group was associated with high incidence of kidney involvement. Incidence of severe infection was markedly higher in the neutrocytosis/lymphocytopenia-related group than the other two groups. Incidence of disease relapse was comparable among the three groups.

Conclusion

Patients with active AAV can be divided into three subgroups based on immuno-phenotyping. These results may provide a hint to understanding disease pathophysiology and prognosis, and determining appropriate treatment.
Long-term follow-up of patients in the TIght COntrol of inflammation in early Psoriatic Arthritis (TICOPA) trial
Authors: Coates Laura C , Mahmood Farrouq , Freeston Jane , Emery Paul , Conaghan Philip G , Helliwell Philip S
Published: July 2019

Objectives

The TIght COntrol of inflammation in early Psoriatic Arthritis (TICOPA) study was the first strategy trial in psoriatic arthritis using an early treat-to-target strategy to improve clinical outcomes. The current study aimed to review a cohort of patients who had completed TICOPA to judge if the clinical advantage gained by participants in the tight control (TC) arm was sustained, and to explore subsequent therapy.

Methods

A case note review was conducted for a cohort of patients who had participated in TICOPA. Current drug use and clinical status were obtained, with low disease activity judged as no tender or swollen joints, no dactylitis and enthesitis, and no change in treatment required.

Results

Approximately five years after completion of the TICOPA study, notes were reviewed for 110 patients [TC, n = 54; standard care (StdC), n = 56]. Disease activity was found to be similar in both groups (current low disease activity: TC 69%, StdC 76%). Biologic use at the end of the study was higher in the TC arm (TC 33%, StdC 9%), but at review a similar percentage in both groups were taking biologic drugs (TC 54%, StdC 52%), whereas MTX use diminished.

Conclusion

After several years, clinical outcomes and therapeutic drug use were similarly good for patients in both arms of the TICOPA study, with no obvious clinical advantage after TC ended. Notably, TC did not result in greater biological use long term, and MTX use decreased in both arms of the study.
Shooting a high-density electroencephalographic picture on sleep in children with attention-deficit/hyperactivity disorder
Authors: Miano Silvia , Amato Ninfa , Garbazza Corrado , Abbafati Manuel , Foderaro Giuseppe , Pezzoli Valdo , Ramelli Gian Paolo , Manconi Mauro
Published: July 2019

Study Objectives

Sleep-related slow-wave activity (SWA) has been recognized as a marker of synaptic plasticity. In children affected by attention deficit hyperactivity disorder (ADHD), SWA is mainly located in the central rather than frontal regions, reflecting a maturational delay. A detailed subjective and objective sleep investigation, including a full night video-polysomnography (PSG-HD-EEG), was performed on 30 consecutive drug naïve outpatients with a diagnosis of ADHD. They received a diagnosis of sleep disorders in 29/30 cases, and most of them had a past history of sleep problems. They had a higher apnea–hypopnea index at PSG, and slept less than 9 hr at actigraphy. We aimed to describe the SWA behavior in the same group of children with ADHD.

Materials and Methods

The full-night PSG-HD EEG of children with ADHD was compared with the one of the 25 healthy controls. The scalp SWA mapping, the decrease of SWA during the night, and the EEG source of SWA were analyzed.

Results

At scalp topography, the focus of SWA was observed over the centro–parietal–occipital regions in participants with ADHD (p < 0.01), which remained significant in the subgroups divided between subgroups according to the sleep diagnosis (p < 0.01). The physiological decrease in SWA was more evident in control participants. The source analysis revealed a greater delta power over the posterior cingulate in participants with ADHD (p < 0.01).

Conclusions

Our results confirm static and dynamic changes in SWA behavior in children with ADHD, which may reflect a maturational delay occurring at a vulnerable age, as a consequence of chronic sleep deprivation.
The Death of Leviathan: Feminist Dilemmas and State Phobia
Authors: Dhawan Nikita
Published: July 2019

This essay takes the growing popularity of “hijab/refugee porn” in the West as a point of departure to revisit the historical feminist debate on pornography. While Catharine MacKinnon criticizes pornography as an eroticization of violence and advocates state intervention, Judith Butler warns of the dangers of state censorship, alternatively proposing nonjuridical forms of opposition. Instead of taking up unequivocal positions for or against the state, this essay addresses the political costs of evacuating the state as a site of redress of racial and sexual injustice and examines the risks of state phobia for postcolonial queer--feminist politics.
Determining Mancozeb Deposition Benchmark Values on Apple Leaves for the Management of Venturia inaequalis
Authors: Rebel P. , Poblete-Echeverría C. , van Zyl J. G. , Wessels J. P. B. , Coetzer C. , McLeod A.
Published: July 2019

Apple scab, caused by Venturia inaequalis, is the most common fruit and foliar disease in commercial apple production worldwide. Early in the production season, preventative contact fungicide sprays are essential for protecting highly susceptible continuously unfolding and expanding young leaves. In South Africa, mancozeb is a key contact fungicide used for controlling apple scab early in the season. The current study developed deposition benchmarks indicative of the biological efficacy of mancozeb against apple scab, using a laboratory-based apple seedling model system. The model system employed a yellow fluorescent pigment that is known to be an effective tracer of mancozeb deposition. A concentration range of mancozeb (0.15 to 1 times the registered dosage) and fluorescent pigment concentrations was sprayed onto seedling leaves, which yielded various fluorescent particle coverage (FPC%) levels. Modeling of the FPC% values versus percent disease control yielded different benchmark values when disease quantification was conducted using two different methods. Thermal infrared imaging (TIRI) disease quantification resulted in a benchmark model where 0.40%, 0.79%, and 1.35 FPC% yielded 50, 75, and 90% apple scab control, respectively. These FPC% values were higher than the benchmarks (0.10, 0.20, and 0.34 FPC%, respectively) obtained with quantitative real-time PCR (qPCR) disease quantification. The qPCR benchmark model is recommended as a guideline for evaluating the efficacy of mancozeb sprays on leaves in apple orchards since the TIRI benchmark model underestimated disease control. The TIRI benchmark model yielded 68% disease control at the lowest mancozeb dosage, yet no visible lesion developed at this dosage. Both benchmark models showed that mancozeb yielded high levels of disease control at very low concentrations; for the qPCR benchmark model the FPC% value of the FPC90 (90% control) corresponded to 0.15 times that of the registered mancozeb concentration in South Africa, i.e., 85% lower than the registered dosage.
A Day by the Sea
Authors: Kennedy Maureen Shawn
Published: July 2019

Caring for others is stressful—we all need to find our beach.
Opioid-Dependent Patients Require Slow Tapering Of Drug Dose
Authors: Aschenbrenner Diane S.
Published: July 2019

The Food and Drug Administration (FDA) is reminding health care providers that patients receiving long-term opioids for pain could experience significant withdrawal symptoms if the drugs are stopped too abruptly.

The FDA recommends a 10% to 25% dose reduction every two to four weeks for opioid-dependent patients.
Certain Characteristics May Help Identify Patients at Higher Fall Risk
Authors: Rosenberg Karen
Published: July 2019

According to this study:

Patients in a geriatric care facility are more likely to fall if they are male, frail, don't walk independently, or have impaired balance or cognition.

Fall patterns differ between patients with impaired cognition and those who have impaired mobility and balance.
The power of mentorship
Authors: Lewis C. Preston , Johnson Brenda Hulker , Donnell Carla , Phillips Tracy , Jackson Diana , Backus Marcie , Payne Annie , Greenwell Ralph W. , Wentz Aimee
Published: July 2019

How one healthcare system became the first in the world to achieve a combination of Magnet® recognition and Pathway to Excellence® designation for all of its hospitals
Awake videolaryngoscopy versus fiberoptic bronchoscopy
Authors: Moore Albert , Schricker Thomas
Published: July 2019

Purpose of review

The difficult airway remains an ongoing concern in daily anesthesia practice, with awake intubation being an important component of its management. Classically, fiberoptic bronchoscope-assisted tracheal intubation was the method of choice in the awake patient. The development of new generation videolaryngoscopes has revolutionized the approach to tracheal intubation in the anesthetized patient. The question whether videolaryngoscopes have a place in the intubation of the difficult airway in the awake patient is currently being addressed.

Recent findings

Randomized controlled trials and their meta-analysis have shown that videolaryngoscopes provide similar success rates and faster intubation times when compared with fiberoptic bronchoscope intubation in awake patients with difficult airways.

Videolaryngoscopy is a valid technique that should be considered for difficult airway management in the awake patient.
Barriers and Facilitators to Cochlear Implant Uptake in Australia and the United Kingdom
Authors: Bierbaum Mia , McMahon Catherine M. , Hughes Sarah , Boisvert Isabelle , Lau Annie Y. S. , Braithwaite Jeffrey , Rapport Frances
Published: July 2019

Objectives:

Hearing loss (HL) affects a significant proportion of adults aged >50 years by impairing communication and social connectedness and, due to its high prevalence, is a growing global concern. Cochlear implants (CIs) are effective devices for many people with severe or greater sensorineural HL who experience limited benefits from hearing aids. Despite this, uptake rates globally are low among adults. This multimethod, multicountry qualitative study aimed to investigate the barriers and facilitators to CI uptake among adults aged ≥50 years.

Design:

Adult CI and hearing aid users with postlingual severe or greater sensorineural HL, general practitioners, and audiologists were recruited in Australia using purposive sampling, and a comparative sample of audiologists was recruited in England and Wales in the United Kingdom. Participants were interviewed individually, or in a focus group, completed a demographic questionnaire and a qualitative survey. Data were analyzed using thematic analysis.

Results:

A total of 143 data capture events were collected from 55 participants. The main barriers to CI uptake related to patients’ concerns about surgery and loss of residual hearing. Limited knowledge of CIs, eligibility criteria, and referral processes acted as barriers to CIs assessment referrals by healthcare professionals. Facilitators for CI uptake included patients’ desire for improved communication and social engagement, and increased healthcare professional knowledge and awareness of CIs.

Conclusions:

There are numerous complex barriers and facilitators to CI uptake. Knowledge of these can inform the development of targeted strategies to increase CI referral and surgery for potential beneficiaries.
Washers do not affect the rate of implant removal or elbow motion in medial epicondyle fractures
Authors: Patel Neeraj M. , Gajewski Christopher R. , Ascoli Anthony M. , Lawrence J. Todd R.
Published: July 2019

The use of a washer to supplement screw fixation can prevent fragmentation and penetration during the surgical treatment of pediatric medial epicondyle fractures. However, concerns may arise regarding screw prominence and the need for subsequent implant removal. The purpose of this study is to evaluate the impact of washer utilization on the need for hardware removal and elbow range of motion (ROM). All pediatric medial epicondyle fractures treated with a single screw over a 7-year period were queried for this retrospective case-control study. Hardware removal was performed only if the patient experienced a complication or implant-related symptoms that were refractory to non-operative management. Of the 137 patients included in the study, a washer was utilized in 90 (66%). Thirty-one patients (23%) ultimately underwent hardware removal. There was not an increased need for implant removal in those with a washer (P = 0.11). When analyzing a subgroup of 102 athletes only, there was similarly no difference in the rate of implant removal if a washer was used (P = 0.64). Overall, 107 (78%) patients regained full ROM at a mean of 13.9 ± 9.7 weeks after surgery with no significant difference along the lines of washer use. Use of a washer did not affect the need for subsequent implant removal or elbow ROM after fixation of medial epicondyle fractures, even in athletes. If there is concern for fracture fragmentation or penetration, a washer can be included without concern that future unplanned surgeries may be required.
Admission NarxCare Narcotics Scores are not Associated With Adverse Surgical Outcomes or Self-reported Patient Satisfaction Following Elective Spine Surgery
Authors: Galivanche Anoop R. , Mercier Michael R. , Adrados Murillo , Pathak Neil , McLynn Ryan P. , Anandasivam Nidharshan S. , Varthi Arya G. , Rubin Lee E. , Grauer Jonathan N.
Published: July 2019

Study Design.

Retrospective cohort study

Objective.

The aim of this study was to investigate how elective spine surgery patient preoperative opioid use (as determined by admission NarxCare narcotics use scores) correlated with 30-day perioperative outcomes and postoperative patient satisfaction.

Summary of Background Data.

The effect of preoperative narcotics usage on postoperative outcomes and patient satisfaction following spine surgery has been of question. The NarxCare platform analyzes the patients’ state Physician Drug Monitoring Program (PDMP) records to assign numerical scores that approximate a patient's overall opioid drug usage.

Methods.

Elective spine surgery cases performed at a single institution between October 2017 and March 2018 were evaluated. NarxCare narcotics use scores at the time of admission were assessed. Patient characteristics, as well as 30-day adverse events, readmissions, reoperations, and mortality, were abstracted from the medical record. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data were also abstracted when available.

Cases were binned based on the following ranges of admission NarxCare scores: 0, 1 to 99, 100 to 299, 300 to 499, and 500+. Multivariate logistic regressions were performed to compare the odds of having an adverse events, readmission, reoperation, and mortality between the different narcotics groups. One-way analysis of variance analyses were performed to compare HCAHPS survey response rates and HCAHPS survey results between the different narcotics score groups.

Results.

In total, 346 patients met criteria for inclusion in the study (NarxScore 0: n = 74, 1–99: n = 58, 300–499: n = 117, and 500+: n = 21). Multivariate logistic regressions did not detect statistically significant differential odds of experiencing adverse events, readmission, reoperation, or mortality between the different groups of admissions narcotics scores. Analyses of variance did not detect statistically significant differences in HCAHPS survey response rates, total HCAHPS scores, or HCAHP subgroup scores between the different narcotics score groups.

Conclusion.

Although there are many reasons to address preoperative patient narcotic utilization, the present study did not detect perioperative outcome differences or patient satisfaction based on the narcotic use scores as stratified here.

Level of Evidence: 3
Are Peripherally Inserted Central Catheters Suitable for Cardiac Output Assessment With Transpulmonary Thermodilution?*
Authors: D’Arrigo Sonia , Sandroni Claudio , Cacciola Sofia , Dell’Anna Antonio Maria , Pittiruti Mauro , Annetta Maria Giuseppina , Colosimo Cesare , Antonelli Massimo
Published: July 2019

Objectives:

Peripherally inserted central catheters are increasingly used in ICU as an alternative to centrally inserted central catheters for IV infusion. However, their reliability for hemodynamic measurements with transpulmonary thermodilution is currently unknown. We investigated the agreement between transpulmonary thermodilution measurements obtained with bolus injection through peripherally inserted central catheter and centrally inserted central catheter (reference standard) using a transpulmonary thermodilution–calibrated Pulse Contour hemodynamic monitoring system (VolumeView/EV1000).

Design:

Prospective method-comparison study.

Setting:

Twenty-bed medical-surgical ICU of a teaching hospital.

Patients:

Twenty adult ICU patients who required hemodynamic monitoring because of hemodynamic instability and had both peripherally inserted central catheter and centrally inserted central catheter in place.

Intervention:

The hemodynamic measurements obtained by transpulmonary thermodilution after injection of a cold saline bolus via both centrally inserted central catheter and either a single-lumen 4F or a double-lumen 5F peripherally inserted central catheter using were compared. In order to rule out bias related to manual injection, measurements were repeated using an automated rapid injection system.

Measurements and Main Results:

A total of 320 measurements were made. Cardiac index was significantly higher when measured with double-lumen 5F peripherally inserted central catheter than with centrally inserted central catheter (mean, 4.5 vs 3.3 L/min/m2; p < 0.0001; bias, 1.24 L/min/m2 [0.27, 2.22 L/min/m2]; bias percentage, 31%). Global end-diastolic index, extravascular lung water index, and stroke volume index were also overestimated (853 ± 240 vs 688 ± 175 mL/m2, 12.2 ± 4.2 vs 9.4 ± 2.9 mL/kg, and 49.6 ± 14.9 vs 39.5 ± 9.6 mL/m2, respectively; p < 0.0001). Lower, albeit significant differences were found using single-lumen 4F peripherally inserted central catheter (mean cardiac index, 4.2 vs 3.7 L/min/m2; p = 0.043; bias, 0.51 L/min/m2 [–0.53, 1.55 L/min/m2]; bias percentage, 12.7%). All differences were confirmed, even after standardization of bolus speed with automated injection.

Conclusions:

Bolus injection through peripherally inserted central catheter for transpulmonary thermodilution using EV1000 led to a significant overestimation of cardiac index, global end-diastolic index, extravascular lung water index, and stroke volume index, especially when double-lumen 5F peripherally inserted central catheter was used (ClinicalTrial.gov NCT03834675).
Assessment of Functionality in Elderly Patients When Determining Appropriate Treatment for Nonmelanoma Skin Cancers
Authors: Renzi Michael A. , Belcher Matthew , Brod Bruce , Chadwick Preston W. , Decker Ashley , Dolan Cynthia A. , Ilyas Erum N. , Magee Anna M. , McBurney Elizabeth I. , Regan Thomas D. , Seidenberg Roy S. , Somani Ally-Khan , Sommer Lacy L. , Srivastava Divya , Lawrence Naomi
Published: July 2019

BACKGROUND

The treatment of nonmelanoma skin cancer (NMSC) in the elderly population is a source of significant debate. Mohs micrographic surgery (MMS) is a highly effective treatment option yet not every patient with a cutaneous malignancy that meets appropriate use criteria (AUC) should be treated with surgery.

OBJECTIVE

The purpose of this study was to use the Karnofsky Performance Status (KPS) scale to categorize the functional status of patients aged 75 years and older who required treatment of NMSC. The authors wanted to see whether functionality played a role on the treatment selection.

METHODS

Patients aged 75 years and older presenting for biopsy of a suspected NMSC that met AUC for MMS were included in the study. Trained medical assistants used the KPS scale to assess patient functionality. Treatment modality was recorded once the biopsy confirmed the NMSC.

RESULTS

A cohort of 203 subjects met inclusion criteria for the study. There was a statistically significant difference in utilization of surgical treatments between high and low functionality patients (p = .03).

CONCLUSION

Dermatologists consider patient functionality when selecting a treatment for NMSC and use less invasive modalities for patients with poor functional status, even when the tumor meets AUC.
Nitroglycerin, or Not, When Treating Impending Filler Necrosis
Authors: Carley Sama K. , Kraus Christina N. , Cohen Joel L.
Published: July 2019

BACKGROUND

Dermal necrosis is a rare yet serious risk associated with cosmetic filler injections, and although current consensus recommends the use of hyaluronidase injections in cases of hyaluronic acid filler, the efficacy of topical nitroglycerin as a treatment has not yet been fully investigated.

OBJECTIVE

To review the literature on tissue necrosis resulting from soft tissue augmentation and to highlight the use of topical nitroglycerin as a first-line treatment.

METHODS

A review of the literature was performed with no time limitations resulting in 35 articles and 66 patients who experienced tissue necrosis secondary to injectable fillers. Articles were reviewed for pertinent information and presented.

RESULTS

Only 7 of the 66 reported cases (10%) used topical nitroglycerin as a treatment. Six of 7 (85%) were successful in halting the impending necrosis. Fifty-nine patients received alternative treatments, with hyaluronidase injection being the most common. Few reports of novel treatments for necrosis included the use of topical growth factors and injection of adipose-derived stem cells.

CONCLUSION

Topical nitroglycerin is a potentially effective and underused treatment for tissue necrosis from soft tissue augmentation, but because data are very limited, topical nitroglycerin should be used in conjunction with hyaluronidase injections in cases of hyaluronic acid filler dermal necrosis.