bluuebunny/crossref_metadata_2025 huggingface dataset:
The End Times
Authors: Spence Martin
Published: November 2023

This chapter explores the links between beliefs about the end times and the emergence and development of the Christian Fundamentalist movement. In particular it examines the ways that the eschatological paradigm called ‘dispensationalist premillennialism’ contributed to the formation of the fundamentalist coalition, and how it sustained key fundamentalist precepts such as ‘biblical literalism’. The chapter argues that despite ostensibly focusing on the return of Christ to establish a kingdom on earth, dispensationalist premillennialism also resonated with a broader evangelical popular piety that focused on heaven. This earth/heaven duality was one reason for the success of the doctrine in the folk culture of mid-twentieth century fundamentalism, as well as for its ongoing purchase within contemporary popular American evangelicalism.
Family and Gender
Authors: Johnson Emily Suzanne
Published: November 2023

The family has been a central institution in fundamentalist theology and practice from the movement’s beginnings. Fundamentalists’ insistence on maintaining ‘traditional’ gender and family roles has been one of the key ways believers have set themselves apart from shifting mainstream ideals. The hierarchies embedded in the patriarchal nuclear family also offer a concrete representation of fundamentalists’ understandings of God’s intended social order. In churches, parachurch ministries, and fundamentalist subcultures, religious and social activities are often segregated by gender. These homosocial spaces instruct believers in fundamentalist gender ideology but also offer space for expressing difficulties with this ideology and renegotiating its bounds. For fundamentalist women, gender-segregated ministries have fostered spaces for female authority even in a broader religious culture that emphasizes women’s submission. Aspects of fundamentalist ideology on gender and family have shifted over time, but the commitment to conservative, binary, and patriarchal roles has remained consistent.
Global Mission
Authors: Stanley Brian
Published: November 2023

Fundamentalist missionaries can be broadly defined as those who believed that those who had never heard the gospel were destined for hell, and therefore needed urgently to hear it. They gave priority to rapid evangelistic expansion to inland peoples. Many were affiliated to the non-denominational ‘faith missions’. They looked to spiritual and visionary leaders, who were often linked by friendship or marriage in networks that spanned the continents. Yet missionary endeavour had the potential to encourage mutations in fundamentalism. Some missionaries found their theology changing in response to the questions posed by the field. Fundamentalist missions initially participated in ecumenical missionary bodies, but then tended to secede. The churches they founded, however, sometimes chose to affiliate to ecumenical bodies. Women missionaries played prominent roles in fundamentalist missions, sometimes challenging male authority. In the long run, preoccupation with saving souls paradoxically encouraged more corporate understandings of Christian conversion.
Fundamentalism and Charismatic Renewal
Authors: Maiden John
Published: November 2023

This chapter examines the complex relationships between fundamentalism and charismatic renewal. In some ways, charismatic renewal was a pushing back against intellectual and social aspects of mid-century fundamentalism and Pentecostalism. However, there were also continuities between these movements and the ecumenical dynamic of charismatic renewal—as ‘Pentecostalism outside of Pentecost’—allowed the shifting of some fundamentalistic traits beyond evangelicalism, for example into Roman Catholicism. By the end of the twentieth century, furthermore, some sections of evangelicalism traditionally associated with the legacy of B. B. Warfield and cessationism had been profoundly impacted by charismatic renewal, and made arguments from Scripture for the continuation of the supernatural gifts in the Church.
Transportation Networks and Least-Cost Paths
Authors: Herzog Irmela
Published: November 2023

This chapter presents an overview of methods for reconstructing past transportation networks based on least-cost path (LCP) computations and different network models. After outlining the methodology for creating an LCP connecting two locations, several network models for linking a larger set of destinations by LCPs are introduced, most of these are derived from straight-line networks. LCP methods for detecting travel arteries with limited or no knowledge of the sites to be connected are presented as well. For instance, a least-cost hub-and-spoke network can be generated if only the hub location is known. Several models are tested in a hilly study region, east of Cologne, Germany, where the nodes are medieval settlements with a church or chapel located close to well-known old long-distance trade routes. The performance indicators of the network models are derived by calculating the lengths of LCP sections coinciding roughly with the known ancient routes. For the models applied, closeness as well as betweenness centrality of the nodes are computed, and the results are compared to the hubs in the known network.
Community Detection
Authors: Grujić Jelena , Radivojević Miljana
Published: November 2023

We critically review the application of community detection in archaeology, as well as its potential to be developed on archaeological big data. The challenges in applying community detection algorithms are presented with a reference case study from the Balkans. We demonstrate the robustness of different community detection algorithms applied on chemical composition of 410 copper-based objects spanning c. 3,000 years. The highlight of this study is correlation of resulting modules with the known archaeological cultures within this time frame, which opens a new avenue in re-evaluating the concept of archaeological cultures with the application of community detection. Through this case study we also indicate what kind of issues arise when different high-performance algorithms are applied, and we propose problem-solving avenues for future community detection studies in archaeology.
Social Networks and Inequality
Authors: Pailes Matthew
Published: November 2023

This chapter explores the limited engagement of social networks analysis (SNA) with ancient inequality. Researchers have developed a set of first principles for understanding the relationship between SNA and inequality but have only haltingly integrated these concepts into archaeological case studies. I advocate for applications of SNA to the ample body of theory that already exists on elite emergence and maintenance. To illustrate future potential, I provide heuristic hypotheses for the relationship between network properties and prime-movers that facilitate elite emergence, the inevitability of inequality in complex societies, and the relationship of inequality and societal resilience. Methodologically, I suggest greater emphasis on household scale studies and approaches to SNA construction that move beyond networks inferred from spatial propinquity.
Network Models and the Past
Authors: Terrell John Edward
Published: November 2023

Archaeologists have been using many of the diagnostic and visualization tools of what is now widely known as social network analysis (SNA) at least since the early 1970s. Unfortunately, it has evidently been easy to mistake similarity in the methods used for shared commonality in research goals and key assumptions. Seen as a body of theory rather than as a set of formal methods, the goodness of fit between the aims and a priori assumptions of modern SNA and the goals of contemporary archaeology is far less than what most archaeologists would surely wish for. Furthermore, it is not a good idea—and can be misleading—to label what can be achieved using formal network methods as “network analysis,” “network science,” and so forth. A more accurate (although perhaps less appealing) way of labeling what is involved is captured by phrases such as “relational thinking” and “contingency analysis.” Nonetheless, when used as a set of exploratory techniques for data analysis and visualization rather than as a predetermined view of history or causation, there are good reasons for keeping the “networks revolution” going in archaeology.
The Idea of European Culture(s) and Diversity
Authors: Bílková Veronika
Published: November 2023

The chapter discusses the way in which the tension between the promotion of a uniform European culture and the need to accommodate cultural diversity in Europe has shaped international law and, vice versa, how international law has helped to strike a balance between the two interests. It shows that this area itself has been marked by ‘cultural diversity’. Three main approaches can be distinguished. The first approach is reserved to cultures seen as components of a uniform European culture. The doctrine of the margin of appreciation and the principle of subsidiarity are legal tools used here. The second approach applies to cultures seen as complementary to a uniform European culture. Legal tools employed in this context encompass the principle of non-discrimination and positive measures for minority groups. The third approach pertains to cultures seen as alternative to the European culture(s). Intercultural dialogue is one of the tools used here.
Fire as Rebellion and Repression
Authors: Clark Gemma
Published: November 2023

Arson (as defined in law, in most jurisdictions) is the act of setting fire to property with the intent to cause damage. While diverse groups destroy things that do not belong to them for various reasons, there is a longstanding cultural/historiographical association of fire with protest by non-state actors. However, this chapter uses violence theory, comparative colonial histories, and an early-twentieth-century Irish case study to look beyond interpretations of fire as a ‘weapon of the weak’. I argue that incendiarism functioned, during Ireland’s independence struggles against British rule, c.1912–1923, as a powerful means of both insurgency, committed largely by the Irish Volunteers (or Irish Republican Army, IRA), and counter-insurgency (COIN), executed chiefly by British soldiers and civil authorities. The efficacy of fire-setting as insurgency/COIN lies not only in its physical capacity to destroy infrastructure and/or resources that enemy forces might use. Burning or threatening to burn property also works well—though arguably better for one side more than for the other—as intimidation, to control behaviour and territory, as well as to communicate hostility in a more abstract sense. These interconnected practical, psychological, political, etc. functions of incendiarism are key findings in a growing scholarly field that traces the evolution of arson from an individual malicious act to a prominent mode of collective violence and modern conflict.
The Hunger General
Authors: Goscha Christopher
Published: November 2023

The economy was part of the battlefield during the First Indochina War between the French Fourth Republic and the Democratic Republic of Vietnam led by Ho Chi Minh. This was particularly true during the second half of the conflict from 1950 when the French targeted their adversary’s food supply as a military objective. This included the strategic bombing of Vietnam’s agriculture and infrastructure, as well as the use of French Union troops to collect rice from the fields so that Ho could not use it to feed his army and civil servants. Led by General Raoul Salan, this economic offensive also included the creation of a ‘cordon sanitaire’ between French colonial zones and those of the enemy so that no clandestine trade could occur between the two zones. One of the results of all of this was that the French worsened the plight of the Vietnamese peasantry already pushed to the limits by a decade of war and sealed an alliance with a third force the Vietnamese called the ‘Rice General’ whose preferred arms were hunger, indeed famine.
Decolonization’s Wars and the Civilianization of Violence
Authors: Thomas Martin
Published: November 2023

Decolonization, like the conflicts it generates, is a story of inequalities, asymmetries—and violence. The transformational nature of these conflicts is difficult to grasp unless we dwell on particular ways in which organized violence changed through and because of decolonization. (1) Local populations invariably bore the brunt. Disaggregating the levels of violence further, within those local populations particular communities suffered especially badly. Markers of identity could prompt accusations of association with colonial authority or insurgent ideology, exposing people to cycles of attack and reprisal. In other communities that were ostensibly multiethnic, multicultural, or multifaith, unarmed colonial subjects from minority or outsider groups typically faced more violent attacks than the armed forces or insurgent groups that claimed authority over them. Common throughout was the refusal to acknowledge the ‘civilian status’ of colonial subjects, something never recognized or protected in the pluralities of colonial or international law. Instead, differentiation between civilians and fighters in decolonization conflicts was a dynamic process, one in which the changing nature of war, national mobilization, and international norms came together, sometimes expanding the civilian-combatant distinction, more often collapsing it. (2) All of which begs a question: as analysts, should we approach decolonization through its processes of violence?
The Architecture of Colonial Control
Authors: Hughes Matthew
Published: November 2023

Britain’s crushing of the 1936–1939 Arab revolt against Jewish immigration to and British rule in Mandate Palestine was at heart an administrative war by an Emergency State. Military search-and-sweep operations after 1936 played second fiddle to systemic (and systematic) politico-legal pacification of the whole country by undemocratic colonial government. The target was the people. Of the three variables determining victory or defeat in Palestine—insurgent action, British counter-insurgency military operations, and the colonial Emergency State—this chapter argues that the last was the key to victory. The Arab revolt was a clash between disorganized insurgency versus well-organized colonial civil rule that drove forward pacification by collectively and legally punishing Palestinians. Powerful colonial legal-administrative structures won the battle, as readers will discover. Pacification of the population was more significant than the military suppression of rebellion. This started not in 1936, but in 1920 with the arrival of the first civil High Commissioner for Palestine and the establishment of collective punishment laws. This is the subject of the chapter.
The Aden Protectorate Levies, Counter-Insurgency, and the Loyalist Bargain in South Arabia, 1951–1957
Authors: Bennett Huw , Burke Edward
Published: November 2023

Loyalist bargains between European colonial powers and indigenous collaborators were fluid and frequently renegotiated. Indigenous forces could mutiny or refuse to execute orders they believed violated the terms of their agreement with the colonial power. As well as enabling colonial violence, locally recruited forces could also restrain it. This chapter examines the experiences and influence of local security forces in the Western Aden Protectorate from 1951 to 1957. It focuses on the Aden Protectorate Levies (APL) who proved increasingly reluctant to carry out a new forward policy in South Arabia. Rather than accepting the Air Ministry’s recommendation to temper their expansionism, colonial administrators blamed Royal Air Force officers in command of the APL for a collapse in morale and successfully campaigned for an increased role for the British Army in Aden and its protectorates. The result was the continued prosecution of a failed policy that consumed ever-greater British military resources.
Discourses of Development and Practices of Punishment
Authors: Bruce-Lockhart Katherine , Rebisz Bethany
Published: November 2023

From 1952 to 1960, the landscape of Kenya was drastically changed by the British through the widespread implementation of detention camps, prisons, and strategic villages in response to the ‘Mau Mau’ insurgency. Of the 80,000 detained, approximately 8,000 were female, and of the 1.2 million Kenyans forcibly resettled, the majority were female. While many colonial states targeted female insurgents, these gendered geographies of coercion were particularly pronounced in Kenya and were shaped by racialized notions of respectable and deviant femininity. Within these sites, the British introduced development and ‘rehabilitation’ schemes to encourage women and girls to embrace domestic roles in support of colonial visions of social order. Colonial officials sought to carefully code and categorize their counter-insurgency efforts, presenting the strategic villages and the rehabilitation programme in the camps as part of their wider ‘civilizing mission’ while insisting that any violence in these sites was incidental or aberrant. This framing not only ignored the reality of systematic abuses in these spaces, but also narrowly defined violence as solely a physical phenomenon. Instead, this chapter argues that violence, in its multiple dimensions, was not simply an outcome of counter-insurgency development and ‘rehabilitation’ schemes, but was rather intrinsic to them.
Dark Networks and Conflict Transformation in Northern Ireland
Authors: Edwards Aaron
Published: November 2023

The end of major hostilities in Northern Ireland in the 1990s is celebrated as an achievement in the peaceful settlement of internal armed conflicts. However, there remains a significant residual security challenge evident in the persistence of loyalist and republican paramilitary structures and their increasing convergence with organized crime activities. Indeed, there is considerable evidence of a symbiosis between terrorists and criminals, which has direct consequences for the local peace process. Scholars such as Jupp and Garrod have argued that it is not possible to understand organized crime in Northern Ireland without also comprehending the role that paramilitaries play in these activities. This chapter builds on the theoretical perspective advanced by these scholars by making the broader, conceptual case that the security situation has changed radically since the 1990s and, therefore, must be understood as more complex, dynamic, and multilayered. The chapter seeks to engage with the broader literature on the ‘Crime-Terror Nexus’, which traces the convergent activities of terrorism and criminality, and dark networks, which reveals much more synchronization between terrorism and criminality, to offer a way forwards for practitioners dealing with these ‘new’ security challenges in ‘old’ conflict zones.
Learning Disabilities
Authors: Swanson H. Lee , Kong Jennifer E. , Arizmendi Genesis D.
Published: November 2023

This chapter provides an overview of definitions, cognitive characteristics, and instructional treatments for children and adults with learning disabilities. A particular focus is placed on reviewing the meta-analysis literature on two subgroups: reading disabilities (RD) and math disabilities (MD). Also reviewed are intervention outcomes and some of the controversies (e.g., role of IQ testing, discrepancy models, response to intervention, language disorder, and English learners) related to identifying children and adults with learning disabilities. Individuals with learning disabilities experience a number of cognitive inefficiencies, especially in the areas processing speed, phonological processing, and working memory. In addition, studies suggest that children and adults with learning disabilities, when exposed to the best instructional conditions, continue to experience difficulties mastering skills in such areas as reading and mathematics. Further, their problems in reading and/or math persist into adulthood.
School Violence and Bullying
Authors: Mayer Matthew J.
Published: November 2023

School violence and disruption, including bullying, continue to concern parents, educators, community stakeholders, and governmental bodies at the local, state, and national levels. While high-profile school shootings are often at the forefront of media coverage of school safety, schools are among the safest places for students in the community. This chapter unpacks key issues central to the field, providing an overview of recent data trends and measurement approaches, dimensions of the issues, and resultant harm from violence and bullying. Research on prevention approaches is examined, with attention to several types of school-wide approaches for minimizing school violence and disruption and bullying. The chapter closes with a discussion of future challenges across research, policy, and practice.
Coming in Hot: A quality improvement approach to improving care of febrile infants
Authors: Gupta Joel , Zipursky Amy R , Pirie Jonathan , Freire Gabrielle , Karin Amir , Bohn Mary Kathryn , Adeli Khosrow , Ostrow Olivia
Published: November 2023

Background and Objectives

Significant practice variation exists in managing young infants with fever. Quality improvement strategies can aid in risk stratification and standardization of best care practices, along with a reduction of unnecessary interventions. The aim of this initiative was to safely reduce unnecessary admissions, antibiotics, and lumbar punctures (LPs) by 10% in low-risk, febrile infants aged 29 to 90 days presenting to the emergency department (ED) over a 12-month period.

Methods

Using the Model for Improvement, a multidisciplinary team developed a multipronged intervention: an updated clinical decision tool (CDT), procalcitonin (PCT) adoption, education, a feedback tool, and best practice advisory (BPA) banner. Outcome measures included the proportion of low-risk infants that were admitted, received antibiotics, and had LPs. Process measures were adherence to the CDT and percentage of PCT ordered. Missed bacterial infections and return visits were balancing measures. The analysis was completed using descriptive statistics and statistical process control methods.

Results

Five hundred and sixteen patients less than 90 days of age were included in the study, with 403 patients in the 29- to 90-day old subset of primary interest. In the low-risk group, a reduction in hospital admissions from a mean of 24.1% to 12.0% and a reduction in antibiotics from a mean of 15.2% to 1.3% was achieved. The mean proportion of LPs performed decreased in the intervention period from 7.5% to 1.8%, but special cause variation was not detected. Adherence to the CDT increased from 70.4% to 90.9% and PCT was ordered in 92.3% of cases. The proportion of missed bacterial infections was 0.3% at baseline and 0.5% in the intervention period while return visits were 6.7% at baseline and 5.0% in the intervention period.

Conclusions

The implementation of a quality improvement strategy, including an updated evidence-based CDT for young infant fever incorporating PCT, safely reduced unnecessary care in low-risk, febrile infants aged 29 to 90 days in the ED.

Purpose

To develop and implement a multipronged improvement strategy including an evidence-based CDT utilizing PCT to maximize value of care delivered to well-appearing, febrile infants presenting to EDs.
The characteristics of driver lane-changing behaviour in congested road environments
Authors: Wang Wanqi , Cheng Guozhu
Published: November 2023

Lane-changing behaviour is one of the complex driving behaviours. The lane-changing behaviour of drivers may exacerbate congestion, however driver behavioural characteristics are difficult to accurately acquire and quantify, and thus tend to be simplified or ignored in existing lane-changing models. In this paper, the Bik-means clustering algorithm is used to analyse the urban road congestion state discrimination method. Then, simulated driving tests were conducted for different traffic congestion conditions. Through the force feedback system and infrared camera, the data of driver lane-changing behaviours at different traffic congestion levels are obtained separately, and the definitions of the start and end points of a vehicle changing lanes are determined. Furthermore, statistical analysis and discussion of key feature parameters including driver lane-changing behaviour data and visual data under different levels of traffic congestion were conducted. It is found that the average lane-change intention times in each congestion state are 2 s, 4 s, 6 s and 7 s, while the turn-signal duration and the number of rear-view mirror observations have similar patterns of change to the data on lane-changing intention duration. Moreover, drivers’ pupil diameters become smaller during the lane-changing intention phase, and then relatively enlarge during lane-changing; the range of pupil variation is roughly 3.5 mm to 4 mm. The frequency of observing the vehicle in front of the target lane increased as the level of congestion increased, and the frequency of observation in the driver's mirrors while changing lanes approximately doubled compared to driving straight ahead, and this ratio increased as the level of congestion increased.
Comparing the Efficacy of Zinc Oxide Versus Barrier Creams for Pressure Injury Prevention: A Retrospective Cross-sectional Study
Authors: Koc Ferhat , Eren Merve Gulbahar , Sert Havva
Published: November 2023

OBJECTIVE

To compare the efficacy of zinc oxide versus barrier creams for the maintenance of skin integrity in intensive care patients with a risk of pressure injury (PI).

METHODS

This was a retrospective and cross-sectional study. The authors included data from 95 patients treated in the neurology and respiratory ICUs of a training and research hospital between January and June 2022. Patients in the neurology ICU were treated with zinc oxide cream (group 1, n = 48), and patients in the respiratory ICU received classic barrier cream (group 2, n = 47). Sociodemographic characteristics and PI data (Braden Scale score, Pressure Ulcer Healing Assessment Scale [PUSH] score, and PI stage) were obtained from each patient’s file.

RESULTS

The mean PUSH score of the patients who received zinc oxide cream was 3.83 ± 4.39 at discharge versus 6.79 ± 4.40 for the group who received barrier cream. When PUSH scores and PI stages during hospitalization and discharge were compared, the authors found a statistically significant between-group difference in mean discharge scores (P < .05).

CONCLUSIONS

Within the limitations of this retrospective study based on patient records, zinc oxide creams had more positive effects on the prevention of PIs than barrier creams.
A Clinical Classification of Cervical Ossification of the Posterior Longitudinal Ligament to Guide Surgical Strategy
Authors: Sun Xiaofei , Li Fudong , Zhao Baolian , Zhang Bin , Sun Kaiqiang , Sun Jingchuan , Xu Ximing , Wang Yuan , Shi Jiangang
Published: November 2023

Study Design.

A clinical classification of cervical ossification of the posterior longitudinal ligament (COPLL) was developed based on imaging findings.

Objective.

This study aimed to establish a clinical classification for COPLL and provide corresponding surgery strategies for each subtype.

Summary of Background Data.

A practical and reliable classification is needed to guide the treatment of COPLL.

Methods.

This study retrospectively reviewed plain radiographs, computed tomography scans, and magnetic resonance images of patients diagnosed with COPLL between 2018 and 2022 in Shanghai Changzheng Hospital. The types of COPLL were classified according to the location, morphology, and canal occupying ratio of the ossification mass. Interobserver and intraobserver reliability were evaluated using Cohen’s kappa.

Results.

A total of 1000 cases were included, which were classified into five types: Focal type (F type), Short-Sequential type (S type), Long-Sequential type (L type), High type (H type), and Mixed type (M type). In addition, each type could be classified into subtype 1 or subtype 2 according to the canal occupying ratio. Then each type could be further classified into other subtypes according to the location and morphology. The interobserver reliabilities in the first and second round were 0.853 and 0.887, respectively. The intraobserver reliability was 0.888.

Conclusion.

We classified COPLL into a system comprised of five types and several subtypes according to canal occupying ratio, location and morphology. Surgical strategies for each subtype are also suggested. This provides a theoretical guide for the description and surgical management of COPLL.
Fourth Generation Hallux Valgus Correction
Authors: Acevedo Jorge I. , Garcia Alexander R. , Queen Joseph D. , McWilliam James R.
Published: November 2023

The surgical method described in this paper has shown numerous benefits when compared with traditional minimally invasive surgery (MIS) techniques for the correction of hallux valgus. Although modern, third-generation MIS techniques have been widely adopted for this purpose due to perceived improvements in patient outcomes, those can be largely attributed to the incorporation of a novel system of rigid internal fixation allowing for a reduced risk of surgical complications. By incorporating the second-generation MIS technique of transverse osteotomy with third-generation fixation techniques, the authors have been able to devise a hybrid, fourth-generation MIS technique that shows improvements both in terms of patient recovery and ease of surgical operation.

Level of Evidence:

The mechanism-based reasoning used in this study classifies it as diagnostic level V in accordance with the OCEBM 2011 Levels of Evidence. For a complete description of levels of evidence, see Instructions for Authors.
Epstein–Barr Virus–Associated Lymphomatoid Papules: A Sign of Immunosuppression Resembling Lymphomatoid Papulosis
Authors: Hooper Madeline J. , Lee Woo Jin , LeWitt Tessa M. , Nguyen Cuong , Griffin Teresa , Chung Christopher , Zhou Xiaolong A. , Guitart Joan
Published: November 2023

Epstein–Barr virus (EBV)–positive lymphoproliferative disorders associated with immunodeficiency constitute a spectrum of lymphoid and plasma cell proliferations that vary in cytomorphology, immunophenotype, and clinical behavior. CD30-positive cutaneous lymphocytic infiltrates with EBV expression and lymphomatoid papulosis–like presentations have been rarely reported. This retrospective study assessed the clinical and histopathological characteristics of EBV-positive cases with papulonodular morphologies and CD30 positivity seen by Northwestern Medicine Dermatopathology. Twelve patients (7M:5F, mean age 69 years) were presented with papular cutaneous lesions without antecedent patch/plaque disease. Nine cases were associated with known immunosuppression in the setting of transplant-related therapies (n = 4), hematopoietic malignancy (n = 2), post-transplant hematopoietic malignancy (n = 1), and autoimmune disease treatment (n = 2). Two patients had age-related immunosenescence. Four patients demonstrated EBV viremia; for 2 patients, this finding comprised the first sign of immunosuppression. Workup was negative for systemic lymphoma in all patients. Various treatment strategies were used, including observation (n = 3), discontinuation/reduction of immunosuppression (n = 3), rituximab (n = 4), and steroids (n = 4). At mean 30-month follow-up, 4 patients (33.3%) were alive, 3 with and 1 without disease. Eight patients (67.6%) had died, 3 after lesional resolution and 5 with recurrent disease. Biopsies revealed mixed lymphoid infiltrates composed of atypical CD30-positive T cells (n = 5) or B cells (n = 7) with variable EBV-encoded small RNA expression. These cases suggest clinicopathologic presentations resembling lymphomatoid papulosis with atypical, large CD30-positive, EBV-positive cells could comprise first sign of potentially serious immunodeficiency and should prompt evaluation for EBV viremia. These cases also broaden the current picture of immunodeficiency-associated lymphoproliferative disorders to include lymphomatoid papulosis–like clinical presentations.
The Safety of Abdominal Contouring in the Presence of a Gastric Band
Authors: Bresnick Stephen D. , Lagman Carlito
Published: November 2023

Background:

Gastric bands, specifically the Lap-Band, have been widely used for weight loss. However, little is known about the complications associated with abdominal contouring procedures in patients with Lap-Bands. This study aimed to determine the complication rates and consent processes for these procedures.

Methods:

We conducted a survey study of 300 members of the American Society of Aesthetic Plastic Surgery. Commonly performed abdominal contouring procedures included abdominal liposuction, abdominoplasty, and combined abdominoplasty with abdominal liposuction.

Results:

The overall infection rate was low (1%) and did not significantly differ between the procedural groups. Abdominoplasty and combined liposuction with abdominoplasty had significantly higher complication rates (4.7% and 10.5%, respectively) than liposuction alone (1%, P = 0.0004). Abdominoplasty procedures also had higher rates of port/tubing malposition (2.3%, P = 0.04) and system leaks (1.6%, P = 0.003). Approximately 59% of plastic surgeons provided written or dictated consent as part of the standard procedural consent to address the presence of the Lap-Band, whereas 8% of plastic surgeons provided a separate written or printed signed consent specifically related to the procedure in the presence of a Lap-Band.

Conclusions:

Our study supports the relative safety of aesthetic abdominal contouring procedures in patients with gastric bands but highlights the increased risk of complications in the presence of a Lap-Band. Surgeons should use careful dissection techniques to minimize complications and consider involving a bariatric surgeon, especially with abdominoplasty procedures. Surgical consent should explicitly outline the risks identified in this study to ensure that patients are fully informed.
An Atypical Presentation of Disseminated Varicella Infection
Authors: Ferguson Derrick , Aguilar-Aragon Javier Antonio , Obeid Imad
Published: November 2023

We present the case of a 61-year-old woman with a medical history of rheumatoid arthritis on immunosuppressive therapy who presented with generalized weakness, progressive dry cough, and dyspnea. She rapidly progressed to profound acute hypoxemic respiratory failure prompting initiation of mechanical ventilatory support. She was subsequently discovered to have diffuse vesicular rash about her abdomen without respect for dermatome borders that disseminated to her back and neck. Diagnostic testing confirmed varicella zoster virus with concomitant varicella pneumonia. Disseminated varicella infection is not uncommon and most frequently affects those with immunosuppression, but cases have been documented somewhat regularly in those without overt immunosuppression. Of the complications associated with disseminated varicella infection, varicella pneumonia is the most deadly. Mortality rate for disseminated varicella infection with varicella pneumonia ranges from 10% to 30%. However, for those with extreme respiratory failure requiring mechanical ventilation, mortality can reach as high as 50%. The most common presentation is a patient with cutaneous eruption that does not follow dermatomal distribution; this is followed by the onset of pulmonary symptoms within 2 to 5 days of rash. However, our case contributes another example of a rare presentation of varicella pneumonia, that being a case wherein the viral exanthem was preceded by the onset of respiratory failure. Recognizing the possibility of respiratory symptoms preceding the classic cutaneous manifestations of disseminated varicella infection is an important lesson, as it will allow for earlier detection and initiation of therapy. The profound mortality associated with varicella pneumonia is justification for further dedicated research into improved prevention and treatment, and increasing physician awareness of this clinical entity will be beneficial to that end.
A Red Swollen Leg
Authors: Narayanan Shivakumar , Traver Edward C. , Greenblatt Aaron David
Published: November 2023

We present a case of pseudocellulitis in a patient with chronic wounds from active injection drug use and edema and edema from secondary amyloidosis and highlight diagnostic challenges and approaches to differentiate infection from vascular and other noninfectious causes as well as the opportunity to intervene at a reachable moment to try to mitigate risk related to injection drug use.
Outcomes of Pleural Space Infections in Patients With Indwelling Pleural Catheters for Active Malignancies
Authors: Chang Christopher H. , Ost David E. , Jimenez Carlos A. , Saltijeral Sahara N. , Eapen Georgie A. , Casal Roberto F. , Sabath Bruce F. , Lin Julie , Cerrillos Eben , Nevarez Tinoco Tamara , Grosu Horiana B.
Published: November 2023

Background:

Pleural infections related to indwelling pleural catheters (IPCs) are an uncommon clinical problem. However, management decisions can be complex for patients with active malignancies due to their comorbidities and limited life expectancies. There are limited studies on the management of IPC-related infections, including whether to remove the IPC or use intrapleural fibrinolytics.

Methods:

We conducted a retrospective cohort study of patients with active malignancies and IPC-related empyemas at our institution between January 1, 2005 and May 31, 2021. The primary outcome was to evaluate clinical outcomes in patients with malignant pleural effusions and IPC-related empyemas treated with intrapleural tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) compared with those treated with tPA alone or no intrapleural fibrinolytic therapy. The secondary outcome evaluated was the incidence of bleeding complications.

Results:

We identified 69 patients with a malignant pleural effusion and an IPC-related empyema. Twenty patients received tPA/DNase, 9 received tPA alone, and 40 were managed without fibrinolytics. Those treated with fibrinolytics were more likely to have their IPCs removed as part of the initial management strategy (P=0.004). The rate of surgical intervention and mortality attributable to the empyema were not significantly different between treatment groups. There were no bleeding events in any group.

Conclusion:

In patients with IPC-related empyemas, we did not find significant differences in the rates of surgical intervention, empyema-related mortality, or bleeding complications in those treated with intrapleural tPA/DNase, tPA alone, or no fibrinolytics. More patients who received intrapleural fibrinolytics had their IPCs removed, which may have been due to selection bias.
Performance of OC-Auto Micro 80 Fecal Immunochemical Test in an Integrated Academic-Community Health System
Authors: Durowoju Lindsey , Mathias Patrick C. , Bell-Brown Ari , Breit Nathan , Liao Hsuan-Chieh , Burke Wynn , Issaka Rachel B.
Published: November 2023

Goals:

We aimed to determine the performance of the OC-Auto Micro 80 fecal immunochemical test (FIT) in an average-risk population receiving care in an integrated, academic-community health system.

Background:

The FIT is the most used colorectal cancer (CRC) screening test worldwide. However, many Food and Drug Administration–cleared FIT products have not been evaluated in clinical settings.

Study:

We performed a retrospective cohort study of patients (50 to 75 y old) in the University of Washington Medicine health care system who were screened for CRC by OC-Auto Micro 80 FIT between March 2016 and September 2021. We used electronic health records to extract patient-level and clinic-level factors, FIT use, colonoscopy, and pathology findings. The primary outcomes were the FIT positivity rate and neoplasms detected at colonoscopy. Secondary outcomes were FIT positivity by sex and safety-net versus non–safety-net clinical settings.

Results:

We identified 39,984 FITs completed by 26,384 patients; 2411 (6.0%) had a positive FIT result (>100 ng/mL of hemoglobin in buffer), and 1246 (51.7%) completed a follow-up colonoscopy. The FIT positive rate was 7.0% in men and 5.2% in women (P <0.01). Among those who completed a colonoscopy after an abnormal FIT result, the positive predictive value for CRC, advanced adenoma, and advanced neoplasia was 3.0%, 20.9%, and 23.9%, respectively.

Conclusions:

In a retrospective analysis of a large heterogeneous population, the OC-Auto Micro 80 FIT for CRC screening demonstrated a positivity rate of 6.0% and a positive predictive value for CRC of 3.0%.
Health economics of detection and treatment of children with familial hypercholesterolemia: to screen or not to screen is no longer the question
Authors: Marquina Clara , Morton Jedidiah I. , Ademi Zanfina
Published: November 2023

Purpose of review

Heterozygous familial hypercholesterolemia (HeFH) is one of the most common monogenic disorders and is safely treatable with lipid-lowering medication. However, most individuals with HeFH remain untreated and undetected, especially in paediatric populations where the potential for long-term therapeutic benefit is higher. Here, we review the recent literature on health economic outcomes for the detection and management of FH in children.

Recent findings

A targeted literature review identified eight studies evaluating detection and management strategies for paediatric FH populations in the last 25 years. Most studies conducted modelled cost-effectiveness analyses to understand the long-term impact of these strategies on health outcomes and the financial impact on the healthcare system. All studies reported that detection and management of HeFH in paediatric populations was cost-effective, regardless of the age of the children. However, cost-effectiveness varied depending on the method of case ascertainment – targeted screening was generally cheaper overall, but less effective, than whole-of-population screening, although both methods were generally cost-effective.

Detection and management of HeFH in paediatric populations is a cost-effective way to significantly lower the burden of disease later in life for these individuals. These strategies should be implemented across healthcare systems.
Clinical practice competence and associated factors among undergraduate midwifery and nursing sciences students at Bahir Dar city, Northwest Ethiopia
Authors: Yezengaw Telksew Yelma , Debella Adera , Animen Simachew , Aklilu Almaz , Feyisa Wondu , Hailu Mickiale , Sime Betelhem , Mohammed Ahmed , Deressa Alemayehu , Mussa Ibsa , Alemu Addisu , Mezmur Haymanot , Lami Magarsa , Eyeberu Addis
Published: November 2023

Background:

Competence describes actions that will be demonstrated or observed and assessed while competency refers to the skill itself. Following appropriate theoretical and practical training, clinical experience is required to achieve the highest level of clinical competence. It is estimated that many women and newborns die each year due to a lack of qualified health professional around the world. As a result, the purpose of this study was to determine the prevalence and factors influencing clinical competency in the study area.

Methods:

An Institutional-based cross-sectional study was conducted from 12 August to 12 September 2022, among 403 undergraduate health sciences students of Bahir Dar University. Participants were approached through simple random sampling technique. Data were collected using a pre-tested structured questionnaire through a face-to-face interview, and entered into Epidata version 3.1 and analyzed using SPSS version 22. The prevalence was reported using proportion with 95% CI and summary measures. Predictors were assessed using a multivariable logistic regression analysis model and reported using an adjusted odds ratio (AOR) with 95% CI. Statistical significance was declared at P value less than 0.05.

Results:

Overall, the prevalence of clinical practice competency was 36.5% [95% CI; 33.5, 39.1]. Students who were provided a logbook (AOR=5.40, 95% CI 2.91, 10.02), adequate clinical cases in the clinical practice placement (AOR=2.72, 95% CI 1.60, 4.60), preceptor show different procedures (AOR=2.50, 95% CI 1.33, 4.71), student’s confidence during conducting procedure (AOR=4.16, 95% CI 1.67, 10.35) and the suitability of the way of teaching to the learning styles of students during skills demonstration (AOR=2.10, 95% CI 1.00, 4.40) were factors statistically associated with clinical practice competence.

Conclusions:

According to this study, more than three out of every five participants were found to be clinically incompetent. Providing logbooks, adequate clinical cases, preceptors showing different procedures, students’ confidence, and suitability of the way of teaching to the learning styles of students were significantly associated with clinical practice competence. Implementing logbooks, selecting clinical sites, enhancing the confidence of students, preferred teaching/learning styles, and clinical preceptor support were important to improve the clinical competence of students.
Clinical and Organizational Nursing Innovations in Primary Care
Authors: Duhoux Arnaud , Rioux-Dubois Annie , Poitras Marie-Eve , Lazarovici Marion , Gabet Morgane , Dufour Emilie
Published: November 2023

Nursing innovations in primary care, based on interprofessional care models, could be better identified, recognized, and deployed. This article presents the results of a symposium discussing the implementation of nursing innovations in primary care in Quebec, Canada, in partnership with researchers and stakeholders. Built on the appreciative inquiry approach, 9 nursing innovations were described. To support the implementation of such nursing innovations responding to current primary care issues and population needs, 4 recommendations emerged: the need to implement strategies to achieve optimal scope of practice for primary care nurses; the importance to develop funding and organizational models that support primary care nursing innovation; the need to enhance a collaborative and democratic governance open to innovation; and the opportunity to create partnerships with the research community and teaching institutions.
Applying the Patient Empowerment, Engagement, and Activation Survey to Improve Patient Outcomes
Authors: Stichler Jaynelle F. , Pelletier Luc R.
Published: November 2023

This article focuses on applying the patient empowerment, engagement, and activation (PEEA) model as an implementation strategy to achieve patient- or person-centered care. There is substantial evidence linking PEEA to improved patient care outcomes and reduced healthcare costs. Interrelationships among the 3 concepts are discussed and how the PEEA survey can be used to evaluate patients' activation for self-care postdischarge and their perceptions of nurses' empowering and engaging them during the care encounter.