bluuebunny/crossref_metadata_2025 huggingface dataset:
Track-Change Diplomacy: Technology, Affordances, and the Practice of International Negotiations
Authors: Adler-Nissen Rebecca , Drieschova Alena
Published: June 2019

How does technology influence international negotiations? This article explores “track-change diplomacy,” that is, how diplomats use information and communication technology (ICT) such as word processing software and mobile devices to collaboratively edit and negotiate documents. To analyze the widespread but understudied phenomenon of track-change diplomacy, the article adopts a practice-oriented approach to technology, developing the concept of affordance: the way a tool or technology simultaneously enables and constrains the tasks users can possibly perform with it. The article shows how digital ICT affords shareability, visualization, and immediacy of information, thus shaping the temporality and power dynamics of international negotiations. These three affordances have significant consequences for how states construct and promote national interests; how diplomats reach compromises among a large number of states (as text edits in collective drafting exercises); and how power plays out in international negotiations. Drawing on ethnographic methods, including participant observation of negotiations between the European Union's member states, as well as in-depth interviews, the analysis casts new light on these negotiations, where documents become the site of both semantic and political struggle. Rather than delivering on the technology's promise of keeping track and reinforcing national oversight in negotiations, we argue that track-change diplomacy can in fact lead to a loss of control, challenging existing understandings of diplomacy.
Competitive Intervention, Protracted Conflict, and the Global Prevalence of Civil War
Authors: Anderson Noel
Published: June 2019

This article develops a theory of competitive intervention in civil war to explain variation in the global prevalence of intrastate conflict. I describe the distortionary effects competitive interventions have on domestic bargaining processes and explain the unique strategic dilemmas they entail for third-party interveners. The theory uncovers the conditional nature of intervention under the shadow of inadvertent escalation and moves beyond popular anecdotes about “proxy wars” by deriving theoretically grounded propositions about the strategic logics motivating intervener behaviors. I then link temporal variation in patterns of competitive intervention to recent decreases in the prevalence and average duration of internal conflicts. The theory is tested with a quantitative analysis of all civil wars fought between 1975 and 2009 and a qualitative case study of the Angolan civil war (1975–1991). My results underscore the importance of a generalizable account of competitive intervention that not only explains past conflicts, but also informs contemporary policy.
Optimized meropenem dosage regimens using a pharmacokinetic/pharmacodynamic population approach in patients undergoing continuous venovenous haemodiafiltration with high-adsorbent membrane
Authors: Padullés Zamora A , Juvany Roig R , Leiva Badosa E , Sabater Riera J , Pérez Fernández X L , Cárdenas Campos P , Rigo Bonin R , Alía Ramos P , Tubau Quintano F , Sospedra Martinez E , Colom Codina H
Published: June 2019

Background

The pharmacokinetics (PK) of antibiotics change during sepsis and continuous renal replacement therapies in critically ill patients. Limited evidence exists on the use of the oXiris® high-adsorbent membrane.

Objectives

To develop a PK/pharmacodynamic (PD) model for meropenem in critically ill sepsis patients undergoing continuous venovenous haemodiafiltration (CVVHDF) with the oXiris® membrane, and to design an optimal dosing regimen assessed according to the PTA.

Methods

A prospective, open-label, observational PK trial was performed (EUDRACT 2011-005902-30). We conducted PK studies (plasma and ultrafiltrate) for at least 24 h after concomitant administration of CVVHDF and meropenem 1 g q8h. We constructed a PK model using the non-linear mixed-effects approach (NONMEM 7.3). We evaluated the suitability of different dosage regimens using Monte Carlo simulations and calculated the PTA as the percentage of subjects achieving a given percentage of time above the MIC (fT>MIC).

Results

The PK of meropenem was best captured by a two-open-compartment model with zero-order input kinetics and first-order elimination. Extracorporeal CL was 7.78 L/h [relative standard error (RSE) 16.45 L/h] and central compartment V (Vc) was 24.9 L (RSE 13.73 L). Simulations showed that, for susceptible Pseudomonas aeruginosa isolates (EUCAST MIC ≤2 mg/L) and attainment of 100%fT>MIC, 500 mg q8h given as extended (EI) or continuous infusion (CI) would be sufficient. For a target of 100%fT>4×MIC, CI of 3000 mg q24h or 2000 mg q8h administered as EI or CI would be required.

Conclusions

We have constructed a PK model of meropenem in sepsis patients undergoing CVVHDF using the oXiris® membrane. This tool will support physicians when calculating the optimal initial dose.
Navigation bronchoscopy: A new tool for pulmonary infections
Authors: Ashraf Syed Faaz , Lau Kelvin K W
Published: June 2019

Infections remain a common cause of lung nodules, masses, and cavities. Safe tissue sampling is required to establish a diagnosis, differentiate between malignant and infectious causes, and provide microbiological material for characterization and sensitivity analysis. Tissue samples could be obtained bronchoscopically, percutaneously, or through surgical biopsy. Among these, bronchoscopy is the safest by avoiding the complications of pleural and chest wall puncture including pneumothorax, pain, pleural contamination and empyema, and hemothorax. However, the diagnostic yield with conventional bronchoscopy for small, peripheral lesions is poor. Electromagnetic navigation bronchoscopy (ENB) is a technique where the bronchoscope and working channel are guided through the bronchial tree to accurately reach a peripheral lesion. It dramatically improves on the diagnostic yield of peripheral lesions especially of small lesions, and its role has developed beyond diagnosis to treatment enablement and to direct therapy. Its role in infection is less defined, but it has value especially in the diagnosis of fungal and mycobacterial infections and in cavitating lesions. This review will explore what electromagnetic navigation bronchoscopy is, its use in diagnosis and therapy, and its role in the management of pulmonary infections. The potential for local therapy delivery for infection is also discussed.
Being Part of Something Bigger Than Ourselves
Authors: Blustein David L.
Published: June 2019

This chapter explores the ways in which work provides people with a sense of contributing to the broader social and economic well-being of a community. Initially, a review of the experience of social contribution and prosocial behavior at work is provided. This is followed by vignettes from the Boston College Working Project participants, whose insights into the ways that meaning and mattering, direct and indirect social contribution, and deriving meaning from impacting others explicated the depth and nuance of striving to be part of something bigger than ourselves. The chapter concludes with a review of work as a calling and job crafting, as well as implications for policy about work.
Being Motivated and Being the Best We Can Be
Authors: Blustein David L.
Published: June 2019

This chapter explores the role of motivation in contemporary work. Beginning with an overview of motivation in the recent history of working, the role of the Hawthorne effect and contributions on flow provide a contrasting view of both extrinsic and intrinsic motivation. The narrative excerpts from the participants of the Boston College Working Project identified the role of creating and accomplishing, intrinsic and extrinsic motivation, personal attributes related to motivation, relationships and motivation, and the role of competition in motivation. The chapter concludes with a review of promising new directions in motivation, including self-determination and organizational justice, culminating in a discussion of how work-based policies need to support and nurture our natural striving to accomplish and do well at work.
Foundations
Authors: Budasz Rogério
Published: June 2019

This chapter examines the conventions of Iberian theater with music from the mid-sixteenth to the early eighteenth century, as they surface in written sources and theatrical practices primarily related to Brazilian contexts. It presents an overview of the main theatrical genres, character types, and standard plots and the basic structure of theatrical functions, as well as the role of music in Jesuit autos and tragédias, religious oratorios, and secular comédias and entremezes. The chapter discusses the pedagogical function of musical theater in the early colonial period and the use of Latin, Spanish, Portuguese, and indigenous languages in these plays. It also examines the work of Brazil-born aficionados and playwrights in Europe and their role in the development of music-dramatic arts in Brazil and abroad.
The Group Experience in Camping
Authors: Schwartz William , Shulman Lawrence
Published: June 2019

“The Group Experience in Camping: Observations from Schwartz and Shulman” pairs an April 1960 article by social worker William Schwartz with commentary by Lawrence Shulman, who has continued to enhance Schwartz’s Mutual Aid or Interactional model of group work. Schwartz explores some factors inherent in the resident camp setting as a unique group experience: the compressed time frame, the rapid demand for intimacy, being away from home and “insulated” from the outside world. All these aspects produce intense cabin-group interaction. Schwartz discusses several implications related to the camp milieu that impact the individual camper. Shulman introduces the article by providing a snapshot of Schwartz’s perspective and follows the article with an analysis proposing that Schwartz’s 1960 article represents a way-station en route to the model he elaborated in 1961.
Urban Growth Machines—But at What Scale?
Authors: Brenner Neil
Published: June 2019

Theories of the urban growth machine have long been a central analytical tool for contemporary research on urban governance. But in what sense are growth machines, in fact, “urban”? To what degree must “the city” serve as the spatial locus for growth machine strategies? To address such questions, this chapter critically evaluates the influential work of urban sociologists John Logan and Harvey Molotch on US growth machine dynamics. In contrast to an influential line of critique that reproaches these authors for their putative methodological localism, it is argued that their framework is, in fact, explicitly attuned to the role of interscalar politico-institutional relays in the construction of urban growth machines. These considerations lead to a dynamically multiscalar reading of the national institutional frameworks that have facilitated the formation of growth machines at the urban scale during the course of US territorial development. This analysis has broad methodological implications for the comparative-historical investigation of urban governance.
Introduction to Teaching Piano Pedagogy
Authors: Crappell Courtney
Published: June 2019

The introduction offers an overview of the book’s central themes and provides guidance to readers about how to approach it in the most productive way. It begins by presenting the educational philosophy that forms the basis for the book’s content. In brief, the central principle of this philosophy is that learning comes from within, not from without. After outlining the purpose and methodology, the introduction also describes the book’s intended audience. Since it appeals to readers with various backgrounds and training, the introduction also serves to provide guidance for how readers might choose to explore the text. It concludes with an overview of the book’s organization, which includes the introduction and ten chapters.
Occupying Schools, Occupying Land
Authors: Tarlau Rebecca
Published: June 2019

Contrary to the conventional belief that social movements cannot engage the state without becoming co-opted and demobilized, this study shows how movements can advance their struggles by strategically working with, in, through, and outside of state institutions. The success of Brazil’s Landless Workers Movement (MST) in occupying land, winning land rights, and developing alternative economic enterprises for over a million landless workers has made it an inspiration for progressive organizations globally. The MST’s educational initiatives, which are less well known but equally as important, teach students about participatory democracy, collective work, agroecological farming, and other practices that support its socialist vision. This study details how MST activists have pressured municipalities, states, and the federal government to implement their educational proposal in public schools and universities, affecting hundreds of thousands of students. Based on twenty months of ethnographic fieldwork, Occupying Schools, Occupying Land documents the potentials, constraints, failures, and contradictions of the MST’s educational struggle. A major lesson is that participating in the contentious co-governance of public education can help movements recruit new activists, diversify their membership, increase practical and technical knowledge, and garner political power. Activists are most effective when combining disruption, persuasion, negotiation, and co-governance into their tactical repertoires. Through expansive leadership development, the MST implemented its educational program in local schools, even under conservative governments. Such gains demonstrate the potential of schools as sites for activists to prefigure, enact, and develop the social and economic practices they hope to use in the future.
The Problem
Authors: Buzsáki György
Published: June 2019

This chapter reviews how empiricist philosophy shaped the dominant outside-in thinking in neuroscience that gave rise to the perception-decision-action framework. In contrast, the inside-out framework takes action as the primary source of knowledge. Action validates the meaning and significance of sensory signals by providing a second opinion. The chapter also compares the relationship between “blank slate” and preconfigured brain models. It describes the brain as a sort of “dictionary” with preexisting internal dynamics and syntactical rules, filled initially with nonsense neuronal words. These nonsense words acquire significance for the animal through exploratory action and represent a distinct event or situation. Preconfigured neuronal networks can generalize and provides fast and “good-enough” solutions under many situations, while detailed and precise computation mobilizes a large fraction of brain resources.
Internally Organized Cell Assembly Trajectories
Authors: Buzsáki György
Published: June 2019

Sequences of neuronal patterns are not always imposed on brain circuits in an outside-in manner by the sensory inputs. Internally organized processes can sustain self-organized and coordinated neuronal activity even without external inputs. A prerequisite of cognition is the availability of internally generated neuronal sentences. Self-generated, sequentially evolving activity is the default state of affairs in most neuronal circuits. Neuronal activity moves perpetually, and its trajectory depends only on initial conditions. Large recurrent networks can generate an enormous number of trajectories without prior experience. On the other hand, each is available to be matched by experience to “represent” something useful for the downstream reader mechanisms. The richness of the information depends not on the numbers of generated sequences but on the reader mechanisms. It is typically the reader structure that initiates the transfer of information, coordinating the onset of messages from multiple senders.
The Brain’s Best Guess
Authors: Buzsáki György
Published: June 2019

In this final chapter, I propose that behavior-based calibration of perceptions and abstract representations are constrained by a preconfigured brain. The nervous system may have evolved to mimic the statistical probabilities of the physical world and the behavior of already existing species and thus become an efficient predictor of events. Because of their high diversity, neurophysiological and perceptual brain dynamics, both spanning several orders of magnitude, share a common mathematical foundation: the log rule. The tails of these wide and skewed distributions have apparently distinct qualitative features that we describe by discrete words, such as familiar and novel, rigid and plastic, good-enough and precise. Yet every novel situation contains elements of familiarity. Brain correlates of newly acquired experience are not created in the sense of adding new neuronal words to an ever-expanding vocabulary. Instead, the preconfigured brain is a dictionary in which the behavioral significance or meaning of initially nonsense neuronal words is acquired through exploration.
Introduction
Authors: Antonello Alessandro
Published: June 2019

This introduction situates this book within the fields of Antarctic, environmental, and international history. It poses the central question of the book: How did Antarctica transform from a cold, abiotic, and sterile wilderness into a fragile environment and ecosystem demanding international protection and management? It outlines how both parties to the Antarctic Treaty and scientists have sought order, stability, power, and authority in geopolitical, institutional, conceptual, and epistemic realms. It argues for reading international treaties as complex texts that articulate and shape human-environment relationships. It further argues for an approach to international environmental history that balances understanding the material reality of the physical environment with a range of imaginative and conceptual understandings of it. The chapter provides a concise guide to the development of Antarctic geopolitics after 1945, as well as a gloss of the Antarctic Treaty.
The Plenitude of Nature and Sovereignty
Authors: Antonello Alessandro
Published: June 2019

This chapter investigates how the foundational tension of Antarctic geopolitics over sovereignty and territory fared in the context of discussions on mineral and marine living resources in the 1970s. It investigates how the Antarctic Treaty parties fought off concerted interests from forums and states outside the treaty, including the Non-Aligned Movement within the United Nations Conference on the Law of the Sea and the Food and Agriculture Organization, and growing international environmentalist organizations. It also investigates how the Antarctic Treaty parties tried to shift the balance of power among themselves, especially between the claimant and nonclaimant states. In the end, the Antarctic Treaty parties as a whole secured the treaty from outside forces, and the claimant states successfully perpetuated their ideas about sovereignty and territory in the changing context of the UN Law of the Sea against the acquiescent nonclaimants.
Introduction
Authors: Wempe Sean Andrew
Published: June 2019

The introduction outlines the core focus of the book, the Kolonialdeutsche (Colonial Germans): officials and settlers who had invested substantial time and money in German imperialism. The book will examine the difficulties this diverse group of men and women encountered adjusting to their new circumstances, in Weimar Germany or in the new mandates, as they situated their notions of group identity between colonizers and colonial subjects in a world of empires that were not their own. The introduction outlines the temporal scope of the book, starting with the Treaty of Versailles and ending the in-depth analysis in 1933. The epilogue looks into the Nazi era and beyond. The author highlights the importance of Colonial German involvement in such diplomatic flashpoints as the Naturalization Controversy in South African-administered Southwest Africa, and German participation in the Permanent Mandates Commission (PMC) from 1927 to 1933, and the participation of one of Germany’s former colonial governors in the League of Nations’ commission sent to assess the Manchurian Crisis between China and Japan. The introduction also illustrates the contributions this book makes: revising standard historical portrayals of the League of Nations’ form of international governance, German participation in the League, the role of interest groups in international diplomacy, and liberal imperialism. In analyzing Colonial German investment and participation in interwar internationalism, the book also challenges the idea of a direct continuity between Germany’s colonial period and the Nazi era.
From Unfit Imperialists to Fellow Civilizers
Authors: Wempe Sean Andrew
Published: June 2019

During the tenure of the League’s mandates system, several former German colonial officials rose to prominence in the League of Nations as “imperial experts.” The involvement of German colonial officials in League agencies and events suggests that although no longer part of an imperial power and officially ostracized from the “work of civilization,” Germans remained adaptive contributors to international discourses on empire. In order to determine how individual Germans and lobbying interests were able to make use of the spirit of internationalism to minimize their association with “unfit imperialists” and re-establish themselves as “fellow civilizers,” this chapter focuses on the interwar careers and interactions of two colonial officials, Dr. Ludwig Kastl and Dr. Julius Ruppel—former bureaucrats who had served in the African colonies, each of whom became German members on the PMC.
Handling Ultra-Radicals
Authors: Mironova Vera
Published: June 2019

Ideology is a strong weapon, but it could work against the group itself. Adopting strict rules grounded in ideology could help screen out undedicated people from a group, but it could not control the upper bar of dedication. Therefore, a group that portrays itself as ideological could be attractive to recruits more interested in the ideology than in the actual goal of the group. In other words, these recruits may be more radical than the group wants its fighters to be. Counterintuitively, this represents a major vulnerability for a group that claims to be ideological. In fact, it is even more dangerous for the group than not controlling the lower bar and letting undedicated members in. Such recruits waste a group’s resources (they draw a paycheck but are not interested in fighting) and could lead to internal conflicts.
Policy Implications
Authors: Mironova Vera
Published: June 2019

Although today’s civil conflicts are very different from those of previous generations, it is not a foregone conclusion that today’s Western-affiliated rebel groups will suffer defeat. While with any new conflict the task becomes more and more difficult, it is still possible to outcompete other groups in the rebel bloc, at least right now. On the other hand, it is hard to imagine a victory of a Western-oriented, startup armed group without significant outside support, because they lack experience and resources. At the same time, international actors with a different agenda also don’t want to miss a chance to use their money, experience, and knowledge to increase their sphere of influence through proxy groups in war-torn countries. That, in sum, makes this generation’s civil wars a highly competitive market for outside supporters. I this chapter the author discusses how this knowledge can be used to terminate a conflict more quickly by making foreign government intervention more effective—in particular, how a foreign actor could (1) choose a group in the rebel bloc to support; (2) persuade the group to accept support; and (3) provide the proper help at the right time in order to empower one group at the expense of others within the rebel camp.
Career Paths that Twist and Turn
Authors: Ladge Jamie , Greenberg Danna
Published: June 2019

Chapter 7 moves beyond workplace flexibility to consider career flexibility, which refers to the varied career choices working mothers make as they pursue their work/life path. We begin by introducing a more expansive view of career beyond the traditional career ladder. This holistic career model encompasses work, family, and community interests and activity. This career metaphor more accurately fits the reality of today’s workplace for men and women. It also gives working mothers authority to consider something beyond the next promotion as they construct their careers. We then go into more depth on two of the more prominent twists working mothers make: taking time off from paid work and starting their own business. We focus on the tactics working mothers can use to ensure that these options fit with their work/family interests.
Twofold Righteousness in Early Lutheranism
Authors: Grobien Gifford A.
Published: June 2019

This chapter explains justification and the two kinds of righteousness among early Lutherans. The Lutheran Confessions speak of justification as both forensic and regenerative. Forgiveness on account of Christ is proclaimed to hearers, and in that proclamation faith is created to receive the forgiveness as it is announced. Faith is no power or quality in itself, but receives the merits of Christ. Thus, Christ himself gives form to faith. Christ’s merits forgive through imputation and regenerate to new spiritual life. In this new life and its accompanying qualities, a Christian is empowered to act righteously. This imputed and imparted righteousness is commonly called the two kinds of righteousness, taught by Luther at various points both early and later in his career. This conception of two kinds of righteousness suggests that ethical progress—the growth of the regenerate life—develops out of forensic justification, and is compatible with it
The Oxford Gothic Grammar
Authors: Miller D. Gary
Published: June 2019

This reference grammar of Gothic includes much history along with a description of Gothic grammar. Apart from runic inscriptions, Gothic is the earliest attested language of the Germanic family in Indo-European. Specifically, it is East Germanic. Most of the extant Gothic corpus is a 4th-century translation of the Bible, traditionally ascribed to Wulfila. This translation is historically important because it antedates Jerome’s Latin Vulgate. Gothic inflectional categories include nouns, adjectives, and verbs. Nouns are inflected for three genders, two numbers, and four cases. Adjectives also have weak and strong forms, as do verbs. Verbs are inflected for three persons and numbers, indicative and nonindicative mood (here called optative), past and nonpast tense, and voice. The mediopassive survives as a synthetic passive and syntactically in innovated periphrastic formations. Middle and anticausative functions were taken over by simple reflexive structures. Nonfinite are the infinitive, the imperative, and two participles. Gothic was a null subject language. Aspect was effected primarily by prefixes, relativization by relative pronouns built on demonstratives plus a complementizer. Complementizers were the norm with subordinated verbs in the indicative or optative. Switch to the optative was triggered by irrealis (the unreal), matrix verbs that do not permit a full range of subordinate tenses (e.g. hopes, wishes), potentiality, and alternate worlds. Many of these are also relevant to matrix clauses (independent optatives). Essentials of linearization include prepositional phrases, default postposed genitives and possessive adjectives, and preposed demonstratives. Verb-object order predominates, but there is considerable variation. Verb-auxiliary order is native Gothic.
Geography of Subterranean Biodiversity
Authors: Culver David C. , Pipan Tanja
Published: June 2019

Globally, for troglobionts, southern Europe, especially the Dinaric karst, and the Canary Islands are regions of high richness. For stygobionts, southern Europe, especially the Dinaric karst, is a hotspot. Other sites are typically chemoautotrophic and/or phreatic. In Europe and North America, there appears to be a ridge of high troglobiotic and stygobiotic diversity in southern Europe and the southeast United States that corresponds to an area of long-term high surface productivity. In Europe, local diversity is a small component of regional stygobiotic diversity and the importance of spatial heterogeneity, historical climate stability, and productivity are both scale and spatially dependent. Habitat availability seems especially important at smaller scales. The analogy with islands in ecological time is most appropriate at scales smaller than caves, such as seeps or epikarst drips, and the analogy with caves in evolutionary time is more appropriate at larger scales, such as karst basins or contiguous karst areas.
Digesting Decolonization
Authors: O’Leary Brendan
Published: June 2019

This chapter examines how and when the Irish Free State went from partial to full political decolonization. It argues that Collins’s stepping-stone theory of the Treaty of 1921 would be proved correct, but that de Valéra and Childers and their allies also correctly observed the deficiencies of that treaty. The fate of southern Protestants is examined. The wilder allegations of genocide and ethnic expulsion are demonstrated to be without merit; their twentieth-century story is mostly one of integration and assimilation. Fianna Fáil’s program of constitutional transformation is traced and its significance for Northern Ireland evaluated. The Irish Free State’s state-building and consolidation of its sovereignty were diplomatic accomplishments of both Cumann na nGaedheal and Fianna Fáil governments. The program of Irish state-building clashed with the aspirations behind all-Ireland nation-building. The “economic war” of the 1930s and the Anglo-Irish Agreements of 1938 are surveyed, before the decisions of de Valéra’s cabinet regarding neutrality in the Second World War and the supposed British offer of reunification are interpreted for their long-run significance for Northern Ireland.
Metaphysical Rationalism
Authors: Lin Martin
Published: June 2019

This chapter explores the meaning of Spinoza’s Principle of Sufficient Reason (the PSR) and the role it plays in his system. Some commentators have argued that Spinoza’s PSR applies to every truth and that Spinoza relies on it in deriving a great deal of his system. Against such interpretations, this chapter argues that Spinoza’s PSR is restricted to existential truths and is applied only once by Spinoza, to the case of the existence of God. In making this case, it considers Spinoza’s arguments for necessitarianism, causal and conceptual dependence, and the identity of indiscernibles, and it concludes that none of them rely on the PSR. It further argues that the limited scope of Spinoza’s PSR is a philosophical advantage because a fully unrestricted PSR is an unattractive doctrine that creates demands for explanation that cannot be met.
Disability Rights at a Crossroads
Authors: Jain Sanjay
Published: June 2019

The primary objective of this chapter is to advance claim for the recognition of new category in public law, physical and mental disability. While making the phenomenon of public law exclusion of persons with disability a structural issue, it argues for the inclusion of persons with disability in constitutional discourse and recognition of physical and mental disability as one of the distinct fields of public law. The crux of the arguments advanced in this chapter is the emphasis on physical and mental disability as a legitimate difference and variation in the human body rather than a deviation from the mainstream Anthropos.
Ageing, Stigma, and Disgust
Authors: Nussbaum Martha C.
Published: June 2019

The category of age is the only category of discrimination that includes all human beings—if they live long enough. With other categories—racial, caste-based, ethno-religious, gender-based, sexual, and disability-based, the dominant group can view itself as immune from the traits it imputes to the group targeted for discrimination. Because age and its signs are associated with death, this condition is regarded with particular fear and with a disgust closely linked to fear. It is thus no surprise that one of the most tenacious types of prejudice in all societies is prejudice against people who are aging. They are stigmatized in popular culture and discourse, and very often law gives sanction to those forms of stigma. The bodies of aging people remind younger people of their own frailty and mortality, and popular discourse portrays those bodies as incompetent, unattractive, even revolting. Moreover, even ageing people themselves often come to feel disgust with their own bodies, as new research proposes. This stigma is itself a social problem, producing much unhappiness, and it leads to various forms of injustice, such as discrimination against aging people in employment and in informal social interactions, not to mention the huge social evil of compulsory retirement. Age may well be the new issue for our time, since discrimination on the basis of age deprives all societies of valuable human capital. After situating this case in the context of my theory of disgust and stigma, I focus on the special aspects of this case.
Phylogenetic analysis of the Baikalodrilus species flock (Annelida: Clitellata: Naididae), an endemic genus to Lake Baikal (Russia)
Authors: Martin Patrick , Sonet Gontran , Smitz Nathalie , Backeljau Thierry
Published: June 2019

Lake Baikal is populated by an endemic genus of oligochaetes (Baikalodrilus), which currently comprises 24 morphospecies. The genus can be considered as a ‘species flock’. However, the validity of many species is questionable: the great similarity in their description and the lack of unequivocal diagnostic characters often lead species identification to an impasse. In order to clarify the systematics of this genus, we analysed two nuclear and two mitochondrial DNA markers of 40 Baikalodrilus specimens. DNA and morphological approaches are mostly congruent in suggesting ten candidate species, although two additional species are suspected. A reassessment of the taxonomic value of the morphological characteristics of Baikalodrilus suggests that there are few that can be used as distinctive, specific criteria in the genus. The association between candidate and nominal species remains problematic, except for three species identified prior to molecular analyses. Baikalodrilus trituberculum sp. nov. is described. Phylogenetic inferences suggests that the earliest split in Baikalodrilus and the time of divergence of most lineages corresponding to species are consistent with the hypothesis of a general rearrangement of the Baikal fauna, following major environmental changes due to a general cooling in the Early Pleistocene.
Measuring Tensile Strength to Better Establish Protective Capacity of Sacral Prophylactic Dressings Over 7 Days of Laboratory Aging
Authors: Burton Joshua N. , Fredrickson Abigail G. , Capunay Cassidee , Tanner Laurel , Oberg Craig , Santamaria Nick , Gefen Amit , Call Evan
Published: June 2019

Results from large-scale randomized clinical trials support the application of prophylactic dressings to provide protection from body-weight force-induced deformations known to damage skin and underlying tissues, which often result in pressure injuries (pressure ulcers). This laboratory study using a new method for aging dressings in simulated use followed by tensile testing was conducted to further understand the protective effect of sacral prophylactic dressings (SPDs) in alleviating tissue deformations in the sacral region through the course of typical application. Specifically, four SPDs were exposed to a simulation of the clinical environment incorporating saline solution absorption, mechanical loading, and repetitive sliding-induced shear. After aging, the protective endurance of the SPDs was measured through tensile testing to determine their effectiveness against tissue-damaging forces over time.

This study uses the concepts of axial stiffness, protective endurance, and elastic limit to describe more accurately the protective aspects of SPDs under dry and moist conditions and how they interact with the skin and underlying tissues over the life of the dressing. The authors propose two primary features in SPD effectiveness in preventing pressure injuries: high conformability (ie, low flexural stiffness) and protective endurance (the dressing’s capacity to maintain biomechanical performance when moist).
USTUR Special Session Roundtable—US Transuranium and Uranium Registries (USTUR): A Five-decade Follow-up of Plutonium and Uranium Workers
Authors: Tolmachev Sergei Y. , Swint Margery J. , Bistline Robert W. , McClellan Roger O. , McInroy James F. , Kathren Ronald L. , Filipy Ronald E. , Toohey Richard E.
Published: June 2019

The US Transuranium and Uranium Registries is a human tissue program that collects tissues posthumously from former nuclear workers and radiochemically analyzes them for actinides such as plutonium, americium, and uranium. It was established in 1968 with the goal of advancing science and improving the safety of future workers. Roundtable participants recalled various aspects of this multidisciplinary research program, from establishing consistent autopsy protocols to comparing the registries’ findings to those of other programs, such as the historical beagle dog studies and the Russian Radiobiological Human Tissue Repository. The importance of meeting ethical and legal requirements, including written consent forms, was emphasized, as was the need to know whether workers were exposed to nonradiological hazards such as beryllium or asbestos. At Rocky Flats, a bioassay program was established to follow workers after they terminated employment. The resulting data continue to help researchers to improve the biokinetic models that are used to estimate intakes and radiation doses. After 50 y, the US Transuranium and Uranium Registries continues to contribute to our understanding of actinides in humans, which is a testament to the vision of its founders, the generosity of its tissue donors, and the many dedicated scientists who have worked together to achieve a common goal.
Posterior Segment Complications and Impact on Long-Term Visual Outcomes in Eyes With a Type 1 Boston Keratoprosthesis
Authors: Moshiri Ala , Safi Mustafa , Morse Lawrence S. , Tang Vincent Duong , Yiu Glenn , Park Susanna S. , Schwab Ivan , Li Jennifer , Mannis Mark J.
Published: June 2019

Purpose:

To determine the spectrum of retinal complications (RCs) in a cohort of eyes with a type 1 Boston keratoprosthesis (KPro).

Methods:

All patients (36 eyes of 31 patients) who received a type 1 Boston KPro from January 2004 to December 2015 at the University of California, Davis, were included. Electronic medical records were reviewed for relevant clinical data. Demographic information, initial corneal diagnosis, postoperative course, posterior segment complications, preoperative and final visual acuity were tabulated and analyzed.

Results:

Posterior segment complications after type 1 Boston KPro were identified in 56% of eyes (n = 20). They included retinal detachment (n = 11; 31%), retroprosthetic membrane (n = 10; 28%), endophthalmitis (n = 7; 19%), cystoid macular edema (n = 5; 14%), epiretinal membrane (n = 4; 11%), vitreous hemorrhage (n = 2; 6%), choroidal detachment (n = 2; 6%), retinal vein occlusion (n = 1; 3%), and macular hole (n = 1; 3%). During the average follow-up period of 53.8 months (median, 57.1 months; range, 1.8–108.7 months) after type 1 Boston KPro, final best-corrected visual acuity improved by a mean of 0.12 logarithm of the minimum angle of resolution (LogMAR) units (range, −2.26 to +2.26) overall. The proportion of eyes with final best-corrected visual acuity better than 20/200 was 2 of 20 (10%) in the group with RCs, in contrast to 7 of 16 eyes (44%) noted among eyes without RCs.

Conclusions:

Long-term visual outcomes in eyes after type 1 Boston KPro may depend, in part, on maintaining a healthy posterior pole. Retinal detachment, in particular, may represent a threat to ultimate visual functioning. Regular examination of the peripheral fundus is recommended.
A Case of Intermittent Exercise–Induced Foot Drop in a Recreational Runner
Authors: Sheridan Craig J. , Bowditch Mark
Published: June 2019

Foot drop is a reduction in ankle dorsiflexion during the swing phase of gait. We report a case of a 51-year-old recreational runner and cyclist who presented with intermittent left foot drop initially triggered by running distances in excess of 10 km. The patient was investigated with magnetic resonance imaging (MRI) of the spine and leg, nerve conduction studies, electromyography, and compartment pressure testing, which were all normal. Surgical release of fascia, which was restricting the common peroneal (fibular) nerve, failed to resolve her symptoms. Subsequent brain MRI revealed demyelination. This case describes the unusual case of a recreational runner presenting with exercise-induced foot drop secondary to multiple sclerosis (MS). Motor fatigability is a common feature of MS, and this case highlights the need to remain cognizant of central and peripheral causes of exertional lower limb pathology, particularly in the absence of pain.
Improving Quality of Chest Computed Tomography for Evaluation of Pediatric Malignancies
Authors: Mansfield Sara A. , Dykes Michael , Adler Brent , Uffman Joshua C. , Sales Stephen , Ranalli Mark , Kenney Brian D. , Aldrink Jennifer H.
Published: June 2019

Introduction:

Atelectasis is a problem in sedated pediatric patients undergoing cross-sectional imaging, impairing the ability to accurately interpret chest computed tomography (CT) imaging for the presence of malignancy, often leading to additional maneuvers and/or repeat imaging with additional radiation exposure.

Methods:

A quality improvement team established a best-practice protocol to improve the quality of thoracic CT imaging in young patients with suspected primary or metastatic pulmonary malignancy. The specific aim was to increase the percentage of chest CT scans obtained for the evaluation of pulmonary nodules with acceptable atelectasis scores (0–1) in patients aged 0–5 years with malignancy, from a baseline of 45% to a goal of 75%.

Results:

A retrospective cohort consisted of 94 patients undergoing chest CT between February 2014 and January 2015 before protocol implementation. The prospective cohort included 195 patients imaged between February 2015 and April 2018. The baseline percentage of CT scans that were scored 0 or 1 on the atelectasis scale was 44.7%, which improved to 75% with protocol implementation. The mean atelectasis score improved from 1.79 (±0.14) to 0.7 (±0.09). Sedation incidence decreased substantially from 73.2% to 26.5% during the study period.

Conclusions:

Using quality improvement methodology including standardization of care, the percentage of children with atelectasis scores of 0–1 undergoing cross-sectional thoracic imaging improved from 45% to 75%. Also, eliminating the need for sedation in these patients has further improved image quality, potentially allowing for optimal detection of smaller nodules, and minimizing morbidity.
Health Disparities Among Hispanics With Rheumatoid Arthritis
Authors: Riad Mariam , Dunham Daniel P. , Chua Jacquelin R. , Shakoor Najia , Hassan Sobia , Everakes Sarah , Block Joel A. , Castrejon Isabel
Published: June 2019

Objective

The aim of this study was to evaluate referral and treatment delays by ethnicity/race in patients with rheumatoid arthritis (RA) treated at an academic rheumatology center.

Methods

We reviewed the medical records of all RA patients evaluated at an outpatient clinic between 2011 and 2016 to identify newly diagnosed and naive-to-treatment patients. We determined the durations between symptom onset and first rheumatology visit and time to initiate treatment. Data extraction included referral source, demographics, treatment, and laboratory tests. Routine use of a multidimensional health assessment questionnaire allowed us to calculate baseline RAPID3 (routine assessment of patient index data 3) scores. Comparisons between self-reported ethnicity/race groups were performed. We used logistic regression models to analyze associations between baseline variables and early referral.

Results

Data from 152 disease-modifying antirheumatic drug-naive RA patients were included in the study; 35% were white, 37% black, 20% Hispanic, and 8% other. The range in median time to first rheumatology visit was 6 to 8 months for all patient groups, except Hispanic. This group had a median time of 22.7 months (p= 0.01). The referral pattern was considerably variable between-groups; 40% of Hispanic patients were self-referred (p= 0.01). There were no statistically significant between-group differences for time to treatment initiation according to ethnicity/race. RAPID3 scores (p= 0.04) and erythrocyte sedimentation rates (p= 0.01) were significantly higher in the black and Hispanic groups. A high C-reactive protein value at baseline was associated with earlier referral.

Conclusions

There is significant delay in initial presentation to a rheumatologist that was associated with a higher disease severity at presentation, especially for Hispanic patients.
Congruency effects can compensate for deficits of healthy older adults in crossmodal integration
Authors: Higgen Focko L. , Heine Charlotte , Krawinkel Lutz , Göschl Florian , Engel Andreas K. , Hummel Friedhelm C. , Xue Gui , Gerloff Christian
Published: June 2019

One of the pivotal challenges of aging is to maintain independence in the activities of daily life. In order to adapt to changes in the environment, it is crucial to continuously process and accurately combine simultaneous input from different sensory systems, i.e., crossmodal integration.

With aging, performance decreases in multiple cognitive domains. The processing of sensory stimuli constitutes one of the key features of this deterioration. Age-related sensory impairments affect all modalities, substantiated by decreased acuity in visual, auditory or tactile detection tasks.

However, whether this decline of sensory processing leads to impairments in crossmodal integration remains an unresolved question. While some researchers propose that crossmodal integration degrades with age, others suggest that it is conserved or even gains compensatory importance.

To address this question, we compared behavioral performance of older and young participants in a well-established crossmodal matching task, requiring the evaluation of congruency in simultaneously presented visual and tactile patterns. Older participants performed significantly worse than young controls in the crossmodal task when being stimulated at their individual unimodal visual and tactile perception thresholds. Performance increased with adjustment of stimulus intensities. This improvement was driven by better detection of congruent stimulus pairs (p<0.01), while detection of incongruent pairs was not significantly enhanced (p=0.12).

These results indicate that age-related impairments lead to poor performance in complex crossmodal scenarios and demanding cognitive tasks. Performance is enhanced when inputs to the visual and tactile systems are congruent. Congruency effects might therefore be used to develop strategies for cognitive training and neurological rehabilitation.