bluuebunny/crossref_metadata_2025 huggingface dataset:
10. From Amsterdam to Lisbon (2000–2009)
Authors: Bache Ian , Bulmer Simon , George Stephen , Parker Owen
Published: September 2017

This chapter examines the new strategy adopted in March 2000 by a special European Council in Lisbon to make the European Union more competitive, culminating in the signing of the Treaty of Lisbon. The Amsterdam Treaty had scarcely entered into force before further treaty reform emerged on the agenda. Throughout the year 2000 a new intergovernmental conference met to address outstanding institutional issues that had not been settled at Amsterdam. It concluded in December 2000 with the longest European Council in history, which led to the Treaty of Nice. The chapter first considers the Nice Treaty before discussing the Lisbon Strategy, the European Security and Defence Policy, the Constitutional Treaty, the issue of enlargement, the European Parliament, and the nomination of a new European Commission. It ends with a discussion of the Treaty of Lisbon.
11. The EU in Crisis (2009–)
Authors: Bache Ian , Bulmer Simon , George Stephen , Parker Owen
Published: September 2017

This chapter examines the eurozone crisis that dominated the period after the Lisbon Treaty was adopted in 2009 and the challenges it presented for European institutions. It shows that the eurozone crisis affected European Union member states in starkly diffrent ways and that acute disagreements emerged over the appropriate reform agenda, particularly between ‘debtor’ and ‘creditor’ countries. The chapter first provides an overview of how the eurozone crisis unfolded before discussing the politics of the crisis and how it led to the increased relevance of intergovernmentalism within the EU, along with national government power in the crisis context. It then considers other developments during this period, including elections to the European Parliament, a further enlargement to include Croatia in 2013, and the launch of ‘Europe 2020’ strategy. It also looks at the United Kingdom’s adoption of a series of measures that raised doubts about its future relationship with the EU.
13. The European Commission
Authors: Bache Ian , Bulmer Simon , George Stephen , Parker Owen
Published: September 2017

This chapter examines the European Commission’s functions and structure, along with its role in policy making. The Commission initiates legislation, may act as a mediator, manages some policy areas, is guardian of the Treaties, is a key actor in international relations, and the ‘conscience of the European Union’. The chapter proceeds by discussing the debate on the extent to which the Commission is an autonomous political actor or simply an agent of the member states. Finally, it analyses the increasing challenges faced by the Commission in securing effective implementation of EU policies and its response to concerns over its financial management of EU programmes.
14. The European Council and the Council of Ministers
Authors: Bache Ian , Bulmer Simon , George Stephen , Parker Owen
Published: September 2017

This chapter focuses on two European Union institutions that principally composed of government representatives: the European Council and the Council of Ministers. By virtue of their composition of government representatives (government heads, ministers, and civil servants), both the European Council and the Council of Ministers remain part of a hierarchy of EU institutions. The chapter first provides an overview of definitions and distinctions before discussing the intergovernmentalism of the European Council and how the Council of Ministers helped increase the supranationalism of the EU. It also considers the role of the Committee of Permanent Representatives (COREPER) and various preparatory committees of the European Council and the Council of Ministers.
19. Agriculture
Authors: Bache Ian , Bulmer Simon , George Stephen , Parker Owen
Published: September 2017

This chapter examines the European Union’s policy on agriculture. The importance that the EU has given to the agricultural sector can be attributed in large part to food shortages at the end of the Second World War. Governments agreed that it was important to ensure adequate supplies of food at reasonable prices. To achieve this, it was necessary to provide an adequate income to farmers, while taking measures to increase their productivity. The Common Agricultural Policy (CAP) was the first redistributive policy of the European Community, and for many years the only one. The chapter first provides a historical background on European agriculture in the 1980s and 1990s before discussing the Agenda 2000 budget negotiations and the 2003 reform of the CAP. It also explores the cumulative effect on the CAP of the reform process that started in 1992.
21. Economic and Monetary Union
Authors: Bache Ian , Bulmer Simon , George Stephen , Parker Owen
Published: September 2017

This chapter examines the various attempts to create the Economic and Monetary Union (EMU), which first became an official objective of the European Community (EC) in 1969 but was achieved only thirty years later. In December 1969, the Hague Summit meeting of the EC heads of government made a commitment to the achievement of EMU ‘by 1980’. However, France and West Germany disagreed over how to do it. Germany made anti-inflationary policies the priority, while France made economic growth the priority, even at the risk of higher inflation. The chapter first provides a historical background on efforts to create the EMU before discussing the launch of the single currency, the euro, and its subsequent progress up to and including the eurozone crisis in the late 2000s. It also considers some of the explanations for and critiques of EMU that have been offered by various academic commentators.
27. Enlargement
Authors: Bache Ian , Bulmer Simon , George Stephen , Parker Owen
Published: September 2017

This chapter examines the European Union’s main enlargement rounds. The European Community (EC)/EU started with six member states, but has grown through successive enlargements. The first enlargement occurred in 1973 when Britain, Denmark, and Ireland were admitted as members. The second (1981) and third (1986) enlargements are often treated as a single ‘Southern enlargement’. The fourth enlargement took place in 1995, which admitted Austria, Finland, and Sweden. The fifth and sixth enlargements, in 2004 and 2007, are known as the ‘Eastern enlargement’. The seventh enlargement saw the admittance of Croatia in 2013. The chapter describes what happened during each round and considers the effect on the EC/EU. It also reviews academic explanations of why the various applications for membership were made, and why they were accepted by the EC/EU. Finally, it looks at the controversial case of Turkey, taking into account the notion of ‘enlargement fatigue’.
3. The European Policy Process in Comparative Perspective
Authors: Young Alasdair R.
Published: September 2017

This chapter examines the European Union’s policy-making process with a comparative perspective. It outlines the stages of the policy-making process (agenda-setting, policy formation, decision-making, implementation, and policy feedback) and considers the prevailing approaches to analysing each of these stages. It also shows how these approaches apply to studying policy-making in the EU. Themes addressed in this chapter include policy-making and the policy cycle, the players in the policy process, executive politics, legislative politics, and judicial politics. The chapter argues that theories rooted in comparative politics and international relations can help elucidate the different phases of the EU’s policy process. It concludes by explaining why policy-making varies across issue areas within the EU.
7. Policy-Making under Economic and Monetary Union Crisis, Change, and Continuity
Authors: Hodson Dermot
Published: September 2017

This chapter examines the role of the economic and monetary union (EMU) in the European Union’s macroeconomic policy-making. As of 2015, nineteen members of the euro area have exchanged national currencies for the euro and delegated responsibility for monetary policy and financial supervision to the European Central Bank (ECB). EMU is a high-stakes experiment in new modes of EU policy-making insofar as the governance of the euro area relies on alternatives to the traditional Community method, including policy coordination, intensive transgovernmentalism, and delegation to de novo bodies. The chapter first provides an overview of the origins of the EMU before discussing the launch of the single currency and the sovereign debt crisis. It also considers variations on the Community method, taking into account the ECB and the European Stability Mechanism.
9. The Budget Who Gets What, When, and How?
Authors: Laffan Brigid , Lindner Johannes
Published: September 2017

This chapter examines the European Union’s budgetary procedures with an eye towards elucidating the characteristics of budgetary politics and policy-making. Where EU money comes from, how it is spent, and the processes by which it is distributed are the subjects of intense political bargaining. Budgets matter politically, because money represents the commitment of resources to the provision of public goods and involves political choices across sectors and regions. The chapter first provides a thumbnail sketch of the EU budget before looking at the major players involved in the budgetary process. It then considers budgetary politics over time, focusing on two phases, one dominated by budgetary battles and other by ordered budgetary decision-making. It also discusses the relevant provisions of the Treaty of Lisbon with respect to budgetary procedures and concludes with an assessment of the budget review and how the EU manages a larger budget.
12. Employment Policy Between Efficacy and Experimentation
Authors: Rhodes Martin
Published: September 2017

This chapter focuses on the European Union’s employment policy, which is currently formulated and implemented via several parallel modes of policy-making, including the standard Community method of legislating and a softer mode of policy-making and innovation via the European Employment Strategy (EES). The chapter begins with a discussion of the three modes of policy-making and governance in European employment policy that have been developed since the 1960s: the mode of legislated ‘rights’, based on the classical Community method; the mode of ‘law via collective agreement’; and a ‘new’ mode of governance, using the open method of coordination. It then considers employment policy-making before the Treaty of Amsterdam and employment policy innovations post-Amsterdam. It also examines social and employment vs economic rights in EU law and concludes with an assessment of future prospects for EU employment policy.
16. Trade Policy Policy-Making after the Treaty of Lisbon
Authors: Woolcock Stephen
Published: September 2017

This chapter examines the decision-making process in the European Union’s trade and investment policy following the changes brought about by the Treaty of Lisbon. It shows how EU policy competence has been extended progressively over many years due to internal institutional developments, but also in response to demands made upon the EU by external drivers. It also considers the respective roles of the EU institutions and argues that effective policy-making requires that all of the major actors have faith in the decision-making regime. Such a regime involving the European Commission and the European Council was developed by the EU over many years. The challenge for decision-making is for the European Parliament to be integrated into this regime. The chapter explains how the EU has shifted to a policy that includes the active pursuit of free trade agreements in parallel with efforts to promote a comprehensive multilateral trade agenda.
2. Two Worlds East and West, 1945–8
Authors: Young John W. , Kent John
Published: September 2017

This chapter examines how the world was divided into two opposing blocs, East and West, during the period 1945–1948. It begins with a discussion of the Marshall Plan, focusing on its implementation and its Cold War consequences, and the Western economic system. It then considers the Soviet Union’s takeover of Eastern and Central Europe, with emphasis on the split between Soviet leader Joseph Stalin and Marshal Tito of Yugoslavia. It also looks at the struggle for influence in East Asia and concludes with an assessment of the division of Germany. The chapter suggests that the Berlin crisis was in many ways a symbolic crisis in a city which came to epitomize Cold War tensions until 1989; the crisis has also been regarded as an important cause of the militarization of the Cold War and the formation of NATO.
5. Soviet–American Relations: Avoiding Hot War and the Search for Stability
Authors: Young John W. , Kent John
Published: September 2017

This chapter examines US–Soviet relations during the Cold War as well as the question of the genuineness of efforts by the United States and the Soviet Union to achieve disarmament and resolve troublesome disputes. It begins with a discussion of the German question, noting that Germany’s future position was vital to the future of Europe and a particular concern of the Soviets. It then considers the progress of arms control and peace efforts by the United States and the Soviet Union before concluding with an analysis of the relationship of arms control to the use of armaments in hot war and to some aspects of fighting the Cold War.
8. Collapsing Empires: The Cold War Battle for Hearts and Minds, 1953–63
Authors: Young John W. , Kent John
Published: September 2017

This chapter examines how the United States and the Soviet Union sought to win the hearts and minds of people in various parts of the world as empires began to collapse during the period 1953–1963. It begins with a discussion of the end of the French Empire, taking into account the loss of French Indo-China and the start of American involvement in Vietnam, along with the collapse of French rule in Morocco and Tunisia. It then considers the crises in the Congo, Angola, and the Middle East, focusing on the zenith of the Cold War in Black Africa, Britain’s declining power, and the Suez crisis. It concludes by looking at the end of the British Empire in Africa.
10. The Vietnam War
Authors: Young John W. , Kent John
Published: September 2017

This chapter focuses on the United States’s involvement in the Vietnam War. Lyndon B. Johnson inherited the Vietnam conflict in difficult circumstances. He had not been elected president in his own right and so, perhaps, believed that he should carry on with John F. Kennedy’s policies. It was unclear what exactly Kennedy would have done in Vietnam, but Johnson retained his predecessor’s foreign policy team and did not question the basic principle of America’s foreign policy, which called for communism to be resisted. The chapter first considers the escalation of US involvement in Vietnam during the period 1963–1965 before discussing the conflict between the US and North Vietnam in the succeeding years, along with the Tet offensive and its implications. It concludes with an assessment of Richard Nixon’s decision to restart large-scale US bombing of North Vietnam.
1. Making Sense of Earth’s Politics: A Discourse Approach
Authors: Dryzek John S.
Published: September 2017

This edition examines the politics of the Earth through reference to discourses based on the argument that language matters, that the way we construct, interpret, discuss, and analyze environmental problems has all kinds of consequences. The goal is to elucidate the basic structure of the discourses that have dominated recent environmental politics, and to present their history, conflicts, and transformations. The text discusses four basic environmental discourses: environmental problem solving, limits and survival, sustainability, and green radicalism. This introduction provides an overview of the changing terms of environmental politics, questions to ask about discourses, the differences that discourses make, and the uses of discourse analysis.
6. Leave it to the Market: Economic Rationalism
Authors: Dryzek John S.
Published: September 2017

This chapter examines economic rationalism, a discourse of environmental problem solving which builds on its advances in all areas of political life to generate alternatives to and remedies for the pathologies it identifies in both administration and liberal democratic governance. Economic rationalism may be defined by its commitment to the intelligent deployment of market mechanisms to achieve public ends. It differs from administrative rationalism in its hostility to environmental management by government administrators — except in establishing the basic parameters of designed markets. The chapter first considers the issue of privatization and private property rights before discussing less radical strands that stress market incentives but not necessarily private property. It also describes the discourse analysis of economic rationalism and concludes with an assessment of the limitations of economic rationalism, including its treatment of government.
8. Industrial Society and Beyond: Ecological Modernization
Authors: Dryzek John S.
Published: September 2017

This chapter examines ecological modernization, a discourse that addresses the restructuring of the capitalist political economy along more environmentally defensible lines. At one level ecological modernization is about the search for green production technology, and especially clean energy. However, this search also opens the door to intriguing possibilities for more intensive transformation, involving political change as well as technological change. So although at first sight ecological modernization looks like a rescue mission for industrial society, albeit an imaginative one, it also points to political and economic possibilities beyond industrial society. The central assumption of ecological modernization is that the capitalist political economy needs conscious reconfiguring and far-sighted action so that economic development and environmental protection can proceed hand-in-hand and reinforce one another. The chapter first explains the idea of ecological modernization before discussing its discourse analysis. It concludes with some remarks on the future of ecological modernization.
Satellite driven distribution models of endangered Atlantic sturgeon occurrence in the mid-Atlantic Bight
Authors: Breece Matthew W , Fox Dewayne A , Haulsee Danielle E , Wirgin Isaac I , Oliver Matthew J
Published: September 2017

Atlantic sturgeon (Acipenser oxyrinchus oxyrinchus) is an endangered species that migrate through, and occupy the coastal waters of the mid-Atlantic Bight where they interact with anthropogenic activities. Measures to understand and avoid Atlantic sturgeon that take into consideration the dynamic nature of their habitat may reduce harmful interactions. In this study, we matched fisheries independent biotelemetry observations of Atlantic sturgeon with daily satellite observations to construct a time resolved spatial distribution model of Atlantic sturgeon. We determined that depth, day-of-year, sea surface temperature, and light absorption by seawater were the most important predictors of Atlantic sturgeon occurrence. Demographic factors, such as sex and river-of-origin were of secondary importance. We found strong spatial differences in spring and fall migration patterns, when anthropogenic interactions peak. Our cross-validated models correctly identified > 88% of biotelemetry observations in our study region. Our models also correctly identified ∼64% of bycatch observations throughout the year. However, during their migrations, when harmful interactions were highest, our models correctly identified ∼90% of fisheries dependent observations. We suggest that this model can be used for guidance to managers and stakeholders to reduce interactions with this highly imperiled species, thereby enhancing conservation and recovery efforts.
Ionised accretion discs in active galactic nuclei: the effects of a lamppost with a variable height
Authors: Ballantyne D. R.
Published: September 2017

The X-ray emitting corona irradiates and ionizes the surface of the inner accretion disc in active galactic nuclei (AGNs). The ionization parameter of the inner disc at a radius r from the black hole, ξ(r), can be used to infer information about the location of the corona. Here, a new formula is derived that predicts ξ(r, h) for a disc irradiated by an X-ray source at a height h above the black hole symmetry axis (i.e. a lamppost geometry). The equation is independent of the black hole mass and the X-ray spectrum, and accounts for the effects of gravitational light-bending on the ionization state and a variable coronal dissipation factor. We predict a strong ionization gradient across the surface of the inner disc that depends on the black hole spin and lamppost height. For a fixed h, the ionization parameter is also expected to increase as λ3, where λ is the observed bolometric Eddington ratio of the AGN. Comparing this formula to the observed ξ-λ relationship for Mrk 335 yields h ∝ λ0.5–0.6, supporting the view of a dynamic X-ray corona in AGNs.
The Impact of a Pediatric Shunt Surgery Checklist on Infection Rate at a Single Institution
Authors: Lee Ryan P , Venable Garrett T , Vaughn Brandy N , Lillard Jock C , Oravec Chesney S , Klimo Paul
Published: September 2017

BACKGROUND

Shunt infections remain a significant challenge in pediatric neurosurgery. Numerous surgical checklists have been introduced to reduce infection rates.

OBJECTIVE

To introduce an evidence-based shunt surgery checklist and its impact on our shunt infection rate.

METHODS

Between January 1, 2008 and December 31, 2015, pediatric patients who underwent shunt surgery at our institution were indexed in a prospectively maintained database. All definitive shunt procedures were included. Shunt infection was defined according to the Center for Disease Control and Prevention's National Hospital Safety Network surveillance definition for surgical site infection. Clinical and procedural variables were abstracted per procedure. Infection data were compared for the 4 year before and 4 year after protocol implementation. Compliance was calculated from retrospective review of our checklists.

RESULTS

Over the 8-year study period, 1813 procedures met inclusion criteria with a total of 37 shunt infections (2%). Prechecklist (2008-2011) infection rate was 3.03% (28/924) and decreased to 1.01% (9/889; P = .003) postchecklist (2012-2015), representing an absolute risk reduction of 2.02% and relative risk reduction of 66.6%. One shunt infection was prevented for every 50 times the checklist was used. Those patients who developed an infection after protocol implementation were younger (0.95 years vs 3.40 years (P = .027)), but there were no other clinical or procedural variables, including time to infection, that were significantly different between the cohorts. Average compliance rate among required checklist components was 97% (range 85%-100%).

CONCLUSION

Shunt surgery checklist implementation correlated with lower infection rates that persisted in the 4 years after implementation.
Prioritizing Parental Liberty in Non-medical Vaccine Exemption Policies: A Response to Giubilini, Douglas and Savulescu
Authors: Navin Mark C , Largent Mark A
Published: September 2017

In a recent paper published in this journal, Giubilini, Douglas and Savulescu argue that we have given insufficient weight to the moral importance of fairness in our account of the best policies for non-medical exemptions (NMEs) to childhood immunization requirements. They advocate for a type of policy they call Contribution, according to which parents must contribute to important public health goods before their children can receive NMEs to immunization requirements. In this response, we argue that Giubilini, Douglas and Savulescu give insufficient weight to the moral importance parental liberty in ways that count against their preferred type of NMEs policy and threaten public support for mandatory vaccination laws and public health initiatives generally.
Critical Care Organizations: Business of Critical Care and Value/Performance Building*
Authors: Leung Sharon , Gregg Sara R. , Coopersmith Craig M. , Layon A. Joseph , Oropello John , Brown Daniel R. , Pastores Stephen M. , Kvetan Vladimir
Published: September 2017

Objective:

New, value-based regulations and reimbursement structures are creating historic care management challenges, thinning the margins and threatening the viability of hospitals and health systems. The Society of Critical Care Medicine convened a taskforce of Academic Leaders in Critical Care Medicine on February 22, 2016, during the 45th Critical Care Congress to develop a toolkit drawing on the experience of successful leaders of critical care organizations in North America for advancing critical care organizations (Appendix 1). The goal of this article was to provide a roadmap and call attention to key factors that adult critical care medicine leadership in both academic and nonacademic setting should consider when planning for value-based care.

Design:

Relevant medical literature was accessed through a literature search. Material published by federal health agencies and other specialty organizations was also reviewed. Collaboratively and iteratively, taskforce members corresponded by electronic mail and held monthly conference calls to finalize this report.

Setting:

The business and value/performance critical care organization building section comprised of leaders of critical care organizations with expertise in critical care administration, healthcare management, and clinical practice.

Measurements and Main Results:

Two phases of critical care organizations care integration are described: “horizontal,” within the system and regionalization of care as an initial phase, and “vertical,” with a post-ICU and postacute care continuum as a succeeding phase. The tools required for the clinical and financial transformation are provided, including the essential prerequisites of forming a critical care organization; the manner in which a critical care organization can help manage transformational domains is considered. Lastly, how to achieve organizational health system support for critical care organization implementation is discussed.

Conclusions:

A critical care organization that incorporates functional clinical horizontal and vertical integration for ICU patients and survivors, aligns strategy and operations with those of the parent health system, and encompasses knowledge on finance and risk will be better positioned to succeed in the value-based world.
HIV and contraception
Authors: Fok Wing Kay , Blumenthal Paul D.
Published: September 2017

Purpose of review

Contraception is a vital component of medical care for women with HIV or at high risk of acquiring HIV. Over the last several years, there has been emerging evidence regarding the safety and effectiveness of various contraceptive methods, ultimately leading to a revision in the WHO Medical Eligibility Criteria for contraceptive use.

Recent findings

Progestogen-only injectables may be associated with an increased risk of HIV acquisition and its use has been revised to category 2 from category 1. Etonogestrel and levonorgestrel levels are lower in women who concurrently use contraceptive implant and efavirenz-based antiretroviral therapy. Multipurpose technology, aimed at providing antiretroviral medication and contraception, is an area of ongoing research but is not yet clinically available.

It is important for providers who care for women with HIV or at high risk of HIV to inquire about pregnancy intentions. If contraception is desired, these women should be offered all available methods, with counseling regarding possible risks of contraceptive failure or HIV acquisition.
Descemet Membrane Endothelial Keratoplasty Patch for Persistent Corneal Hydrops
Authors: Tu Elmer Y.
Published: September 2017

Purpose:

To report successful management of a case of persistent keratoconus-related hydrops with a Descemet membrane endothelial keratoplasty (DMEK) patch graft.

Methods:

A case of corneal hydrops persisting for 7 months treated with DMEK was identified. The following information was collected: demographic data, surgical indications, clinical course, diagnostic tests, and clinical outcome.

Results:

A 55-year-old patient with an established diagnosis of keratoconus was followed for 7 months without improvement in his acute corneal hydrops. Because of excellent vision and central corneal clarity, the patient was treated with a 5-mm DMEK covering the Descemet membrane tear, developing cataract secondary to the procedure, but with resolution of his corneal hydrops. An uncorrected visual acuity of 20/25 was achieved after uncomplicated cataract extraction.

Conclusions:

DMEK, although technically challenging, can be considered for patients with persistent hydrops with preservation of corneal clarity and contour in areas of the uninvolved cornea.
Corneal Densitometry in Healthy Corneas and Its Correlation With Endothelial Morphometry
Authors: Tekin Kemal , Sekeroglu Mehmet Ali , Kiziltoprak Hasan , Yilmazbas Pelin
Published: September 2017

Purpose:

To evaluate the correlations between corneal endothelial cell properties and corneal densitometry values and to investigate whether corneal densitometry may be used as an indicator of the health of corneal endothelium.

Methods:

Two hundred fifty-three eyes were analyzed in this prospective cross-sectional study. Corneal densitometry was measured with densitometry software of Pentacam HR-Scheimpflug corneal topography over a 12-mm diameter of the cornea. Furthermore, corneal endothelial cell properties including cell density (CD), average cell area, SD of the cell area, coefficient of variation (CV) of the cell area, maximum cell area, minimum cell area, and percentage of hexagonal cells (HEX) were measured by a specular microscope. The correlations were calculated using Pearson correlation tests.

Results:

The average cell area, SD, maximum cell area, and minimum cell area values were not statistically significantly correlated with the corneal densitometry values in any layer or concentric annulus. CD, CV, and HEX were statistically significantly correlated with the corneal densitometry values in all layers and concentric annuli (P < 0.05 for each one). Moreover, CD and HEX were inversely and moderately correlated with total corneal densitometry (r = −0.403, P < 0.001, and r = −0.327, P < 0.001, respectively), whereas the CV was positively and moderately correlated with total corneal densitometry (r = 0.349, P < 0.001).

Conclusions:

Corneal densitometry might have potential to be used as an indicator of the health of corneal endothelium in the future.
Sinus pericranii in achondroplasia: a case report and review of the literature
Authors: Scott Abbey A. , Hodge Katelyn D. , Torres-Martinez Wilfredo , Dlouhy Stephen R. , Smith Jodi L. , Weaver David D.
Published: September 2017

In the field of dysmorphology, achondroplasia is a well-known disorder. Sinus pericranii (SP), however, is not. The latter condition is a rare vascular malformation characterized by abnormal connections between the intracranial and the extracranial venous drainage pathways. The etiology of SP remains unclear, and yet, these defects can be present at birth, develop spontaneously later, or evolve following head trauma. Here, we report on a 2-year-old male with achondroplasia, SP, and craniocervical junction stenosis. The latter two defects required surgical correction. SP is an underappreciated malformation that we propose may be induced by increased intracranial pressure. This case appears to be the first report of this condition in achondroplasia.
Use of Fully Covered Self‐expanding Metal Biliary Stents in Pediatrics
Authors: Mark Jacob A. , Mack Cara L. , Marwan Ahmed I. , Kramer Robert E.
Published: September 2017

Objectives:

Endoscopic retrograde cholangiopancreatography is used to manage biliary pathology in pediatric patients. Plastic biliary stents have been used in this population for obstructive lesions and bile leaks; however, they are sometimes not effective due to migration, occlusion, or ineffective sealing. Fully covered self‐expanding metal stents (FCSEMS) have larger diameters making them more suitable for some situations. Their use in pediatrics has, however, not been defined. The aim of the present study is to describe our experience with FCSEMS at our institution.

Methods:

We present a series of all patients who underwent FCSEMS placement at Children's Hospital Colorado including 3 adolescents and 1 young adult with complex medical needs.

Results:

Patient age range was 12 to 24 years and the weight ranged between 36 and 75 kg. All patients underwent previous endoscopic retrograde cholangiopancreatography and 1 or more rounds of plastic stenting without adequate clinical response before consideration of FCSEMS placement. Indications included recalcitrant biliary anastomotic stricture after liver transplant, persistent bile leak after needle perforation, recurrent obstructive choledocholithiasis after cholecystectomy, and malignant biliary stricture. Sizes of FCSEMS depended on patient bile duct size and biliary pathology. Dwell time was 6 to 8 weeks. Three patients had resolution of biliary pathology after FCSEMS therapy. One patient had distal migration of FCSEMS necessitating repeat stenting. There were no adverse events from FCSEMS placement or removal.

Conclusions:

FCSEMS therapy should be considered in appropriate pediatric patients when plastic biliary stents are not effective. Further studies are needed to evaluate the safety and efficacy of FCSEMS in the pediatric age group.
Functional Gastrointestinal Disorders and Joint Hypermobility
Authors: Saps Miguel , Blom Puck J.J. , Velasco‐Benitez Carlos A. , Benninga Marc A.
Published: September 2017

The aim of the study was to assess the prevalence of joint hypermobility (JH) among school children with and without functional gastrointestinal disorders (FGIDs). School children completed validated Rome III questionnaires to diagnose FGID. Each child diagnosed with an FGID was matched for age and sex with a healthy control. The prevalence of JH in both groups was compared. A total of 654 school children participated in the study. One hundred forty‐eight (22.6%) children were diagnosed with an FGID. Data from 136 FGIDs and 136 healthy controls were analyzed. Joint laxity was assessed to establish the Beighton score (≥4 was considered JH). There was no significant difference in JH between children with and without diagnoses of FGIDs odds ratio (OR) 1.03 (95% confidence interval [CI]: 0.59–1.81, P = 0.89). Multivariate analysis showed that younger age OR 2.31 (95% CI: 1.30–4.10, P = 0.004) and female sex OR 2.27 (95% CI: 1.22–4.24, P = 0.009) were significantly associated with JH. JH is equally prevalent in school children with and without FGIDs.
Diagnostic Criteria of Pediatric Intestinal Myopathies
Authors: Lombardi Laura , Bruder Elisabeth , Pio Luca , Nozza Paolo , Thai Elena , Lerone Margherita , Del Rossi Carmine , Mattioli Girolamo , Silini Enrico Maria , Paraboschi Irene , Martucciello Giuseppe
Published: September 2017

The authors aim to identify criteria for the diagnosis of intestinal visceral myopathy (IVM); results were compared with ultrastructural studies. Six IVM patients and 7 pediatric control cases (without gastrointestinal diseases) were studied. One case was a typical megacystis‐microcolon‐intestinal hypoperistalsis syndrome. The diagnostic path included: rectal suction biopsy, one‐trocar transumbilical laparoscopic intestinal full‐thickness biopsy technique. Pathological analysis included anti‐alpha smooth muscle actin staining, and US study of intestinal biopsies. IVM histological examination demonstrated thinning of longitudinal muscle layer. The ratio of circular/longitudinal thickness was evaluated in all samples; in cases, this ratio presented as a mean value of 2.91, and in controls, a mean value of 1.472 (P = 0.0002). Ultrastructural diagnosis revealed variable myofibrils density in smooth muscle cells, irregularity of sarcolemma membranes, interstitial fibrosis, and myofiber disarray. The authors concluded that in IVM, circular/longitudinal thickness ratio and alpha smooth muscle actin staining can be used as significant tools to address the diagnosis.
Comparison of Different Iron Preparations in the Prophylaxis of Iron-deficiency Anemia
Authors: Aydin Ali , Gur Emel , Erener-Ercan Tugba , Can Gunay , Arvas Ahmet
Published: September 2017

We compared the efficacy of ferrous sulfate (divalent) and ferric polymaltose (trivalent) compounds for the prophylaxis of iron-deficiency anemia (IDA). Study infants included exclusively breast milk-fed term infants. Subjects were divided randomly into 2 groups at 4 months of age and group 1 (n=56) received divalent and group 2 (n=56) received trivalent iron (Fe) preparation at a dose of 2 mg/kg/d for 5 months. At 9 months of age, after a 5-month prophylaxis, a significant increase was observed in hemoglobin (Hb), hematocrit, serum Fe levels, and transferrin saturation in both groups. However, group 1 had significantly higher Hb, hematocrit, mean corpuscular volume, Fe, and transferrin saturation than group 2 (11.7±0.6 g/dL, 34.6%±1.7%, 76.2±2.9 fL, 55.5±1.8 mcg, 20.8±3.9 g/L, respectively in group 1 vs. 11.3±0.5 g/dL, 33.5%±1.5%, 74.7±3.2 fL, 42.5±1.8 mcg, 14.1±7.5 g/L, respectively in group 2). No significant difference was found in ferritin values between the groups. Fe deficiency was found in 17 (30.3%) of the subjects in group 1, and 23 (41%) of subjects in group 2 whereas 5 (8.9%) subjects had IDA in group 1 and 12 (12%) in group 2 which were insignificant between groups. No significant difference was found with regard to side effects between 2 Fe preparations. Although divalent Fe therapy led to a higher Hb and serum Fe level, both ferrous and ferric Fe preparations were effective for prophylactic use in the prevention of Fe deficiency and IDA with comparable side effects.
When Fever, Leukocytosis, and Right Lower Quadrant Pain Is Not Appendicitis
Authors: Kurbedin Jeanette , Haines Lawrence , Levine Marla C. , Dickman Eitan
Published: September 2017

Mesenteric cystic lymphangioma (MCL) is an uncommon, benign, slow-growing abdominal tumor that is derived from the lymphatic vessels (World J Gastroenterol. 2012;18:6328–6332, Radiographics. 1994;14:729–737). It is most often diagnosed in the head and neck of affected children. Rarely, a lymphangioma can develop within the small bowel (Pan Afr Med J. 2012;12:7). The clinical presentation of patients with an abdominal MCL can range from asymptomatic to acute abdominal pain (J Korean Surg Soc. 2012;83:102–106). We report a case of small bowel volvulus caused by an MCL in a 3-year-old child who presented to the pediatric emergency department with right lower quadrant pain. The child was thought to have a perforated appendicitis and was taken to the operating room where an MCL was identified and resected. This case illustrates the need to consider MCL when a patient presents to the emergency department with right lower quadrant pain.
Do User-Applied Safety Labels on Medication Syringes Reduce the Incidence of Medication Errors During Rapid Medical Response Intervention for Deteriorating Patients in Wards? A Systematic Search and Review
Authors: Mikhail John , Grantham Hugh , King Lindy
Published: September 2017

Introduction

Intravenous medication errors (MEs) occur during medical emergency situations. An initiative, not yet in common practice, that could address these errors is safety labeling. The aim of this review was to identify and appraise research evidence related to the impact of user-applied medication safety labeling on reducing the incidence of MEs during rapid medical response intervention for patient deterioration in the ward setting.

Methods

A systematic search and review framework was used to conduct the review. A comprehensive database search was conducted of BioMed Central, Clinical Trials, Cumulative Index to Nursing and Allied Health Literature, Expanded Academic ASAP, Joanna Briggs Institute, MEDLINE, OVID, ProQuest Central, PubMed, Wiley Online Library, and World Health Organization Library. The Young and Solomon (2009) critical appraisal tool was used to critically appraise the identified research articles. Each article was then analyzed using a thematic network strategy to identify commonality.

Results

Four primary themes were identified; they were as follows: MEs occur during medical emergency responses (MERs); MEs occur throughout the medication administration process; MERs are stressful and are associated with MEs; and role of medication labeling in reducing MEs during MERs.

Discussion

Greater vigilance is required by health professionals during the medication administration process. The implementation of specific medication safety labeling into the MER could be beneficial in reducing the overall incidence of MEs. Further research is required to validate the merits of a MER medication safety labeling system.
Hybrid SPECT/CT Helps Characterization and Localization of a Dual Thyroid Ectopia
Authors: Abdelhafez Yasser , Khalil Maha , Roshdy Esraa , Diab Waleed A. , Eltoni Lobna
Published: September 2017

The presence of ectopic thyroid tissue in 2 or more different sites is rare. A 12-year-old girl presented with midline anterior neck swelling in the infrahyoid region with subclinical hypothyroidism. Thyroid scanning with 99mTc-pertechnetate was performed, and SPECT/CT was ordered for further evaluation. Two hyperdense lesions demonstrating intense radiotracer uptake were seen in the midline at the base of the tongue and infrahyoid neck. We emphasis the role of hybrid SPECT/CT for characterization and localization of suspected ectopic thyroid tissue.
18F-FDG PET/CT Imaging of Tracheal Mucoepidermoid Carcinoma
Authors: Jiang Lei , Huang Yan , Huang Shanshan , Li Qiang , Wang Huoqiang
Published: September 2017

A 54-year-old woman presented with dry cough for 3 months. An FDG PET/CT was performed to evaluate a tracheal nodule, which was revealed by chest CT. The PET/CT images showed increased FDG uptake with SUVmax of 3.3 in the known tracheal lesion. The results of pathological examination from the specimen of bronchoscopy were consistent with tracheal mucoepidermoid carcinoma.
Sodium Thiosulfate in the Treatment of Lung and Breast Calciphylaxis
Authors: Shen Guohua , Huang Rui , Liu Bin , Kuang Anren
Published: September 2017

A 19-year-old woman, with normal kidney function, was diagnosed as having visceral calciphylaxis, especially diffuse breast and lung calcification. The calcification findings were clearly shown on CT, and bone scintigraphy revealed diffuse uptake in the thoracic area. Although there was no standard therapeutic approach for this clinical setting, the patient received empiric therapy with sodium thiosulfate. After 5 months of consecutive therapy, the calcification condition had a striking regression.
Myoepithelioma of the Nasal Septum
Authors: Kim Seo Bin , Kwon Jae Hwan
Published: September 2017

Myoepithelioma is defined as myoepithelial cells composed of tumor with solid, myxoid, and reticular growth pattern by the World Health Organization. It is a rare neoplasm that arises in the major salivary gland or minor salivary gland comprising approximately 1% of all salivary gland tumor. This neoplasm occurs in the parotid gland and soft palate mostly, which can be found in other organs. However, up to now, myoepithelioma of nasal septum has not been reported in English medical literature. Histologically, it is grouped as spindle, epitheliod, reticular, and clear cell types. Spindle cell type is the most common. In this case, a 40-year-old woman presented with complaining of nasal stuffiness and accidentally found right nasal cavity mass. Endoscopic surgery for excision of the mass was performed under local anesthesia, which was confirmed as myoepithelioma. After surgery, the patient's symptom was disappeared and there has not been sign of recurrence for 6 months. We present a rare patient of myoepithelioma of the nasal septum with review of relevant literature.
Lingual Short Split: A Bilateral Sagittal Split Osteotomy Technique Modification
Authors: Sant’Ana Eduardo , Souza Denis Pimenta e , Temprano Astrid Buysse , Shinohara Elio H. , Faria Paulo Esteves Pinto
Published: September 2017

The technique of sagittal split osteotomy of the mandibular ramus is an established technique that has been evolving over the years, with significant improvements regarding stability, better bone contact between the segments, and possibilities of osteosynthesis. However, paresthesia is common in the postoperatory, sometimes permanent, and undesirable fractures in the subcondylar region can occur leading to longer operative time and extraoral scars. The short lingual split technique is an easy technique that simplifies the horizontal osteotomy of the ramus and decreases the risk of undesirable fractures with a neurosensitive recovery of patients in a much shorter time because of minor trauma and nerve manipulation during the execution.
Efficacy of Facilitated Capacity Building in Providing Cleft Lip and Palate Care in Low- and Middle-Income Countries
Authors: Jenny Hillary E. , Massenburg Benjamin B. , Saluja Saurabh , Meara John G. , Shrime Mark G. , Alonso Nivaldo
Published: September 2017

Providing surgical repair for congenital anomalies such as cleft lip and palate (CLP) can be challenging in low- and middle-income countries. One nonprofit organization seeks to address this need through a partnership model. This model provides long-term aid on multiple levels: surgeon and healthcare provider education, community outreach, and funding. The authors examined the effectiveness of this partnership model in providing CLP care and increasing cleft care capacity over time. This organization maintains data on each partner and procedure and collected data on hospital and patient characteristics through voluntary partner surveys from 2010 to 2014. Effectiveness of care provision outcomes included number of surgeries/partner hospital and patient demographics. Cleft surgical system strengthening was measured by the complexity of repair, waitlist length, and patient follow-up. From 2001 to 2014, the number of procedures/hospital/year grew from 15 to 109, and frequency of alveolar bone grafts increased from 1% to 3.4%. In addition, 97.9% of partners reported that half to most patients come from rural areas. Waitlists decreased, with 9.2% of partners reporting a waitlist of ≥50 in 2011 versus 2.7% in 2014 (P < 0.001). Patient follow-up also improved: 35% of partners in 2011 estimated a follow-up rate of ≥75%, compared with 51% of partners in 2014 (P < 0.001). The increased number of procedures/hospital/year supports the partnership model's effectiveness in providing CLP care. In addition, data supports cleft surgical system strengthening—more repairs use alveolar bone grafts, waitlists decreased, and follow-up improved. These findings demonstrate that the partnership model may be effective in providing cleft care and increasing cleft surgical capacity.
An Aneurysmal Bone Cyst in the Skull Base
Authors: Kim Sangjun , Jung Dong Won , Pak Min Gyoung , Song Young Jin , Bae Woo Yong
Published: September 2017

An aneurysmal bone cyst (ABC) is believed to be attributable to intraosseous circulatory disturbance. An ABC is a vascular tumor of the bone caused by bony expansion after partial vascular occlusion and congestion. Most ABCs are found in adolescents (approximately 75% of ABCs are observed in patients under 20 years of age). The most common ABC sites are the long bones of the limbs, the vertebrae, and the cranial bone. Aneurysmal bone cysts in the skull base or ethmoid sinus have been but rarely reported worldwide. The authors report on a patient with a very large ABC in the skull base and the ethmoid sinus; this was successfully managed by a neurosurgeon.