bluuebunny/crossref_metadata_2025 huggingface dataset:
Morals
Authors: Root Michael
Published: November 2017

Ethics has rarely in the past been a cause of church-dividing dispute, but recently it has developed into a source of contention. The early ecumenical movement sought to give an agreed moral witness. Conferences at Stockholm (1925), Oxford (1937), and Geneva (1967) developed a tradition of ecumenical moral reflection within the World Council of Churches. Profound changes came to this tradition as emphasis shifted after 1967 towards a ‘contextual liberation ecumenism’, focusing on solidarity with liberation movements of the oppressed. More recently, ethics has been taken up in ecumenical dialogues. Dialogues have discussed specific moral issues (e.g. divorce, war, homosexuality) as well as more general questions of the relation of ethics to the unity of the church. While some dialogues have reported a fundamental agreement of ethical outlook, some recent dialogues have found significant differences, extending from questions related to sexuality to broader issues of the sources of ethical teaching.
Covenants
Authors: Kingston Gillian
Published: November 2017

This chapter explores the notion of covenant as an instrument which may facilitate closer and more binding relationships between or among churches wanting to commit to each other in a further step on the road to complete unity. The history of the term is outlined, noting its origin with the World Council of Churches. Several recent covenant relationships in different parts of the world are examined, with comments on their development and documentation. It is observed that a leading motivation in the establishment of covenants has been that of mission, while a significant challenge has been varying theologies of ministry. Particular note is taken of the covenant between the Methodist Church in Ireland and the Church of Ireland (Anglican), in which these churches are formulating legislation to facilitate interchangeability of ministries.
Polysynthesis in North America
Authors: Mithun Marianne
Published: November 2017

North America is generally regarded as an area rich in polysynthetic languages. Structures usually associated with the type are indeed pervasive, but the variety they show indicates that neither polysynthesis itself, nor any of the characteristics typically cited, is monolithic or criterial. Each property shows varying degrees of development and robustness, none of which is predictive of any of the others. Nevertheless, a survey of the languages shows that the characteristics do tend to co-occur, and furthermore that particular semantic and structural patterns of development can be seen in major linguistic areas, suggesting that language contact may play a role in shaping the type.
Polysynthesis and Language Contact
Authors: van der Voort Hein , Bakker Peter
Published: November 2017

Polysynthetic languages have been involved in a variety of language contact situations. In cases of occasional contacts, polysynthetic languages have been simplified, both by learners (approximate varieties) and native speakers (foreigner talk). Such simplified versions can be the source also of a number of pidgins based on polysynthetic languages. Those pidgins did not inherit the morphological complexity of the source languages, but instead use pronouns for person marking and largely analytic structures. Sometimes unanalyzed complex verbs are used, where the original meaning of the affixes does not play a role. The widespread idea that polysynthetic languages do not display lexical borrowings, but use internal word-building devices instead, should be qualified: loanwords are quite common in polysynthetic languages. In codeswitching, verbs stems rarely combine with foreign elements. Borrowing of pattern is more common than borrowing of matter, and areal diffusion of grammatical traits may lead to the proliferation of polysynthesis.
The Acquisition of Murrinhpatha (Northern Australia)
Authors: Forshaw Bill , Davidson Lucinda , Kelly Barbara , Nordlinger Rachel , Wigglesworth Gillian , Blythe Joe
Published: November 2017

This chapter reports on initial findings of an ongoing large-scale research project into the acquisition of Murrinhpatha, a polysynthetic language of the Daly River region of the Northern Territory of Australia with complex morphology. The complex verbal structures in Murrinhpatha, which can contain a large number of morphemes and bipartite stem morphology discontinuously distributed throughout the verbal template, raise a multitude of questions for acquisition. In this chapter we focus particularly on the acquisition of the complex predicate system in the verb, and the acquisition of subject-marking categories and tense/aspect/mood. Our findings are based on the language development of five Murrinhpatha acquiring children aged from 2;7–4;11 years.
The Acquisition of Polysynthetic Verb Forms in Chintang
Authors: Stoll Sabine , Bickel Balthasar , Mažara Jekaterina
Published: November 2017

In first language acquisition research so far little is known about the affordances involved in children's acquisition of morphologies of different complexities. This chapter discusses the acquisition of Chintang verbal morphology. Chintang is a Sino-Tibetan (Kiranti) polysynthetic language spoken in a small village in Eastern Nepal by approximately 6,000 speakers. The most complex part of Chintang morphology is verbal inflection. A large number of affixes, verb compounding, and freedom in prefix ordering results in over 1,800 verb forms of single stem verbs and more than 4,000 forms if a secondary stem is involved. In this chapter we assess the challenges of learning such a complex system, and we describe in detail what this acquisition process looks like. For this we analyze a large longitudinal acquisition corpus of Chintang.
Polysynthesis and Complexity
Authors: Dahl Östen
Published: November 2017

The notion of polysynthesis has been linked up with that of complexity from the very start. A discussion of the relationship between these two concepts is thus highly motivated, also in view of the recent increased interest in questions relating to complexity among linguists. The chapter discusses different ways of understanding and measuring complexity and how these can be applied to polysynthetic languages. Other topics treated in the chapter are how complexity develops over time in polysynthetic languages, the question of to what extent the notions of maturation and non-linearity as defined in Dahl (2004) are relevant to the synchrony and diachrony of polysynthesis, and how the complexity of constructions in polysynthetic languages compares to functionally equivalent constructions elsewhere.
Innu (Algonquian)
Authors: Drapeau Lynn
Published: November 2017

This chapter is devoted to Innu (aka Montagnais), a member of the Algonquian language family, spoken by roughly 13,000 people in eleven communities scattered over Northeastern Québec and Labrador in Canada. The language forms part of the Cree-Innu-Naskapi dialect continuum (Quebec and Labrador) with ties to the other Cree dialects spoken west of Québec, all the way to the Rocky Mountains in Alberta.The chapter aims at providing a broad description of the main features of the language from a functional typological viewpoint with special emphasis on the aspects that are of interest to the study of polysynthesis (head-marking, word-formation processes including incorporation of nominals, identification of participants on the verb, and the referentiality of incorporated nominals).
CADDO
Authors: Chafe Wallace
Published: November 2017

Caddo is a member of the Caddoan language family, which includes also Wichita, Kitsai, Pawnee, and Arikara. Its verbs are typically polysynthetic, with a base composed of a variety of elements that include incorporated noun roots and various derivational prefixes and suffixes. This base is accompanied by pronominal prefixes expressing person and number and their role as agents, patients, or beneficiaries. Unusual is the division of these pronominal prefixes into realis and irrealis sets that have scope over an entire event or state. The base is followed by suffixes expressing tense and aspect. Caddo is not only polysynthetic but also highly fusional as a result of extensive sound changes that have obscured morpheme boundaries as well as resemblances between different parts of a paradigm. Morphological analysis requires the internal reconstruction of an earlier stage of the language when the composition of a verb was more transparent.
Purepecha, a Polysynthetic but Predominantly Dependent-Marking Language
Authors: Chamoreau Claudine
Published: November 2017

Purepecha (language isolate, Mexico) has one relevant characteristic that leads to identifying it as a polysynthetic language: productive verbal morphology (in particular locative suffixes). Purepecha is a predominantly dependent-marking language, as its pronominal markers are enclitics, generally second position enclitics. But, in some contexts Purepecha shows head-marking characteristics. Today, pronominal enclitics exhibit variation, tending to move to the rightmost position in the clause; they may encliticize to the predicate itself, showing a head-attraction or polypersonalism strategy and making Purepecha more polysynthetic. But this language lacks noun incorporation. Purepecha has three types of non-finite clause: two subordinate clauses (non-finite complement clauses and purpose clauses) and a syntactically independent clause (the chain-medial clause). This seemingly inconsistent situation (characterized by a correlation of different properties, some of which have not been identified as polysynthetic) calls for addressing the typological classification of Purepecha among the polysynthetic languages.
Tariana, an Arawak Language from North-West Amazonia
Authors: Aikhenvald Alexandra Y.
Published: November 2017

Tariana, the only Arawak language spoken in the Vaupés River Basin linguistic area, has developed numerous polysynthetic patterns, as a result of areal diffusion neighbouring East Tucanoan languages. Tariana is spoken in a situation of obligatory societal multilingualism, based on linguistic exogamy. Special features of Tariana shared with other polysynthetic languages include variable order of morphemes, ‘recursive affixing’ (similar to Eskimo-Aleut languages), templatic structures of nouns and verbs, and multiple serial verb constructions which behave as single word structures with respect to derivational processes. Most of these patterns are absent from Baniwa and other closely related Arawak languages, and also from one of the two extant dialects of Tariana under strong influence from Baniwa.
Polysynthesis in Lakondê, a Northern Nambikwaran Language of Brazil
Authors: Wetzels Leo , Telles Stella
Published: November 2017

Lakondê, together with Mamaindê and Latundê, belongs to the Northern Nambikwara branch of the Nambikwara linguistic family spoken in Northwestern Brazil. The language is head-marking, predominantly suffixal, and of great derivational productivity. It has an elaborate system of nominal classifiers; it is incorporating, with nuclear arguments integrated in the morphology of the verb. Lakondê has two ways of incorporating nouns: one is prefixal when the incorporated morphemes represent body parts; the other is suffixal, involving nominal classifiers. When the incorporation occurs in dynamic verbs, the integrated classifier morphemes assume the role of direct object. The verbal template provides for more than thirty morpheme positions, which, from the point of view of their function, can be categorized as argumental, adverbial, evidential, and TAM. Flexional suffixes may function as nuclear arguments and dispense with the lexical realization of the subject and the object. With these characteristics Lakondê may be classified as a typical polysynthetic language.
Koryak
Authors: Kurebito Megumi
Published: November 2017

The present chapter focuses on verbal polysynthesis in Koryak, a member of the Chukotko-Kamchatkan language family and aims to show how a polysynthetic holophrase is formed in this language. The result of the examination reveals that the language owes the major driving force in promoting verbal polysynthesis to incorporation, especially noun incorporation (NI). In NI, polysynthetic incorporative stems are derived through NP incorporation, multiple nominal incorporation, double P-argument incorporation (though not always accepted), and adverbial incorporation. Denominal verbal affixes which express concrete verbal meanings such as ‘make’, ‘go gathering’, and ‘look for’ can also derive polysynthetic holophrases by (quasi)-incorporating one or more modifiers and adverbial stems. The polysynthetic stem thus formed is enclosed and shaped into a polysynthetic holophrase by verbal inflectional categories such as aspect, mood, and agreement in person and number with the core argument.
Nivkh
Authors: Mattissen Johanna
Published: November 2017

Nivkh (Paleosiberian group), spoken on the lower reaches of the Amur River and on Sakhalin island in Siberia by a few hundred speakers in four main varieties, but rapidly dying out, is a polysynthetic head-marking but configurational SOV language, with defective polypersonalism, noun incorporation, verb root serialization, and complex noun forms. Its dominant structural principle and characteristic design is dependent-head-synthesis, with dependents lexically head-marked and still referentially active. Nivkh displays compositional polysynthesis with a mixed internal structure, as the suffixal domain of a word-form may be described by a template, whereas the pre-root domain is scope-ordered due to dependent chaining. The evolutionary path of complex forms is best conceived of as coalescence of formerly adjacent words. Morphophonemic processes at the word-internal morpheme boundaries, especially consonant dissimilation and assimilation, and bound allomorphs prove the wordhood of the complexes. Non-root bound morphemes encode modalities, degree, scalar, and focus operators and phase of action.
Polysynthesis in Ainu
Authors: Bugaeva Anna
Published: November 2017

Ainu is a typical polysynthetic language in that a single complex verb can express what takes a whole sentence in most other languages. A single verb form may include more than one heavy element: up to two applicative prefixes (out of three), two causative suffixes (out of five), two incorporated objects, one lexical prefix (out of two originating in nouns ‘head’ and ‘bottom’), one verbalizing suffix (originating in the verb ‘make’), as well as reciprocal, reflexive, and general object (=antipassive) prefixes and agreement affixes for the first/second person subject and object. The degree of combinability of voice markers and noun incorporation is spectacular. Nevertheless, it has been claimed that Ainu deviates from more typical polysynthetic languages in having less freedom of word order, interrogative phrases in situ, and unrestricted morphological causatives (Baker 1996). This chapter aims to distinguish what Ainu shares with other polysynthetic languages from what is unique.
Sub-Types of Polysynthesis
Authors: Mattissen Johanna
Published: November 2017

The structural heterogeneity of polysynthetic languages is captured by a sublassification of allegedly polysynthetic languages according to their word-formational type (number of roots allowed in a verb form), namely, compositional, transitional, or affixal, and their internal organization (template vs. scope or both). Further parameters show correlations to these independent ones: the number of participants encoded on a verb, the imaginable evolutionary path via which the structure has come about, namely layering (“onion type”), internal expansion (“sandwich type”) or coalescence (“burdock type”), and the characteristic design of a complex verb form: Grammatical category accumulation (integration of non-obligatory, rather grammatical information); ping-pong recategorization (multiple verbalization and nominalization); productive in/excorporation; dependent-head synthesis; multiple packing (integration of rather lexical information); holophrasis (all wordforms being predicates—or particles); composite-stem layout (composite root-like morphemes, unitary concept); and building-block design (multiple classifer-like morphemes make up a wordform). The classification along these parameters reconciles conflicting approaches to polysynthesis.
Polysynthesis in Sora (Munda) with Special Reference to Noun Incorporation
Authors: Anderson Gregory D. S.
Published: November 2017

The Munda language Sora, an Austroasiatic language, has a developed system of noun incorporation. One can always distinguish a structure with incorporation from one that lacks this as the nominal component that is found incorporated into the Sora verbal stem appears in the so-called ‘combining form’ (CF). This CF contrasts with an obligatorily bimoraic syntactically free-standing form of the noun that is lexically associated with the CF, derived through a lexically-determined means of affixation or compounding that includes reduplication, prefixation, infixation, and compounding. Only certain incorporated structures in Sora reduce the valence of the resulting structure, while others do not. Sora is also among the few languages attested that permits verbal constructs with more than one noun incorporated. In Sora a transitive verb may also incorporate its agent argument. Further, these incorporated stems remain transitive in Sora: they allow for the formal indexing of objects as well within in the incorporated complex.
Social and Solidarity Co-operatives
Authors: Galera Giulia
Published: November 2017

Over the past decades, new types of co-operatives with declared social goals have emerged in several countries in and outside Europe. Their development is above all connected to the engagement of co-operatives in the supply of general-interest services, which are carried out beyond the ‘boundaries’ of the co-ops’ membership, undermining the traditional model of co-operatives based on a single stakeholding system and on identifying members and users, and being ready to have additional bearers of interests sharing the duties and benefits of the organization. Drawing on selected country studies, this chapter focuses on new types of co-operatives with declared social goals, often turning into important providers of welfare and general-interest services and facilitators of work integration, which contribute to local development significantly. Selected countries where co-operatives have institutionalized their concern for community so as to pursue explicit general interest aims include Italy, Spain, France, Portugal, Greece, and South Korea.
The Performance of Member-Owned Businesses Since the Financial Crisis of 2008
Authors: Birchall Johnston
Published: November 2017

This chapter examines the performance of several types of member-owned businesses since the financial crisis. It summarizes evidence for three financial co-operative sectors (European co-operative banks, the worldwide credit union sector, and the UK building societies), finding that they have been less risky, more stable, and on a range of indicators more successful than conventional investor-owned banks. It then examines the performance of retail consumer co-operatives, insurance mutuals, retailer-owned wholesalers, and employee-owned businesses. The wider benefits of having a significant member-owned sector are then considered. The conclusion is that economic resilience cannot be taken for granted: it has to be competed for in each industry sector, and the results will vary depending on the extent to which, in each sector, they can realize the ‘co-operative advantage’.
A Worldwide Historical Perspective on Co-operatives and Their Evolution
Authors: Zamagni Vera
Published: November 2017

The birth of co-operatives in Europe in the middle of the nineteenth century shaped this form of enterprise by differentiating it from the established capitalist one, both in terms of internal organization and in terms of sectors of activity. This chapter highlights first the process of diffusion of co-operatives in the nineteenth century by grouping them into models—consumer, worker, financial, and rural co-operatives—that formed the pillars of the movement. The second part of the chapter is devoted to the novelties that emerged after World War II, especially social co-operatives and service co-operatives, giving a general account of developments of co-operation in Western Europe, North America, and Japan. A final glance of the new opportunities offered for co-operation through the Web is offered.
An American Historical Perspective on Employee Ownership
Authors: Blasi Joseph R. , Kruse Douglas L.
Published: November 2017

Worker ownership plays a significant role in the US economy today. This worker ownership takes on different forms. A large proportion of the US population (close to a fifth) owns stock in the company where they work. Meaningful worker holdings are ubiquitous in high-technology companies such as Google in the Internet area, Microsoft in the software area, Gilead Sciences in biotechnology, and Qualcomm in mobile technology. The most intensive sectors of worker ownership in the US are about 10,000 companies with about 15 million workers with Employee Stock Ownership Plans, where about 4,000 of the firms are majority or 100 per cent worker-owned, and a compact but vibrant and growing sector of about 300 worker co-operatives with about 6,000 members. Much of this chapter is based on our book, The Citizen’s Share, with economist Richard B. Freeman (Blasi, Freeman, and Kruse, 2015: 57–122).
The Calculus
Authors: Probst Siegmund
Published: November 2017

This chapter discusses the history of Leibniz's work on infinitesimal calculus of which a considerable part is still unknown. His new method, emerging from studies in the summing of infinite number series and the quadrature of curves, combines two procedures with opposite orientation, differentiation and integration. These two procedures are united in a common formalism introducing in 1675 the symbols d and ∫ for differentiation and integration. Subsequently, Leibniz and his followers developed new rules and solution methods, and applied the calculus to physics. During Leibniz’s lifetime the public success of his calculus was overshadowed by discussions over the foundations of his methods and the priority dispute with Newton. While infinitesimals were eliminated from the calculus during the 19th century, non-standard analysis reinstated them again. The status of infinitesimals in Leibniz’s own philosophy of mathematics is still disputed.
The Anti-sophistic Novel
Authors: Selden Daniel L.
Published: November 2017

This chapter discusses the fraught relationship between Second Sophistic discourse and koinē fiction of the second and third centuries ce. Taking its point of departure from a comparison (synkrisis) of Dio of Prusa’s first oration On Kingship and the α-recension of the Greek Alexander Romance, the chapter goes on to argue that Second Sophistic discourse and koinē fiction are not just two different bodies of contemporaneous writings that happened to appear side by side. Rather, they remain engaged in an intertextual agon where literary production in koinē—as opposed to Attic—Greek constitutes a dialectical negation of the overtly imperialist political agendas and monologic cultural objectives that inform Second Sophistic composition. Further consideration of the Life of Sekoûndos and the Story of Aseneth shows how koinē fiction of this period not only aggressively contests the goals and priorities of the Second Sophistic, but pointedly turns its norms and ideals inside out.
Lucian of Samosata
Authors: Richter Daniel S.
Published: November 2017

This chapter discusses the comic-satiric work of the Syrian author Lucian of Samosata (ca.125–180). Traditional biographical accounts of Lucian’s life are avoided in the interest of focusing the reader’s attention on the ways in which Lucian presents a series of authorial personae throughout his large and diverse corpus. In particular, the chapter describes how an interest in the antithesis of Greek and barbarian animates much of Lucian’s work and discusses the series of Hellenized barbarians—both mortal and immortal—who populate Lucian’s comic dialogues. The chapter focuses as well on how Lucian explores the novelty of what he presents as his own invention of the generically transgressive Comic Dialogue—here as well, the chapter suggests, Lucian maps his concerns with generic hybridity onto culture and ethnicity. Finally, the chapter discusses Lucian’s abiding interest in the various types of imposters that defined contemporary intellectual, social, and religious life.
Fronto and His Circle
Authors: Fleury Pascale
Published: November 2017

Fronto, the great orator of the second century and teacher of Latin rhetoric to the future emperors Marcus Aurelius and Lucius Verus, while not fitting Philostratus’s definition of a sophist, did practice some sophistic genres and shares with his Greek homologues an epideictic vision of rhetoric, a love for archaisms and an interest in similar themes. This chapter attempts to show the connections that Fronto maintains with the sophists whom he knows, as seen in the Correspondence (Herodes Atticus, Favorinus, Polemon), and those whom he encounters, as shown in Aulus Gellius’s Attic Nights, and to illustrate the commonality of thought and literary style between the Roman orator and the Greek sophists. Attitudes to Greek and political power are analyzed to show the strategies adopted by Fronto to define his relations with the imperial family and to situate himself in the cultural geography of his time.
Aelius Aristides
Authors: Oudot Estelle
Published: November 2017

This chapter discusses how, despite himself, Aelius Aristides corresponds in many ways to the typical portrait of the sophist. It examines how his personality was both emblematic (practicing epideictic and deliberative eloquence as a counselor, declaimer, and formal speaker) and idiosyncratic: a man who lived in symbiosis with a god, Asclepius, in whom he found both a doctor and a mentor in rhetoric, and who refused to take on civic responsibilities, preferring reclusion to society, yet who also was occupied with promoting language and rhetoric among his contemporaries, and defined himself as the incarnation of the ideal orator in his century. Aristides holds a vital place in literature of the imperial period: his work gives evidence of a real creative process and offers a new vision of the world, where cultural Athens, Roman domination, and the urban world of contemporary Greece and Asia Minor subtly interfere in a new way.
Latinitas
Authors: Bloomer W. Martin
Published: November 2017

This chapter examines the idea of Latinitas, Latinity, the quality of writing and speaking a pure Latin, which in its history from the beginnings of Latin literature in the third century bce has been both a socio-linguistic and a literary critical, stylistic category. Constitutive influences have been the standardization of the language of the capital as the language of an empire, the development of Latin literary styles, and the teaching of Latin in the various Roman schools. Latin was the dialect of Latium, the sociolect of the ruling elite, the language of imperial and military administration, and as a consequence of the last a far-flung language. Latinity as a norm thus faced considerable challenges. In the context of the later schools, ancient and medieval, Latinity came to be a norm to preserve the written language and a science (grammar) to discover and check rules of orthography and expression.
The Development of Nishida Kitarō’s Philosophy
Authors: Masakatsu Fujita
Published: November 2017

This chapter introduces the thought of Japan’s most significant and influential modern philosopher, Nishida Kitarō (1870–1945), by tracing its development through three major periods. The key concept of his early thought is “pure experience” (junsui keiken), which is said to precede the separation of subject and object. In his middle period, Nishida deals with the relation between direct experience and reflective thinking, resulting in his development of a logic of “place” (basho), which, in contrast to Aristotelian logic, seeks the underlying basis for judgments in the direction of the predicate rather than the grammatical subject. Nishida’s constant concern was to elucidate the most concrete experience of reality. In his later period, he rethinks this most fundamental level of experience, which he understands to be the basis for scientific knowledge as well as artistic creativity, in terms of “action-intuition” (kōi-teki chokkan).
The Controversial Cultural Identity of Japanese Philosophy
Authors: Arisaka Yoko
Published: November 2017

This chapter discusses controversies surrounding the cultural identity of Japanese philosophy. Often presented as offering the first “non-Western universalism” over against Eurocentrism, authors have struggled to establish its distinctness, and this endeavor has been mired in questions of essentialism, Japanese imperialism, and cultural nationalism. The exemplary case of Nishida Kitarō’s New World Order essay is examined, and issues surrounding the identity of Japanese philosophy are analyzed historically as well as in the contemporary context of global neo-colonialism. The last section offers an alternative interpretation of Nishida, by way of a first-person approach, in order to produce an existential critical theory aiming at a “decolonized world order.”
Translating Theory Into Practice: Implementing a Program of Assessment
Authors: Hauer Karen E. , O’Sullivan Patricia S. , Fitzhenry Kristen , Boscardin Christy
Published: November 2017

Problem

A program of assessment addresses challenges in learner assessment using a centrally planned, coordinated approach that emphasizes assessment for learning. This report describes the steps taken to implement a program of assessment framework within a medical school.

Approach

A literature review on best practices in assessment highlighted six principles that guided implementation of the program of assessment in 2016–2017: (1) a centrally coordinated plan for assessment aligns with and supports a curricular vision; (2) multiple assessment tools used longitudinally generate multiple data points; (3) learners require ready access to information-rich feedback to promote reflection and informed self-assessment; (4) mentoring is essential to facilitate effective data use for reflection and learning planning; (5) the program of assessment fosters self-regulated learning behaviors; and (6) expert groups make summative decisions about grades and readiness for advancement. Implementation incorporated stakeholder engagement, use of multiple assessment tools, design of a coaching program, and creation of a learner performance dashboard.

Outcomes

The assessment team monitors adherence to principles defining the program of assessment and gathers and responds to regular feedback from key stakeholders, including faculty, staff, and students.

Next Steps

Next steps include systematically collecting evidence for validity of individual assessments and the program overall. Iterative review of student performance data informs curricular improvements. The program of assessment also highlights technology needs that will be addressed with information technology experts. The outcome ultimately will entail showing evidence of validity that the program produces physicians who engage in lifelong learning and provide high-quality patient care.
It Is Time for Zero Tolerance for Sexual Harassment in Academic Medicine
Authors: Bates Carol K. , Jagsi Reshma , Gordon Lynn K. , Travis Elizabeth , Chatterjee Archana , Gillis Marin , Means Olivia , Chaudron Linda , Ganetzky Rebecca , Gulati Martha , Fivush Barbara , Sharma Poonam , Grover Amelia , Lautenberger Diana , Flotte Terence R.
Published: November 2017

While more women are in leadership positions in academic medicine now than ever before in U.S. history, evidence from recent surveys of women and graduating medical students demonstrates that sexual harassment continues in academic health centers. Academic medicine’s ability to change its culture is hampered by victims’ fear of reporting episodes of harassment, which is largely due to fear of retaliation. In this Perspective, the authors describe efforts in scientific societies to address the issue of sexual harassment and to begin to establish safe environments at national meetings. The authors contend that each institution must work to make it safe for individuals to come forward, to provide training for victims and for bystanders, and to abolish “locker room” talk that is demeaning to women.
Resources Used to Teach the Physical Exam to Preclerkship Medical Students: Results of a National Survey
Authors: Uchida Toshiko , Achike Francis I. , Blood Angela D. , Boyle Mary , Farnan Jeanne M. , Gowda Deepthiman , Hojsak Joanne , Ovitsh Robin K. , Park Yoon Soo , Silvestri Ronald
Published: November 2017

Purpose

To examine resources used in teaching the physical exam to preclerkship students at U.S. medical schools.

Method

The Directors of Clinical Skills Courses developed a 49-question survey addressing resources and pedagogical methods employed in preclerkship physical exam curricula. The survey was sent to all 141 Liaison Committee on Medical Education–accredited medical schools in October 2015. Results were averaged across schools, and data were weighted by class size.

Results

Results from 106 medical schools (75% response rate) identified a median of 59 hours devoted to teaching the physical exam. Thirty-eight percent of time spent teaching the physical exam involved the use of standardized patients, 30% used peer-to-peer practice, and 25% involved examining actual patients. Approximately half of practice time with actual patients was observed by faculty. At 48% of schools (51), less than 15% of practice time was with actual patients, and at 20% of schools (21) faculty never observed students practicing with actual patients. Forty-eight percent of schools (51) did not provide compensation for their outpatient clinical preceptors.

Conclusions

There is wide variation in the resources used to teach the physical examination to preclerkship medical students. At some schools, the amount of faculty observation of students examining actual patients may not be enough for students to achieve competency. A significant percentage of faculty teaching the physical exam remain uncompensated for their effort. Improving faculty compensation and increasing use of senior students as teachers might allow for greater observation and feedback and improved physical exam skills among students.
An Anesthesiologist’s Perspective on the History of Basic Airway Management
Authors: Matioc Adrian A.
Published: November 2017

This third installment of the history of basic airway management discusses the transitional—“progressive”—years of anesthesia from 1904 to 1960. During these 56 yr, airway management was provided primarily by basic techniques with or without the use of a face mask. Airway maneuvers were inherited from the artisanal era: head extension and mandibular advancement. The most common maneuver was head extension, also used in bronchoscopy and laryngoscopy. Basic airway management success was essential for traditional inhalation anesthesia (ether, chloroform) and for the use of the new anesthetic agents (cyclopropane, halothane) and intravenous drugs (thiopental, curare, succinylcholine). By the end of the era, the superiority of intermittent positive pressure ventilation to spontaneous ventilation in anesthesia and negative pressure ventilation in resuscitation had been demonstrated and accepted, and the implementation of endotracheal intubation as a routine technique was underway.
Three-Dimensional Analysis of the Fundus of the Human Internal Acoustic Canal
Authors: Schart-Morén Nadine , Larsson Sune , Rask-Andersen Helge , Li Hao
Published: November 2017

Objectives:

Documentation of the nerve components in the internal acoustic canal is essential before cochlea implantation surgery. Interpretations may be challenged by wide anatomical variations of the VIIIth nerve and their ramifications. Malformations may further defy proper nerve identification.

Design:

Using microcomputed tomography, we analyzed the fundus bone channels in an archival collection of 113 macerated human temporal bones and 325 plastic inner molds. Data were subsequently processed by volume-rendering software using a bony tissue algorithm. Three-dimensional reconstructions were made, and through orthogonal sections, the topographic anatomy was established.

Results:

The technique provided additional information regarding the anatomy of the nerve foramina/channels of the human fundus region, including variations and destinations. Channel anastomosis were found beyond the level of the fundus. A foramen of the transverse crest was identified.

Conclusions:

Three-dimensional reconstructions and cropping outlined the bone canals and demonstrated the highly variable VIIIth nerve anatomy at the fundus of the human inner acoustic canal. Myriad channel interconnections suggested an intricate system of neural interactive pathways in humans. Particularly striking was the variable anatomy of the saccule nerve channels. The results may assist in the preoperative interpretation of the VIIIth nerve anatomy.
Hospital Differences Drive Antibiotic Delays for Black Patients Compared With White Patients With Suspected Septic Shock
Authors: Taylor Stephanie Parks , Karvetski Colleen H. , Templin Megan A. , Taylor Brice T.
Published: November 2017

Objective:

Evaluate racial disparities in sepsis processes of care.

Design:

Observational cohort study.

Setting:

Nine hospitals in the Southeastern United States between 2014 and 2016.

Patients:

Two thousand two hundred twenty-one white and 707 black patients treated in the emergency department through “code sepsis” pathway for suspected septic shock.

Measurements and Main Results:

Black patients were less likely to receive timely antibiotics than were white patients using multiple definitions (1 hr from code sepsis activation [odds ratio, 0.57; 95% CI, [0.44–0.74]; 85.6% vs. 91.2%; p < 0.0001]; 1 hr from triage [odds ratio, 0.83; 95% CI, [0.69–1.00]; 28.0% vs. 31.8%; p = 0.06]; 3 hr from triage [odds ratio, 0.71; 95% CI, [0.57–0.88]; 80.1% vs. 85.0%; p = 0.002]). Focusing on antibiotic administration within 1 hour of triage, these differences were enhanced after adjusting for patient-level factors (adjusted odds ratio, 0.80; 95% CI, [0.66–0.96]; p = 0.02), but attenuated after adjusting for hospital-level differences (adjusted odds ratio, 0.90; 95% CI, [0.81–1.01]; p = 0.07). Black and white patients did not differ on other sepsis quality indicators or adjusted mortality.

Conclusions:

Black patients appear to be less likely than white patients to receive timely antibiotic therapy for sepsis. These differences were largely explained by variation in care among hospitals, such that hospitals that disproportionately treat black patients were less likely to provide timely antibiotic therapy overall. There were no differences between races in other sepsis quality measures or adjusted mortality.
A Randomized Control Trial of Preoperative Oral Antibiotics as Adjunct Therapy to Systemic Antibiotics for Preventing Surgical Site Infection in Clean Contaminated, Contaminated, and Dirty Type of Colorectal Surgeries
Authors: Anjum Nadeem , Ren Jianan , Wang Gefei , Li Guanwei , Wu Xiuwen , Dong Hu , Wu Qin , Li Jieshou
Published: November 2017

BACKGROUND:

Preoperative bowel preparation with or without oral antibiotics is controversial in terms of postoperative surgical site infections.

OBJECTIVE:

This study aimed to evaluate the efficacy of oral antibiotics as adjunct therapy to systemic antibiotics with mechanical bowel preparation for preventing surgical site infections in clean contaminated, contaminated, and dirty colorectal procedures.

DESIGN:

This was a single-center, prospective randomized study.

SETTING:

This study was conducted at the General Surgery Department at Jinling Hospital, Nanjing University, China, from July 15, 2014 to January 20, 2016.

PATIENTS:

Patients aged ≥18 years scheduled for abdominal surgery with clean-contaminated, contaminated, and dirty wounds were selected.

INTERVENTIONS:

Patients were randomly assigned to receive preoperative mechanical bowel preparation or mechanical bowel preparation with oral antibiotics.

MAIN OUTCOMES:

The primary outcome was the rate of surgical site infections. The secondary outcomes were extra-abdominal complications, duration of postoperative ileus, and readmission rate.

RESULTS:

Ninety-five patients were allocated to each group. Eight and 26 surgical site infections (8.42% vs 27.3 %, p = 0.004) occurred in the mechanical bowel preparation with oral antibiotics and mechanical bowel preparation groups. Thirteen extra-abdominal complications were reported: 6 in the mechanical bowel preparation with oral antibiotics group and 7 in the mechanical bowel preparation group (6.3% vs 7.3%, p = 0.77). Postoperative ileus duration did not differ between groups (p = 0.23). There were 4 readmissions in the mechanical bowel preparation group and none in the mechanical bowel preparation with oral antibiotics group (p = 0.04). On multivariable analysis, blood loss ≥500 mL (OR, 5.1; 95% CI, 1.27–20.4; p = 0.02), ASA score ≥3 (OR, 3.9; 95% CI, 1.2–12.5; p = 0.01), contaminated types (OR, 3.6; 95% CI, 1.5–8.6; p = 0.01), and administration of preoperative oral antibiotics (OR, 0.20; 95% CI, 0.06–0.60; p = 0.005) independently affected the incidence of surgical site infections.

LIMITATIONS:

This was a single-center study.

CONCLUSION:

Preoperative oral antibiotics, as adjunct therapy to systemic antibiotics and mechanical bowel preparation, significantly reduced surgical site infections and minimized the readmission rates in clean contaminated, contaminated, and dirty types of colorectal surgery. See Video Abstract at http://links.lww.com/DCR/A437.
Rectal Eversion Technique: A Method to Achieve Very Low Rectal Transection and Anastomosis With Particular Value in Laparoscopic Cases
Authors: Poylin Vitaliy , Mowschenson Peter , Nagle Deborah , Cataldo Thomas
Published: November 2017

INTRODUCTION:

Transection of the rectum at the anorectal junction is required for proper resection in ulcerative colitis and restorative proctocolectomy. Achieving stapled transection at the pelvic floor is often challenging, particularly during laparoscopic proctectomy. Transanal mucosectomy and handsewn anastomosis are frequently used to achieve adequate resection. Rectal eversion provides an alternative for low anorectal transection and maintains the ability to perform stapled anastomosis.

TECHNIQUE:

The purpose of this article is to describe a technique for low anorectal transection. The work was conducted at tertiary care center by 2 colon and rectal surgeons on patients undergoing total proctocolectomy with creation of ileal pouch rectal anastomosis for ulcerative colitis. We measured the ability to achieve low stapled anastomosis.

RESULTS:

Very low transection was achieved, allowing for creation of IPAA without leaving significant rectal cuff. This study was limited because it is an early experience that was not performed in the setting of a scientific investigation. No sphincter or bowel functional data were obtained or evaluated.

CONCLUSIONS:

Rectal eversion technique provides an alternative to mucosectomy when low pelvic transection is difficult to achieve. See Video at http://links.lww.com/DCR/A441.
Stromal Cell-Derived Factor 1 Plasmid Regenerates Both Smooth and Skeletal Muscle After Anal Sphincter Injury in the Long Term
Authors: Sun Li , Kuang Mei , Penn Marc , Damaser Margot S. , Zutshi Massarat
Published: November 2017

BACKGROUND:

Regenerating muscle at a time remote from injury requires re-expression of cytokines to attract stem cells to start and sustain the process of repair.

OBJECTIVE:

We aimed to evaluate the sustainability of muscle regeneration after treatment with a nonviral plasmid expressing stromal cell-derived factor 1.

DESIGN:

This was a randomized study.

SETTINGS:

The study was conducted with animals in a single research facility.

INTERVENTIONS:

Fifty-six female age-/weight-matched Sprague–Dawley rats underwent excision of the ventral half of the anal sphincter complex. Three weeks later, rats were randomly allocated (n = 8) to one of the following groups: no treatment, 100 μg of plasmid encoding stromal cell-derived factor 1 injected locally, local injection of plasmid and 8 × 105 bone marrow–derived mesenchymal stem cells, and plasmid encoding stromal cell-derived factor 1 injected locally with injection of a gelatin scaffold mixed with bone marrow–derived mesenchymal stem cells.

MAIN OUTCOME MEASURES:

Anal manometry, histology, immunohistochemistrym and morphometry were performed 8 weeks after treatment. Protein expression of cytokines CXCR4 and Myf5 was investigated 1 week after treatment (n = 6 per group). ANOVA was used, with p < 0.0083 indicating significant differences for anal manometry and p < 0.05 for all other statistical analysis.

RESULTS:

Eight weeks after treatment, all of the groups receiving the plasmid had significantly higher anal pressures than controls and more organized muscle architecture in the region of the defect. Animals receiving plasmid alone had significantly greater muscle in the defect (p = 0.03) than either animals with injury alone (p = 0.02) or those receiving the plasmid, cells, and scaffold (p = 0.03). Both smooth and skeletal muscles were regenerated significantly more after plasmid treatment. There were no significant differences in the protein levels of CXCR4 or Myf5.

LIMITATIONS:

The study was limited by its small sample size and because stromal cell-derived factor 1 was not blocked.

CONCLUSIONS:

A plasmid expressing stromal cell-derived factor 1 may be sufficient to repair an injured anal sphincter even long after the injury and in the absence of mesenchymal stem cell or scaffold treatments. See Video Abstract at http://links.lww.com/DCR/A451.