bluuebunny/crossref_metadata_2025 huggingface dataset:
Insurrectionist Ethics and Racism
Authors: Mcbride Lee A.
Published: January 2017

Insurrectionist ethics is relevant to both racism and the liberation of racially oppressed peoples. Insurrectionist ethics generates moral intuitions, character traits, and specific practices to motivate the liberation of oppressed groups. Accounts of both racism and insurrectionist ethics have been provided in the work of Leonard Harris. The core tenets of insurrectionist ethics can be highlighted through the work of Angela Davis. As a result, insurrectionist ethics and its militant posture of resistance are seen to be crucial to human liberation and social amelioration in the face of racism. This impetus and advocacy are aimed toward creating social and material conditions fundamentally different from the confining and destructive conditions that constrict the freedom of racialized populations.
Music Making on YouTube
Authors: Cayari Christopher
Published: January 2017

People are making music at their leisure and publishing it online. YouTube has provided a space for musicians to publish multitrack music videos, join collective musical ensembles, and collaboratively perform with others. This chapter explores three trends of how musicians are creating music videos and forming virtual ensembles and music making communities: they are showing off their skills through music videos; they are creating videos to join large collective multitrack ensembles of hundreds or even thousands of others; and they are actively collaborating with small groups to create mediated performances. Collective and collaborative music making on the Internet are not only happening among grassroots amateur musicians, but also through educational and commercial institutions. Music making on the Internet allows for global interactions and collaboration, where people come together and enjoy music recreationally, unbound by time and space.
(Un)popular Music Making and Eudaimonism
Authors: Smith Gareth Dylan
Published: January 2017

The author introduces himself as a popular musician making unpopular music. He is a drummer, living his life according to the Aritostelian concept of eudaimonism, which he explains as a socio-psychological construct. The chapter reviews literature on identity, fulfillment, work, play, and leisure, before presenting findings from interviews with eleven other contemporary musicians. Their accounts are discussed under the headings of “motivation,” “making music,” “making time,” and “is it leisure?” with reference to the constructs of eudaimonism and serious leisure. The chapter then considers practical and ideological challenges posed by pursuit of the daimon, critiquing eudaimonism as both opposed to and inseparably bound up with the pervasive neoliberal pact in today’s Western societies. In conclusion, the author highlights the complexity of eudaimonsim, suggesting that, in combination with a reconsideration of leisure, the concept might help scholars and others to better understand success and the meanings of lives lived in music.
Leisure Grooves
Authors: Mantie Roger
Published: January 2017

Charles Keil enjoyed a long and illustrious self-styled career as an activist, musician, educator, and “applied sociomusicologist.” His many investigations included urban blues music, the Tiv people of Africa, polka musicians in Buffalo, and Balkan musicians in Greece. His work has focused on groove and participation, as a response to what he sees as a corrupt and overrationalized Western culture. In this unconventional “open letter” format, the author explores the richness of Keil’s life and work, encouraged by his call for vibrant, vernacular, participatory, nonmediated musics that nurture spontaneity, and by his call for music learning inspired by paideia and groove. The chapter finds excitement in the implications Keil’s practice might hold for music learning and teaching, participatory music making, and for conceptualizing all education as “leisure education.”
Measuring Trust
Authors: Bauer Paul C. , Freitag Markus
Published: January 2017

This article focuses on the measurement of trust. First, we start with a brief conceptualization of trust, contrasting it with the concept of generalized trust. Second, we survey developments in trust measurement since the 1960s. Third, we summarize and try to systematize a number of measurement debates that have taken place. Fourth, we outline how trust measurement may develop in the future, discuss how differently formulated survey questions may abate some of the debates within the field, and present empirical data that follow some of these directions. Essentially we argue that trust—as opposed to generalized trust—should be measured through reliance on a set of more specific questions that measure expectations across a series of different situations.
“Never Had Much Difficulty”
Authors: Brandt Kenneth K.
Published: January 2017

As editor, mentor, and friend, Macmillan President George P. Brett had the single most significant influence on American writer Jack London’s professional publishing career. This essay explores how their partnership developed into one of the model editor-writer duos of the twentieth century putting them in the company of Maxwell Perkins and his authors. It examines the Brett and London’s correspondence regarding the editing, content, and publication of The People of the Abyss, The Iron Heel, The Road, Martin Eden, The Cruise of the Snark and other works. Brandt also highlights the significance of Brett and London’s shared interests—agriculture, arboriculture, travel, and the West.
Toward a Comparative Politics of France
Authors: Elgie Robert , Grossman Emiliano , Mazur Amy G.
Published: January 2017

This chapter returns to the questions that were introduced in the Handbook’s Introduction. The first section identifies four distinct periods in the study of French politics, revisiting the outside-in/inside-out themes of the Handbook. The second section focuses on the individual chapters in more detail and classifies them in terms of what they tell us about the study of French politics and whether there has been convergence or divergence between the study of French politics in France and comparative work outside France. In the third section, potential explanations for trends across the chapters are explored in terms of three patterns: convergence, asymmetry, and divergence. The chapter concludes by reflecting on the future for a comparative politics of France.
Torts and Technology
Authors: Morgan Jonathan
Published: January 2017

This chapter discusses tort law and how it applies to the risks posed by emerging technology. Tort law’s role here is significant. But how does tort adapt to injuries caused by technological innovations, and how should it react? With the increasing pace of technological advances, are the inherited conceptual structures of tort law sufficiently adaptable to both current and yet-unknown developments, or are novel statutory solutions required? We must also ask if tort liability is ultimately able to reconcile the competing demands of compensation, deterrence, and innovation. These questions are considered in various contexts including product liability, internet speech, and the prospect of ‘driverless cars’.
Formal Analysis and Typological Classification in the Study of Ancient Pottery
Authors: Albero Santacreu Daniel , Calvo Trias Manuel , García Rosselló Jaume
Published: January 2017

The morphological and typological study of pottery has traditionally been crucial for organizing excavation records. Hence, a substantial methodological development has encouraged more standardized descriptive and grouping protocols based on mathematical and statistical parameters. However, when compared with the significant growth of related methodology in the last decades, theoretical reflection on the role played by formal description of pottery and the drawing of typological classifications to study ancient societies has been pushed into the background. This chapter enlarges on some of the main approaches for the study of pottery form and, particularly, its typological classification. It also considers their innovative interpretative possibilities when integrated into the Anthropology of Techniques, as a fundamental part of the pottery châine opératoire and the technological traditions regarding potters.
Fabric Description of Archaeological Ceramics
Authors: Whitbread Ian
Published: January 2017

Fabric description is fundamental to the characterization, technological analysis and provenance determination of archaeological ceramics. It encompasses description of the arrangement, size, shape, frequency and composition of ceramic material constituents. These properties are used to identify the raw materials, their processing, vessel construction methods, and firing conditions. The process of description should, so far as possible, be an objective record of observed fabric properties that is independent of interpretations concerning technology and provenance. Fabric descriptions are made of ceramics in hand specimen and of samples prepared as thin sections for examination under a polarizing microscope. Rapid evaluation of fabric properties in the field is achieved by studying hand specimens using a magnifying glass or stereomicroscope. Laboratory-based analysis of thin sections provides more accurate and comprehensive identification of fabric properties, especially mineral and rock fragments in coarse fabrics, in terms of qualitative and quantitative data.
Inductively Coupled Plasma-Mass Spectrometry (ICP-MS) and Laser Ablation Inductively Coupled Plasma-Mass Spectrometry (LA-ICP-MS)
Authors: Golitko Mark , Dussubieux Laure
Published: January 2017

Inductively Coupled Plasma Mass Spectrometry (ICP-MS) is a versatile technique capable of measuring nearly every element on the Periodic Table down to extremely low concentrations. Using liquid sampling, it is a powerful method for bulk compositional characterization but has been only sporadically applied to archaeological ceramic studies. With laser ablation sampling, ICP-MS can be used to produce spatially resolved chemical information and has a wide range of archaeological applications including the analysis of ceramic surface treatments, paste composition, temper composition, and identification of post-burial chemical alteration. ICP-MS and LA-ICP-MS are particularly valuable when used in conjunction with bulk and mineralogical characterization techniques to elucidate which potential cultural, geological, or environmental effects are responsible for bulk compositional patterning, as well as providing complimentary compositional provenance information for individual phases of ceramic paste.
Instrumental Neutron Activation Analysis (INAA) in the Study of Archaeological Ceramics
Authors: Minc Leah D. , Sterba Johannes
Published: January 2017

Instrumental neutron activation analysis (INAA) is one of the most widely used analytical methods for bulk chemical characterization of ceramic pastes, owing to its relatively simple sample preparation procedures, the small sample mass required, and low detection limits for most elements of interest. At least fifty major, minor, and trace elements spanning the main geochemical element groups can be readily determined to the percent, ppm or ppb level, although sensitivity varies by element. In this chapter we provide an overview of the fundamental principles of activation analysis, and describe the steps typically followed in sample preparation, irradiation, gamma spectroscopy, and elemental analysis. In addition, we detail the strengths and weaknesses of INAA for archaeological ceramic studies, and illustrate a few of the many applications that have made INAA the mainstay for studies involving ceramic provenance, the organization of pottery production, and ceramic technology.
Synchrotron Radiation
Authors: Greene Alan F.
Published: January 2017

This chapter outlines the theory, instrumentation, experimental logistics, and body of research associated with the synchrotron radiation (SR)-based analysis of archaeological pottery: the use of accelerated particle energies, dominantly hard X-ray beams, to investigate a wide variety of pottery features, traditions, and technologies. Attention is paid to the wide variety of techniques employed in this highly flexible and emerging sub-field, while also contextualizing those efforts within the broader arc of pottery analysis in archaeology. While much SR-based research to date has focused on surface structures such as paints, slips, and glosses, the non-destructivity of the approach and its high speed of data collection suggest that other pottery features may also provide productive analytical terrain.
Fourier Transform Infrared Spectroscopy (FT-IR) in Archaeological Ceramic Analysis
Authors: Shoval Shlomo
Published: January 2017

The chapter reviews the use of Fourier Transform Infrared Spectroscopy (FT-IR) in study of ancient pottery and its applications to archaeology. FT-IR is a powerful technique for assessing the mineralogical composition of ancient ceramics and is, almost, non-destructive for the pottery. This method can be applied in analyses of the composition of the bulk ceramic as well as of particular pottery attributes, such as separated pastes, temper particles, binders, glazes, slips, paints, and pigments. FT-IR spectroscopy has the advantage of being able to detect both, the crystalline minerals as well as the pseudo-amorphous fired-clay in the ceramic fabric. The assessing of the mineralogical composition of the ceramics can be used in their classification, sourcing, and estimation of firing temperature. Applying spectral analysis by second-derivative and curve-fitting techniques is adding a quantitative dimension to the mineralogical analysis.
Designing Rigorous Research
Authors: Buxeda I Garrigós Jaume , Madrid i Fernandez Marisol
Published: January 2017

This chapter discusses the differences between archaeometric research problems, addressed to the advancement of the discipline, and the application of archaeometric routine problems in archaeological research ones, in order to deep our knowledge in social systems. This archaeometric routine problems start with the as-received state pottery, a composite material, and they address two broad and related questions: the identification of meaningful ceramic groups and provenance, in order to be able to infer the compositions of archaeological ceramic assemblages; and aspects related to ceramic manufacture, in order to reconstructing manufacture processes and identifying performance characteristics, also contributing to the study of technique and technology. It is argued that a fruitful sampling strategy starts with the understanding that pottery is part of assemblages resulting from different formation processes of the archaeological record. Thus a stratified multiphase sampling, performed in different sampling steps with post-stratification after each step, is advisable.
Evaluating Data
Authors: Hazenfratz Marks Roberto
Published: January 2017

Evaluating uncertainties in experimental results is an indispensable task since it can affect the statistical treatment and interpretation of data. This chapter focuses on the possible sources of variability and uncertainty in the chemical characterization of archaeological ceramics. A data set with a high degree of uncertainty and/or one in which the uncertainty is unrelated to cultural factors or inherent variability, such as geochemical heterogeneity, can easily be misinterpreted leading to incorrect answers to archaeological questions. Sources of uncertainty, natural, cultural, post-depositional, and uncertainty related to sampling and analytical instrumentation, are discussed. Finally, the impact of uncertainty on archaeological ceramic studies is addressed, with particular emphasis on grouping samples of similar chemical composition.
Development and Underdevelopment in the Middle East and North Africa
Authors: Cammett Melani
Published: January 2017

This article examines the trajectories of economic development and underdevelopment in the Middle East and North Africa (MENA). It first considers the empirical record of development in the region, paying particular attention to standard measures of GDP, industrialization, and social development. The article contextualizes the region’s development trajectory in a larger set of cross-regional comparisons and looks at the region’s record of economic growth and development in different periods after World War II. It also evaluates a number of factors that account for economic performance in the region—such as colonialism, Islam, social relations, corruption and crony capitalism, authoritarianism, and populism—before offering an alternative account. It argues that the MENA’s suboptimal economic performance is associated with the particular manifestation of business–government relations in the region.
Ballet Bawdies and Dancing Ducks
Authors: Schwadron Hannah
Published: January 2017

This article examines the dancing joke-work of Jewish film stars as ballet swans in Be Yourself and Funny Girl. It shows how the joke of the Jewish swan queers white heterosexual femininity while revealing the sustained power of its classical Western-centric swan tropes. In situating Jewish swan humor within theories of parody, queer discourse, and gendered joke-work, the article highlights the pleasurable embodiment of enduring Jewish female stereotypes and reveals a comic dance legacy of the funny girl body unfit for love. It also explains how the humor of ballet parody and the swan constructs the Jewish funny girl body; how Be Yourself and Funny Girl stake a claim in ethnic and sexual otherness as sites of comic expression and critical difference; and how each film embodies critiques of classical ballet and its idealist proscriptions for white women even as both sustain romantic fantasies of female leads.
Communicative Reason and Religious Faith in Secular and Postsecular Contexts
Authors: Goodson Jacob
Published: January 2017

The German philosopher and social theorist Jürgen Habermas has shifted his position of defending secularism to now defending postsecularism This chapter describes Habermas’s usage of the terms “secularity,” “secularism,” and “postsecularism” and explains how Habermas’s usage of these three terms is best understood in relation to his philosophical theory of communicative rationality. The shift from secularism to postsecularism is based on the fact that the latter allows for better communication between religious believers and nonreligious citizens in the globalized world of the twenty-first century. Habermas argues that the secular academy has responsibilities toward the positive aspects of religious faith as well as the negative aspects found in religious fundamentalism and religious-based violence.
Multiculturalizing Secularism
Authors: Modood Tariq
Published: January 2017

This chapter explores a proposal that multicultural equality require some type of public multifaithism in a civic context where state–religion connections flourish. An establishment of religion, suitably pluralized, can offer one way forward. It deserves consideration as a practical option, especially if it would be the least disruptive and the least threatening to those for whom establishment is important or those who are uncomfortable with multiculturalism. Given the goal of citizen equality for democracy, this challenge deserves an adequate response: how will ethnoreligious groups receive appropriate recognition unless existing state–religion connections are sufficiently pluralized? By attaining that goal, a multiculturalism in which religion is just one of a number of valued identities and forms of social organization can be recognized as such in a public and political way.
Beyond Comparing Secularisms
Authors: Jansen Yolande
Published: January 2017

“Religio-secularism” denotes the tendency to understand specific cultural and political conflicts in terms an opposition between religion on the one hand and secularism on the other. Religio-secularism as a cultural-political paradigm tends to obscure the intricacies of political, socioeconomic, cultural-historical, religious, and ideological dimensions of specific situations (and often conflicts) that require complex analysis and evaluation. Religio-secularism, especially when it becomes the primary or exclusive framework for understanding cultural and political conflict, serves as an ideological barrier rather than an illuminating paradigm. Critique of the increasing grip of religio-secularism on political thinking, in contrast to the captivation with “postsecularism,” takes a reflexive attitude toward religio-secularism and its distorted lens through which to view the historical world. Other lenses should be used to survey contemporary events and situations related to religion, and this is particularly so with regard to conflicts over religion, religion in the public sphere, and secularism.
Secularization and Its Consequences
Authors: Bruce Steve
Published: January 2017

The secularization paradigm argues that the decline of religion in the West is an unintended consequence of a variety of complex social changes known as modernization. Without a dramatic reversal of the increasing cultural autonomy of the individual, secularization is irreversible. In the stable affluent democracies of the West, the individual asserts the rights of the sovereign autonomous consumer. In the absence of social forces eroding that freedom, creation of a detailed ideological consensus is not possible, and no amount of vague spiritual yearning will generate a shared belief system. This diversity and its consequences is explored in this chapter.
Secularism, Humanism, and Secular Humanism
Authors: Blankholm Joseph
Published: January 2017

This chapter considers recent American attempts to recognize secular humanism as a religion in light of more than a century of debates over the religiosity of secularism and humanism. It offers a history of these terms’ codependent evolution in the United States by focusing on the individuals, groups, and institutions that have adopted them and shaped their meanings. The chapter also argues that those who use these terms today bear forth a fraught and sometimes self-contradicting inheritance. In order to recognize the stakes of contemporary struggles over the meaning and purpose of secularism, one needs a deeper understanding of how the term has come to bear its traces and how it fits within a shifting constellation of labels and concepts.
Humanism as a Positive Outcome of Secularism
Authors: Duyndam Joachim
Published: January 2017

Humanism is not the only answer to the conditions of secularism, nor would secularism inevitably equal nihilism without humanism.. This chapter articulates and defends positive humanism, a tradition not defined just by rejecting dogmatic religion but by seeking ethical ideals and human rights. Realizing those values requires hermeneutic interpretations of humanist exemplars from many cultures, past and present, in order to creatively apply those values within individual contexts. Humanism stands for liberty (autonomy and resilience), responsibility (the duty to care, for which one is answerable), justice (upholding institutions and arrangements that protect people from exploitation and humiliation), solidarity (spiritual and material care for one another), diversity (the right to individual and group identity), art of living (refined moral conduct toward oneself and others), and sustainability (long-term care for the inhabitability of the planet). Taken together, these values seek to promote humaneness.
Billy Elliot and Its Lineage
Authors: Gordon Robert
Published: January 2017

In the years since 1954, the British musical has in various ways represented the changes that have occurred in social and political attitudes. The camp style of Salad Days and The Boy Friend encodes its critique of the Conservative government’s repressive policies of heteronormative conformity in the early 1950s by exploiting popular traditions of pantomime and music hall performance to valorize an emergent gay sensibility, while the theatre of Joan Littlewood at Stratford East utilized these same popular forms in the construction of a socialist theatre capable of articulating a working-class culture. These two recurrent conceptions of alternative political performance—the subversive queer/camp strategy and the Marxian aesthetic of alternative politics and culture—interact and are combined to startling effect in Billy Elliot, whose dialectical arguments around the relationship between class and gender/sexual orientation, popular and ‘high’ art provide a prime example of British theatre at its most socially aware.
Introduction
Authors: Pavel Carmen E. , Schmidtz David
Published: January 2017

Debates about freedom traditionally focus on a few central themes. The chapters of this volume update those debates and launch new ones. Whether the freedom worth pursuing is one or many, whether it conflicts with equality, whether it can be secured by the institutions of the modern state, and whether it is compatible with a deterministic understanding of the universe are some of the central questions that animate the chapters in this volume. Our contributors show both that we have made real progress in our understanding of the many faces of freedom and its enabling conditions, and that threats to our freedoms remain various, serious, and real.
Medically Assisted Withdrawal (Detoxification): Considering the Mother-Infant Dyad
Authors: Jones Hendrée E. , Terplan Mishka , Meyer Marjorie
Published: January 2017

Recommendations for opioid agonist pharmacotherapy and against medically assisted withdrawal were based upon early reports that associated withdrawal with maternal relapse and fetal demise. Data from recent case series have called these recommendations into question. Although these data do not support an association between medically assisted withdrawal and fetal demise, relapse remains a significant clinical concern with reported rates ranging from 17% to 96% (average 48%). Given the high loss to follow-up in these studies, the actual relapse rate is likely even greater. Furthermore, while medically assisted withdrawal is being proposed as a public health strategy to reduce neonatal abstinence syndrome (NAS), current data do not support a reduction in NAS with medically assisted withdrawal relative to opioid agonist pharmacotherapy. Overall, the data do not support either benefit of medically assisted withdrawal or equivalence to opioid agonist pharmacotherapy for the maternal-newborn dyad. Medically assisted withdrawal increases the risk of maternal relapse and poor treatment engagement and does not improve newborn health. Treatment of chronic maternal disease, including opioid agonist disorder, should be directed toward optimal long-term outcome.
Primary Gastric Choriocarcinoma Presenting as a Pregnancy of Unknown Location
Authors: Larish Alyssa , Kumar Amanika , Kerr Sarah , Langstraat Carrie
Published: January 2017

BACKGROUND:

Pregnancy of unknown location presents a diagnostic challenge, in rare occasions leading to the diagnosis of malignancy. We describe a case of β-hCG-secreting nongestational primary gastric choriocarcinoma presenting as a pregnancy of unknown location.

CASE:

A 37-year-old woman, gravida 4 para 3013, presented with several days of vaginal bleeding and rising β-hCG level without ultrasound localization of pregnancy. The diagnosis of pregnancy of unknown location was made and methotrexate administered at a β-hCG level of 7,779 milli-international units/mL. A 40% decrease in β-hCG level was noted between days 4 and 7. One week later, an inappropriate β-hCG level rise to 10,937 milli-international units/mL was noted, prompting a second dose of methotrexate and computed tomography imaging, leading to the discovery of gastric and liver lesions. Pathology from gastric biopsies revealed nongestational choriocarcinoma. The patient was treated with chemotherapy, with death from cardiac arrest 7 months after diagnosis.

CONCLUSION:

Malignancies that can secrete β-hCG include gestational trophoblastic disease, gonadal and extragonadal germ cell tumors, and malignancies with choriocarcinoma differentiation. Although ectopic pregnancy compromises approximately 2% of first-trimester pregnancy, gestational trophoblastic neoplasia and gestational choriocarcinoma can be seen in 1 of 1,500 and 1 of 20,000 pregnancies, respectively. When β-hCG levels do not fall appropriately in women undergoing medical management for pregnancy of unknown location, ectopic β-hCG secretion by a malignancy must be considered.
Neurodevelopmental Outcomes After Assisted Reproductive Technologies
Authors: Balayla Jacques , Sheehy Odile , Fraser William D. , Séguin Jean R. , Trasler Jacquetta , Monnier Patricia , MacLeod Andrea A. , Simard Marie-Noëlle , Muckle Gina , Bérard Anick ,   on Behalf of the 3D-Study Research Group From the Integrated Research Network in Perinatology of Quebec and Eastern Ontario
Published: January 2017

OBJECTIVE:

To compare children's cognitive, motor, and language development at 2 years of age after assisted reproductive technologies (ARTs) relative to natural conception.

METHODS:

The 3D-Study (2010–2012) is a prospective cohort study, which sought to improve the understanding among perinatal events, obstetric outcomes, and child development. A total of 2,366 pregnant women were recruited, of whom 278 conceived with ART: ovarian stimulation, intrauterine sperm insemination, in vitro fertilization, intracytoplasmic sperm injection, or in vitro maturation. Natural conception was defined as the unassisted establishment of pregnancy. Cognitive, motor, and language neurodevelopmental outcomes were compared between ART and natural conception groups at 24 months using the Bayley Scales of Infant and Toddler Development, 3rd edition, and the MacArthur-Bates Communicative Development Inventories. Adjusted linear regression models evaluated the effect of ART on neurodevelopmental outcomes using natural conception as a reference.

RESULTS:

A total of 175 children in the ART group (62.9%) and 1,345 children in the natural conception group (64.4%) underwent neurodevelopmental assessment at 24 months postpartum. After adjusting for relevant confounders, children born after ART showed no difference in Bayley scales' cognitive scores (B1 [standard error]=−1.60 [0.9], 95% confidence interval [CI] −3.36 to 0.16), composite motor scores (B1 [standard error]=−1.33 [1.0], 95% CI −3.29 to 0.63), or MacArthur-Bates language scores (B1 [standard error]=−0.28 [2.1], 95% CI −4.39 to 3.83). No difference was observed when independent ART techniques were compared nor when comparing in vivo (ovarian stimulation or intrauterine insemination) or in vitro (in vitro fertilization, intracytoplasmic sperm injection, or in vitro maturation) techniques (P>.05).

CONCLUSION:

Children born after ART had similar cognitive, motor, and language development as children born after natural conception at 2 years of age. These findings may be useful in the clinical counseling of patients undergoing ART.
Relationship Between Alternative Resuscitation Strategies, Host Response and Injury Biomarkers, and Outcome in Septic Shock: Analysis of the Protocol-Based Care for Early Septic Shock Study
Authors: Kellum John A. , Pike Francis , Yealy Donald M. , Huang David T. , Shapiro Nathan I. , Angus Derek C.
Published: January 2017

Objectives:

The Protocol-based Care for Early Septic Shock trial found no differences across alternative resuscitation strategies in all-cause mortality. A separate aim was to determine whether differences in resuscitation strategies affected trajectories of biomarkers of key pathways associated with downstream clinical outcomes of sepsis and whether there were differences in survival across treatment arms for patients with different baseline biomarker profiles.

Design:

Secondary analysis of a large randomized clinical trial.

Setting:

Thirty-one U.S. hospitals.

Patients:

Six hundred twenty-eight patients with septic shock.

Interventions:

Two resuscitation protocols versus usual care.

Measurements and Main Results:

We measured a panel of biomarkers representing four pathophysiologic domains: “inflammation” (tumor necrosis factor, interleukin-6, and -10); “coagulation” (D-dimers, thrombin-antithrombin complex); “oxidative stress” (urine isoprostane); and “tissue hypoxia” (lactate) at 0, 6, 24, and 72 hours after treatment. We analyzed whether alternative resuscitation strategies affected biomarker trajectories over 72 hours and whether effects on 90-day hospital mortality varied by baseline (time 0) biomarker profiles—both using regression models with interaction terms for treatment arms. For all baseline biomarkers, higher concentrations were associated with increased risk of death by 90 days. However, there was no significant effect of treatment assignment on subsequent biomarker trajectories. We did find evidence for heterogeneity of treatment effect of protocol-based care on mortality for patients with different baseline [interleukin-6] and [interleukin-6] × [interleukin-10] profiles, whereas patients with the lowest quartiles fared better with protocol-based care (odds ratios, 0.32 [0.13–075]; p = 0.01 and 0.32 [0.14–0.73]; p = 0.01, respectively).

Conclusions:

In patients with septic shock, alterations in inflammation, coagulation, oxidative stress, and tissue hypoxia are common and associated with adverse outcomes but are not influenced by protocol-based resuscitation compared with usual care. However, contrary to expectation, protocol-based resuscitation appeared to be superior in patients with lower concentrations of inflammatory biomarkers. The mechanisms responsible for this effect are unclear.
Mapping Regional Differences of Local Pressure-Volume Curves With Electrical Impedance Tomography
Authors: Beda Alessandro , Carvalho Alysson R. , Carvalho Nadja C. , Hammermüller Sören , Amato Marcelo B. P. , Muders Thomas , Gittel Claudia , Noreikat Katharina , Wrigge Hermann , Reske Andreas W.
Published: January 2017

Objectives:

Lung-protective mechanical ventilation aims to prevent alveolar collapse and overdistension, but reliable bedside methods to quantify them are lacking. We propose a quantitative descriptor of the shape of local pressure-volume curves derived from electrical impedance tomography, for computing maps that highlight the presence and location of regions of presumed tidal recruitment (i.e., elastance decrease during inflation, pressure-volume curve with upward curvature) or overdistension (i.e., elastance increase during inflation, downward curvature).

Design:

Secondary analysis of experimental cohort study.

Setting:

University research facility.

Subjects:

Twelve mechanically ventilated pigs.

Interventions:

After induction of acute respiratory distress syndrome by hydrochloric acid instillation, animals underwent a decremental positive end-expiratory pressure titration (steps of 2 cm H2O starting from ≥ 26 cm H2O).

Measurements and Main Results:

Electrical impedance tomography-derived maps were computed at each positive end-expiratory pressure-titration step, and whole-lung CT taken every second steps. Airway flow and pressure were recorded to compute driving pressure and elastance. Significant correlations between electrical impedance tomography-derived maps and positive end-expiratory pressure indicate that, expectedly, tidal recruitment increases in dependent regions with decreasing positive end-expiratory pressure (p < 0.001) and suggest that overdistension increases both at high and low positive end-expiratory pressures in nondependent regions (p < 0.027), supporting the idea of two different scenarios of overdistension occurrence. Significant correlations with CT measurements were observed: electrical impedance tomography-derived tidal recruitment with poorly aerated regions (r = 0.43; p < 0.001); electrical impedance tomography-derived overdistension with nonaerated regions at lower positive end-expiratory pressures and with hyperaerated regions at higher positive end-expiratory pressures (r ≥ 0.72; p < 0.003). Even for positive end-expiratory pressure levels minimizing global elastance and driving pressure, electrical impedance tomography-derived maps showed nonnegligible regions of presumed overdistension and tidal recruitment.

Conclusions:

Electrical impedance tomography-derived maps of pressure-volume curve shapes allow to detect regions in which elastance changes during inflation. This could promote individualized mechanical ventilation by minimizing the probability of local tidal recruitment and/or overdistension. Electrical impedance tomography-derived maps might become clinically feasible and relevant, being simpler than currently available alternative approaches.
Short article: Mortality and differential diagnoses of villous atrophy without coeliac antibodies
Authors: Schiepatti Annalisa , Biagi Federico , Fraternale Giacomo , Vattiato Claudia , Balduzzi Davide , Agazzi Simona , Alpini Claudia , Klersy Catherine , Corazza Gino R.
Published: January 2017

Objective

Villous atrophy (VA) of the small bowel is mainly related to coeliac disease (CD), whose diagnosis is made on the basis of positive endomysial/tissue transglutaminase antibodies while on a gluten-containing diet in the vast majority of patients. However, VA can also occur in other conditions whose epidemiology is little known. Our aim was to study the epidemiology and clinical features of these rare enteropathies.

Patients and methods

Clinical and laboratory data of all the patients with VA directly diagnosed in our centre in the last 15 years were collected and statistically analysed.

Results

Between September 1999 and June 2015, 274 patients were diagnosed with VA. A total of 260 patients were also positive to coeliac antibodies; the other 14 had VA, but no IgA endomysial antibodies: five had common variable immunodeficiency, three had dermatitis herpetiformis, two had IgA deficiency associated with CD, one had abdominal lymphoma, one had unclassified sprue, one had olmesartan-associated enteropathy and one had seronegative CD. Mortality was 6.0 deaths per 100 person years (95% confidence interval: 2.2–16) in patients with VA but negative coeliac antibodies, whereas only 0.2 deaths per 100 person years (95% confidence interval: 0.1–0.6) occurred in coeliac patients.

Conclusion

Patients with VA and negative endomysial antibodies are rare. However, these forms of VA identify specific causes that can be diagnosed. These patients are affected by a very high mortality.
Clinical Characteristics of Herpes Simplex Virus Urethritis Compared With Chlamydial Urethritis Among Men
Authors: Ong Jason J. , Morton Anna N. , Henzell Helen R. , Berzins Karen , Druce Julian , Fairley Christopher K. , Bradshaw Catriona S. , Read Tim RH , Hocking Jane S. , Chen Marcus Y.
Published: January 2017

Background

The aim of this study was to ascertain the clinical characteristics associated with herpes simplex virus (HSV) urethritis in men and to compare those with chlamydial urethritis.

Methods

We compared clinical and laboratory data from men diagnosed with polymerase chain reaction confirmed HSV urethritis with those of men with chlamydial urethritis presenting to Melbourne Sexual Health Centre between 2000 and 2015.

Results

Eighty HSV urethritis cases were identified: 55 (68%, 95% confidence interval, 58–78) were by HSV-1 and 25 (32%, 95% confidence interval, 22–42) by HSV-2. Compared with chlamydial urethritis, men with HSV urethritis were significantly more likely to report severe dysuria (20% vs 0%, P < 0.01) or constitutional symptoms (15% vs 0%, P < 0.01). Men with HSV urethritis were significantly more likely to have meatitis (62% vs 23%, P < 0.01), genital ulceration (37% vs 0%, P < 0.01), or inguinal lymphadenopathy (30% vs 0%, P < 0.01) but less likely to have urethral discharge (32% vs 69%, P < 0.01). There was no significant difference in the proportion of men who had raised (≥5) polymorphonuclear leukocytes per high-powered field between the two groups (P = 0.46).

Conclusions

The clinical presentation of HSV urethritis in men may differ from those of chlamydial urethritis and guide testing for HSV in men presenting with non-gonococcal urethritis.
How Reliable Is Microscopy and Culture for the Diagnosis of Gonorrhea? An 11-Year Experience from INDIA
Authors: Bhargava Aradhana , Bala Manju , Singh Vikram , Joshi Naveen Chandra , Kakran Monika , Puri Poonam , Khunger Niti , Ramesh Venkatesh , Saxena Ashok Kumar
Published: January 2017

Positivity of microscopy and culture was greater (P < 0.0001) in men with urethral discharge syndrome (65.8%) than in women with vaginal/cervical discharge (0.5%), indicating that basic diagnostic tests may not be cost-effective for diagnosis of vaginal/cervical discharge syndrome. Microscopy when compared with culture showed sensitivity, specificity, positive predictive value and negative predictive value of 95.4%, 77.6%, 84.6%, and 95.3%, in men, whereas in women, it was 77.8%, 99.9%, 92.1%, and 99.9%, respectively.
Lens Opacity and Hydrogen Sulfide in a New Zealand Geothermal Area
Authors: Bates Michael N. , Bailey Ian L. , DiMartino Robert B. , Pope Karl , Crane Julian , Garrett Nick
Published: January 2017

Purpose

Hydrogen sulfide (H2S) is a highly toxic gas with well-established, acute irritation effects on the eye. The population of Rotorua, New Zealand, sited on an active geothermal field, has some of the highest ambient H2S exposures in the world. Evidence from ecological studies in Rotorua has suggested that H2S is associated with cataract. The purpose of the present study was, using more detailed exposure characterization, clinical examinations, and anterior eye photography, to more directly investigate this previously reported association.

Methods

Enrolled were 1637 adults, ages 18 to 65, from a comprehensive Rotorua primary care medical register. Patients underwent a comprehensive ophthalmic examination, including pupillary dilation and lens photography to capture evidence of any nuclear opacity, nuclear color, and cortical and posterior subcapsular opacity. Photographs were scored for all four outcomes on the LOCS III scale with decimalized interpolation between the exemplars. H2S exposure for up to the last 30 years was estimated based on networks of passive samplers set out across Rotorua and knowledge of residential, workplace, and school locations over the 30 years. Data analysis using linear and logistic regression examined associations between the degree of opacification and nuclear color or cataract (defined as a LOCS III score ≥2.0) in relation to H2S exposure.

Results

No associations were found between estimated H2S exposures and any of the four ophthalmic outcome measures.

Conclusions

Overall, results were generally reassuring. They provided no evidence that H2S exposure at the levels found in Rotorua is associated with cataract. The previously found association between cataract and H2S exposure in the Rotorua population seems likely to be attributable to the limitations of the ecological study design. These results cannot rule out the possibility of an association with cataract at higher levels of H2S exposure.
An Exploratory Study to Assess Individual and Structural Level Barriers Associated With Poor Retention and Re-engagement in Care Among Persons Living With HIV/AIDS
Authors: Colasanti Jonathan , Stahl Natalie , Farber Eugene W. , del Rio Carlos , Armstrong Wendy S.
Published: January 2017

Background:

Retention in care is the most challenging step along the HIV care continuum. Many patients who engage in care and achieve viral suppression have care interruptions, characterized by moving in and out of care (“churn”). Poor retention has clinical consequences and contributes to new HIV transmissions, but how to predict or prevent it remains elusive. This study sought to understand the relationship between individual- and structural-level barriers, and poor retention for persons living with HIV/AIDS in Atlanta, GA.

Methods:

We administered a survey, through interviews, with HIV-infected patients continuously retained in care for 6 years (“continuously retained,” n = 32) and patients with recent gaps in care (“unretained” n = 27). We assessed individual-level protective factors for successful engagement (self-efficacy, resilience, perceived social support, and disclosure), risk factors for poor engagement (substance use, mental illness, and stigma), and structural/systemic-level barriers (financial and housing instability, transportation, food insecurity, communication barriers, and incarceration history). Chi-square and Mann–Whitney U tests were used to compare the 2 populations.

Results:

Both continuously retained and unretained populations had high rates of prior viral suppression but few unretained patients were virologically suppressed upon return to care (11%). Younger age, crack cocaine use, food insecurity, financial instability, housing instability, and phone number changes in the past year were significantly more likely to be present in the unretained population.

Conclusions:

Our findings suggest the need for targeted risk assessment tools to predict the highest-risk patients for poor retention whereby public health interventions can be directed to those individuals.
Evolution of iris colour in relation to cavity nesting and parental care in passerine birds
Authors: Davidson Gabrielle L. , Thornton Alex , Clayton Nicola S.
Published: January 2017

Strong selection pressures are known to act on animal coloration. Although many animals vary in eye colour, virtually no research has investigated the functional significance of these colour traits. Passeriformes have a range of iris colours, making them an ideal system to investigate how and why iris colour has evolved. Using phylogenetic comparative methods, we tested the hypothesis that conspicuous iris colour in passerine birds evolved in response to (a) coordination of offspring care and (b) cavity nesting, two traits thought to be involved in intra-specific gaze sensitivity. We found that iris colour and cooperative offspring care by two or more individuals evolved independently, suggesting that bright eyes are not important for coordinating parental care through eye gaze. Furthermore, we found that evolution between iris colour and nesting behaviour did occur in a dependent manner, but contrary to predictions, transitions to coloured eyes were not more frequent in cavity nesters than non-cavity nesters. Instead, our results indicate that selection away from having bright eyes was much stronger in non-cavity nesters than cavity nesters, perhaps because conspicuous eye coloration in species not concealed within a cavity would be more visible to predators.
Stronger seasonal adjustment in leaf turgor loss point in lianas than trees in an Amazonian forest
Authors: Maréchaux Isabelle , Bartlett Megan K. , Iribar Amaia , Sack Lawren , Chave Jérôme
Published: January 2017

Pan-tropically, liana density increases with decreasing rainfall and increasing seasonality. This pattern has led to the hypothesis that lianas display a growth advantage over trees under dry conditions. However, the physiological mechanisms underpinning this hypothesis remain elusive. A key trait influencing leaf and plant drought tolerance is the leaf water potential at turgor loss point (πtlp).πtlpadjusts under drier conditions and this contributes to improved leaf drought tolerance. For co-occurring Amazonian tree (n= 247) and liana (n= 57) individuals measured during the dry and the wet seasons, lianas showed a stronger osmotic adjustment than trees. Liana leaves were less drought-tolerant than trees in the wet season, but reached similar drought tolerances during the dry season. Stronger osmotic adjustment in lianas would contribute to turgor maintenance, a critical prerequisite for carbon uptake and growth, and to the success of lianas relative to trees in growth under drier conditions.