bluuebunny/crossref_metadata_2025 huggingface dataset:
Military Sanctions Enforcement in the Absence of Express Authorization?
Authors: Nevill Penelope
Published: July 2016

This chapter examines the use of force to enforce sanctions in the absence of express authorization by the UN Security Council. After reviewing the history and background to enforcement of sanctions which primarily takes place at sea, the chapter addresses the question of what amounts to a use of force in this context, paying particular attention to whether sanctions enforcement is ‘law enforcement’ or a use of force in the sense of Article 2(4) of the UN Charter by examining the jurisprudence of the International Court of Justice and under the United Nations Law of the Sea Convention concerning forcible measures used or threatened by state authorities against vessels or oil rigs and platforms. The chapter concludes by assessing the legal bases for the use of force to enforce sanctions, including those imposed by the United Nations.
Retaliation and Reprisal
Authors: Darcy Shane
Published: July 2016

This chapter focuses on the evolution of the international law on the use of force as it relates to the concepts of retaliation and reprisal, particularly since the adoption of the United Nations Charter in 1945. After defining the concepts of retaliation and reprisal as understood in international law, the chapter considers whether armed reprisals are contrary to the UN Charter, along with the debates surrounding the UN Security Council’s condemnation of retaliatory actions. It then examines claimed instances of state practice, as well as judicial and scholarly views on the lawfulness of such reprisals. Finally, it discusses arguments calling for the revival of reprisals or retaliation as permitted exceptions to the prohibition on the use of force.
Evaluation of Two Techniques for Viral Load Monitoring Using Dried Blood Spot in Routine Practice in Vietnam (French National Agency for AIDS and Hepatitis Research 12338)
Authors: Taieb Fabien , Tram Tran Hong , Ho Hien Thi , Pham Van Anh , Nguyen Huong Lan , Pham Ba Hien , Tong Linh An , Tuaillon Edouard , Delaporte Eric , Nguyen Anh Tuan , Bui Duc Duong , Do NhanThi , Madec Yoann
Published: July 2016

Background.  Although it is the best method to detect early therapeutic failure, viral load (VL) monitoring is still not widely available in many resource-limited settings because of difficulties in specimen transfer, personnel shortage, and insufficient laboratory infrastructures. Dried blood spot (DBS) use, which was introduced in the latest World Health Organization recommendations, can overcome these difficulties. This evaluation aimed at validating VL measurement in DBS, in a laboratory without previous DBS experience and in routine testing conditions.

Methods.  Human immunodeficiency virus (HIV)-infected adults were observed in a HIV care site in Hanoi, and each patient provided 2 DBS cards with whole blood spots and 2 plasma samples. Viral load was measured in DBS and in plasma using the COBAS Ampliprep/TaqMan and the Abbott RealTime assays. To correctly identify those with VL ≥ 1000 copies/mL, sensitivity and specificity were estimated.

Results.  A total of 198 patients were enrolled. With the Roche technique, 51 plasma VL were ≥1000 copies/mL; among these, 28 presented a VL in DBS that was also ≥1000 copies/mL (sensitivity, 54.9; 95% confidence interval [CI], 40.3–68.9). On the other hand, all plasma VL < 1000 copies/mL were also <1000 copies/mL in DBS (specificity, 100; 95% CI, 97.5–100). With the Abbott technique, 45 plasma VL were ≥1000 copies/mL; among these, 42 VL in DBS were also ≥1000 copies/mL (sensitivity, 93.3%; 95% CI, 81.7–98.6); specificity was 94.8 (95% CI, 90.0–97.7).

Conclusions.  The Abbott RealTime polymerase chain reaction assay provided adequate VL results in DBS, thus allowing DBS use for VL monitoring.
Vocal Ability and Musical Performances of Nuclear Damages in the Marshall Islands
Authors: Schwartz Jessica A.
Published: July 2016

The United States conducted sixty-seven nuclear tests in the Marshall Islands from 1946 through 1958. The program was shrouded in secrecy; information about the tests conducted on Marshallese bodies and their land remains classified. This essay considers how Marshallese women from Bikini Atoll and Rongelap Atoll musically sound physical and physiological disruptions and dislocations that expose broader damages caused by the nuclear testing program. Analyzing compositions and performances from a repertoire of Marshallese “radiation songs,” the essay proposes a stylistic framework that works to familiarize listeners with a sonorized logic of radiation which is compiled through recurring motifs of the disabled voice, text setting and silences, and the figure of the question, literal and rhetorical. I stress the political import of these songs as highlighting the failures of biopolitical controls on communities by exposing the production of confined disability at the level of cultural and structural violence.
Music, Social Justice, and Social Inclusion
Authors: Marsh Kathryn
Published: July 2016

Refugees and newly arrived immigrants may face a range of social, emotional, and cultural challenges related to geographical and cultural displacement and trauma experienced in the country of origin, en route, and in the process of relocation and resettlement in a host country. In this chapter the role of music in the lives of young refugees and newly arrived immigrants in Sydney, Australia, is investigated in terms of its social and cultural effects. The chapter focuses on the collaborative music and dance activities of a Sierra Leone Youth Group and an Intensive English Centre (a specialist secondary school for newly arrived students). For marginalized participants, the music and dance activities, conceived within a socially just framework, were seen to provide opportunities for participatory parity, cultural justice, and social inclusion, within communities from both the home and host cultures.
Intersecting Social Justices and Music Education
Authors: Jorgensen Estelle R.
Published: July 2016

In this chapter, responses to three interrelated questions are sketched: Why should music educators be interested in justice? What is meant by the term “social justice” and what are the sorts of social justice? How should music educators act on behalf of justice? The case is made for a multifaceted view of justice broadly construed. Aspects of distributive justice, communitarian justice, commutative justice, contributive justice, procedural justice, retributive justice, restorative justice, poetic justice, instrumental justice, legal justice, divine justice, and justice viewed through natural law are applied to notions of social justice from the perspective of education and music education. Several practical steps in working against injustice and toward justice in and on behalf of music education are offered.
Music Education Assessment and Social Justice
Authors: Fautley Martin
Published: July 2016

This chapter considers the role that assessment, particularly formative assessment, has to play with regard to social justice purposes in education. It disentangles the notion of assessment from that of testing. Valorization of music is highly significant, as what is valued tends to be what is assessed. This can result in the disenfranchising of world music, pop, rock, and jazz on a daily basis in music classrooms all over the Western world; so this chapter problematizes the content of the music curriculum, too, asking whether that which can be labeled “school music” has any relevance beyond itself. To counter these problems, this chapter suggests the use of feed forward, which takes place during music making, privileging process over product. It suggests that the principal purpose of assessment should be to improve learning in music, not to simply provide data for systemic purposes.
Evolutionary Dynamics in Internal Market Regulation in the European Union
Authors: Thatcher Mark , Woll Cornelia
Published: July 2016

The chapter shows how European internal market regulation expanded and was transformed from a limited and often non-binding set of policies to an integrated and wide-ranging framework. Incremental but profound change was possible because critical junctures, in particular judgments by the European Court of Justice, allowed the European Commission and its allies to advance new policy proposals with new default positions. This affected the preferences of major member states, created new coalitions, and also led to the emergence of new actors. Feedback loops reinforced the orientation of previous agreements and created changes that most observers would have qualified as impossible three or four decades earlier.
The Europeanization of Swedish Foreign Policy and Beyond
Authors: Brommesson Douglas
Published: July 2016

This chapter analyzes the role conceptions of Swedish foreign policy since the end of the Cold War. The chapter’s point of departure is a theoretical framework based on role theory, including the scope conditions for role change and the possibility of the Europeanization of foreign policy roles. Based on a reading of previous studies of Swedish foreign policy and primary sources, the chapter first analyzes how Swedish foreign policy role conception was Europeanized during the 1990s and early 2000s. Secondly, it examines how this Europeanized role was subsequently complemented by a reemerging Nordic one. The conclusion of the chapter is that Sweden’s foreign policy role conception today is characterized by multiple roles.
Constitutional History
Authors: Petersson Olof
Published: July 2016

In one sense, Sweden follows the general pattern of constitution-making. The major shifts in the constitutional history have occurred in the aftermath of great crises. Constitutions have been important as descriptions and justifications of the prevailing forces of power. On the other hand, the constitutions of Sweden have been relatively insignificant as norms regulating political and public life. Constitutions have been important as history writing but relatively unimportant as normative principles shaping society, and, indeed, profound changes such as the introduction of parliamentary government have taken place without constitutional reform. The Swedish welfare state was built upon negotiations and practical trade-offs rather than constitutional arguments.
Theories of Language
Authors: Fellerer Jan
Published: July 2016

This chapter identifies key notions about the nature and workings of language and their wider political implications in Europe from around 1789 to the first decades of the nineteenth century. There are at least three formations, aesthetic and philosophical, linguistic, and political. Even though treated under separate headings for ease of exposition, they are meant to meet in this introduction in response to more granular surveys. The political dimension in particular tends to be left to historians or to philologists who deal with that part of the continent where it first gained real prominence: East and East Central Europe. Thus, after the first two sections on aspects of philosophy and early linguistics, where the focus is on Germany with France and England, the third section on language and nation moves eastwards to the Slavonic-speaking lands, to finally return back, albeit very briefly, to the West. The main purpose of this survey to provide introduction and guidance.
Deixis and the Interactional Foundations of Reference
Authors: Sidnell Jack , Enfield N.J.
Published: July 2016

Deictic expressions such as here–there, this–that, now–then, I–you make interpretable reference only by virtue of an indexical connection to some aspect of the things, people, places, and times that constitute the speech event. For instance, this refers by identifying some enumerable thing proximate to the speaker. Now indicates a temporal span that overlaps with the time of speaking. In what follows, we suggest that through a study of deixis in both its most basic and its elaborated forms it is possible to apprehend the interactional foundations of all reference which, like deixis, involves directing the attention of others.
Managing Pod Rot of Lima Bean Caused by Phytophthora capsici with Fungicides in the Mid-Atlantic Region
Authors: Kness Andrew A. , Johnson Gordon , Everts Kathryne L. , Evans Thomas A. , Donofrio Nicole M. , Ernest Emmalea G.
Published: July 2016

The baby lima bean (Phaseolus lunatus) is one of the most economically important crops for Delaware. Pod rot of lima bean caused by Phytophthora capsici is a relatively new disease that threatens production and profitability of lima beans grown in Delaware and the mid-Atlantic region. Insensitivity to the fungicide mefenoxam has made managing the disease challenging in recent years. In 2014, 12 fungicides in two trials were tested for their efficacy against P. capsici in lima bean. Results indicated that all fungicide treatments significantly reduced disease incidence compared to the control, with oxathiapiprolin achieving the best control in Trial 1 and fluazinam and mefenoxam achieving the best control in Trial 2. Fungicide treated plots also yielded significantly greater than controls in Trial 2. These results indicate that there are additional fungicides on the market with efficacy towards managing pod rot of lima bean and warrant further investigation for possible new labels.

Accepted for publication 16 May 2016. Published 9 June 2016.
Analysis of Sequenced Genomes of Xanthomonas perforans Identifies Candidate Targets for Resistance Breeding in Tomato
Authors: Timilsina Sujan , Abrahamian Peter , Potnis Neha , Minsavage Gerald V. , White Frank F. , Staskawicz Brian J. , Jones Jeffrey B. , Vallad Gary E. , Goss Erica M.
Published: July 2016

Bacterial disease management is a challenge for modern agriculture due to rapid changes in pathogen populations. Genome sequences for hosts and pathogens provide detailed information that facilitates effector-based breeding strategies. Tomato genotypes have gene-for-gene resistance to the bacterial spot pathogen Xanthomonas perforans. The bacterial spot populations in Florida shifted from tomato race 3 to 4, such that the corresponding tomato resistance gene no longer recognizes the effector protein AvrXv3. Genome sequencing showed variation in effector profiles among race 4 strains collected in 2006 and 2012 and compared with a race 3 strain collected in 1991. We examined variation in putative targets of resistance among Florida strains of X. perforans collected from 1991 to 2006. Consistent with race change, avrXv3 was present in race 3 strains but nonfunctional in race 4 strains due to multiple independent mutations. Effectors xopJ4 and avrBs2 were unchanged in all strains. The effector avrBsT was absent in race 3 strains collected in the 1990s but present in race 3 strains collected in 2006 and nearly all race 4 strains. These changes in effector profiles suggest that xopJ4 and avrBsT are currently the best targets for resistance breeding against bacterial spot in tomato.
Transmission ofXylella fastidiosato Grapevine by the Meadow Spittlebug
Authors: Cornara D. , Sicard A. , Zeilinger A. R. , Porcelli F. , Purcell A. H. , Almeida R. P. P.
Published: July 2016

There is little information available on Xylella fastidiosa transmission by spittlebugs (Hemiptera, Cercopoidea). This group of insect vectors may be of epidemiological relevance in certain diseases, so it is important to better understand the basic parameters of X. fastidiosa transmission by spittlebugs. We used grapevines as a host plant and the aphrophorid Philaenus spumarius as a vector to estimate the effect of plant access time on X. fastidiosa transmission to plants; in addition, bacterial population estimates in the heads of vectors were determined and correlated with plant infection status. Results show that transmission efficiency of X. fastidiosa by P. spumarius increased with plant access time, similarly to insect vectors in another family (Hemiptera, Cicadellidae). Furthermore, a positive correlation between pathogen populations in P. spumarius and transmission to plants was observed. Bacterial populations in insects were one to two orders of magnitude lower than those observed in leafhopper vectors, and population size peaked within 3 days of plant access period. These results suggest that P. spumarius has either a limited number of sites in the foregut that may be colonized, or that fluid dynamics in the mouthparts of these insects is different from that in leafhoppers. Altogether our results indicate that X. fastidiosa transmission by spittlebugs is similar to that by leafhoppers. In addition, the relationship between cell numbers in vectors and plant infection may have under-appreciated consequences to pathogen spread.
Infant Medical Trauma in the Neonatal Intensive Care Unit (IMTN)
Authors: D'Agata Amy L. , Young Erin E. , Cong Xiaomei , Grasso Damion J. , McGrath Jacqueline M.
Published: July 2016

Background:

Trauma is an innately subjective experience ensuing from a deeply distressing event. Research has demonstrated that while the environment of the neonatal intensive care unit (NICU) is capable of providing extraordinary lifesaving measures following birth, the experience may be disruptive to several key aspects of early development, placing infants at risk for adverse behavioral, cognitive, and emotional outcomes.

Purpose:

This article provides rationale for the concept of Infant Medical Trauma in the NICU (IMTN) as a means of describing this unique stress experience. A triad of cumulative early life NICU experiences (stress, parental separation, and pain) is proposed to influence an infant's swinging neurodevelopmental pendulum amid the potential outcomes of risk and resilience.

Implications for Practice and Research:

Creating language that describes the infant experience brings meaning and calls caregivers and parents to action to consider strategies that may improve long-term health. Actively seeking opportunities to decrease the allostatic load of at-risk infants may support an infant's pendulum to swing toward a path of resilience, thereby moderating his or her early life adverse experience.
The Implications of Parental Consanguinity on the Care of Neonates
Authors: Ng Diana
Published: July 2016

Background:

Approximately 6% of births worldwide, 7.9 million children, are born with a serious genetic congenital abnormality each year. A factor thought to increase the prevalence of birth defects is parental consanguinity, which is a social custom practiced in at least 20% of the world's population.

Purpose:

The purpose of this article is to explore the relationship between consanguinity and congenital defects. This article also aims to enhance neonatal healthcare practitioners' comprehension of its implications for practice and research.

Methods:

A review of literature was compiled from a search of the online databases Cumulative Index of Nursing and Allied Health (CINAHL), PubMed, EBSCO MegaFILE, and Google Scholar.

Results:

Literature pertinent to this topic primarily consists of research studies that examine the inbreeding depression phenomenon through comparison of the prevalence of birth defects among the offspring of consanguineous and nonconsanguineous couples. Current studies indicate that the progeny of consanguineous couples are at an increased risk of congenital defects compared with those of nonconsanguineous couples.

Implications for Practice:

Consanguinity is one risk factor among many that can lead to a major birth defect. Relationships between consanguineous populations and neonatal healthcare practitioners such as registered nurses, advanced practice nurses, and physicians could significantly alter neonatal health outcomes. Specific recommendations such as genetic counseling and therapeutic communication are discussed.

Implications for Research:

Further studies need to investigate the connection between consanguinity and birth defects while controlling for nongenetic variables. Moreover, a focus on consanguineous communities in the United States would prove beneficial.
Association of Baseline Proteinuria and Adverse Outcomes in Pregnant Women With Treated Chronic Hypertension
Authors: Morgan Jamie L. , Nelson David B. , Roberts Scott W. , Wells C. Edward , McIntire Donald D. , Cunningham F. Gary
Published: July 2016

OBJECTIVE:

To assess the importance of baseline proteinuria in women treated for chronic hypertension during pregnancy.

METHODS:

This retrospective cohort study included women with chronic hypertension who received antihypertensive therapy in the first half of pregnancy and completed urine protein quantification before 20 weeks of gestation. Maternal and neonatal outcomes were analyzed according to the presence or absence of baseline proteinuria, defined as 300 mg or greater per 24 hours identified before 20 weeks of gestation. Frequencies of superimposed preeclampsia, preterm birth, and small-for-gestational-age neonates were further evaluated according to stratified urine protein excretion levels from less than 50 mg to greater than 1,000 mg/24 hours.

RESULTS:

Between January 2002 and December 2014, a total of 447 women met inclusion criteria. Of these, 56 (13%) had baseline proteinuria. Women with baseline proteinuria were statistically significantly more likely to develop superimposed preeclampsia (79% compared with 49%), deliver preterm (18% compared with 6% 30 weeks of gestation or less, 34% compared with 17% 34 weeks of gestation or less, and 48% compared with 26% less than 37 weeks of gestation), and deliver an small-for-gestational-age neonate (41% compared with 22% less than the 10th percentile, 20% compared with 9% less than the third percentile) when compared with women who did not have proteinuria (all P<.05). Furthermore, the rates of superimposed preeclampsia and small for gestational age were significantly increased as 24-hour protein excretion levels increased across stratified levels (P for trend .002 and .015, respectively). When proteinuria levels less than 300 mg/d were analyzed separately, a significant association was observed for rates of superimposed preeclampsia and preterm birth.

CONCLUSION:

In pregnant women with treated chronic hypertension, baseline proteinuria was significantly associated with increased rates of preeclampsia, preterm birth, and growth restriction—even at proteinuria values previously considered to be within normal range (less than 300 mg/d).
Outcomes of Pregnancies Complicated by Preterm Premature Rupture of Membranes Between 20 and 24 Weeks of Gestation
Authors: Kibel Mia , Asztalos Elizabeth , Barrett Jon , Dunn Michael S. , Tward Carly , Pittini Alex , Melamed Nir
Published: July 2016

OBJECTIVE:

To assess the natural history and contemporary outcomes in pregnancies complicated by previable preterm premature rupture of membranes (PROM).

METHODS:

Retrospective study of all women with a singleton or twin pregnancy admitted to a single tertiary referral center who experienced preterm PROM between 20 and 23 6/7 weeks of gestation during 2004–2014 and underwent expectant management. Women electing termination of pregnancy and pregnancies complicated by major fetal anomalies were excluded. Severe neonatal morbidity was defined as a composite of bronchopulmonary dysplasia, severe neurologic injury, or severe retinopathy of prematurity. Long-term follow-up to a corrected age of 18–21 months was available for the majority of surviving neonates.

RESULTS:

Of the 140 neonates born to women with previable preterm PROM during the study period, 104 were eligible for the study. Overall 51 (49.0%, 95% confidence interval [CI] 39.4–58.6%) newborns survived to discharge, of whom 24 (47.1%, 95% CI 33.4–60.8%) experienced severe neonatal morbidity. The overall rate of long-term morbidity among surviving neonates was 23.3% (95% CI 11.7–34.9%) and was significantly higher among neonates who previously experienced severe neonatal morbidity compared with those who did not (39.1% compared with 10.0%, P=.04). The only two factors that were significantly associated with overall survival and survival without severe neonatal morbidity were gestational age at preterm PROM of 22 weeks or greater (adjusted odds ratio [OR] 12.2, 95% CI 3.3–44.8 and adjusted OR 4.8, 95% CI 1.2–19.3, respectively) and a latency period of greater than 7 days (adjusted OR 10.1, 95% CI 3.2–31.6, and adjusted OR 6.7, 95% CI 2.2–21.0, respectively). Expectant management was associated with maternal risks including placental abruption (17.3%, 95% CI 10.0–24.6%) and sepsis (4.8%, 95% CI 0.7–8.9%).

CONCLUSION:

Expectant management in pregnancies complicated by previable preterm PROM between 20 and 23 6/7 weeks of gestation is associated with an overall neonatal survival rate of 49.0%, high risk of short- and long-term severe morbidity among survivors, and carries considerable maternal risks.
Expression of miRNA-124a in CD4 Cells Reflects Response to a Multidisciplinary Treatment Program in Patients With Chronic Low Back Pain
Authors: Luchting Benjamin , Heyn Jens , Hinske Ludwig Christian , Azad Shahnaz Christina
Published: July 2016

Study Design.

A prospective evaluation of microRNA (miRNA) expression in patients with chronic low back pain (CLBP).

Objective.

The aim of this study was to evaluate whether pain- and T cell-related miRNAs are differentially expressed in CLBP when compared with healthy volunteers and whether these miRNAs may distinguish between responders and nonresponders to a multidisciplinary treatment program.

Summary of Background Data.

CLBP is a common health problem worldwide. Multidisciplinary pain treatment programs have been proven as an effective treatment option. miRNAs are known to be important mediators of gene regulation in various processes, including pathophysiology of pain. The expression of miRNAs in CLBP and changes due to a multidisciplinary treatment programs are still unknown.

Methods.

Thirty-four patients with CLBP were enrolled (46.5 ± 12.7 yrs). CLBP was defined as low back pain with an average intensity of numerical rating scale (NRS) ≥3 during the last 4 weeks, persisting longer than 6 months, and not attributable to a recognized specific pathological condition. Expression of pain- and T cell-related miRNAs in human CD4+ cells were determined using TaqMan assays and RealTime PCR. MiRNA expression in patients with CLBP was compared with the expression in healthy volunteers before a multidisciplinary treatment program started. The multidisciplinary outpatient program (4 weeks, 5 days a week, 8 h per day) is a clinically established outpatient program and comprises medical (examination, education), physical (exercise), work-related, and psychological therapy components. After the program, differentially expressed miRNAs in CLBP (before treatment) were analyzed once more. Expression of these miRNAs in patients who respond to the treatment (n = 14) was compared with those who did not respond (n = 20). Response to therapy was defined as reduction of pain of ≥50% (NRS) from baseline.

Results.

MiRNA-124a (patients: 0.79 ± 0.63 vs. healthy volunteers: 0.30 ± 0.16; P < 0.001), miRNA-150 (patients: 0.75 ± 0.21 vs. healthy volunteers: 0.56 ± 0.20; P = 0.025), and miRNA-155 (patients: 0.55 ± 0.14 vs. healthy volunteers: 0.38 ± 0.16; P = 0.017) were significantly upregulated in CLBP patients when compared with healthy volunteers. After the multidisciplinary treatment program, patients who respond to the treatment showed only an increase of miRNA-124a expression (before treatment: 0.54 ± 0.26 vs. after treatment: 1.05 ± 0.56, P = 0.007).

Conclusion.

MiRNA-124a upregulation is associated with therapy response in a multidisciplinary treatment programs and might help to identify more specific and mechanism-based treatment strategies for CLBP.

Level of Evidence: 3
ACR Appropriateness Criteria® Management of Recurrent Endometrial Cancer
Authors: Elshaikh Mohamed A. , Vance Sean , Gaffney David K. , Biagioli Matthew , Jhingran Anuja , Jolly Shruti , Kidd Elizabeth , Lee Larissa J. , Li Linna , Moore David H. , Rao Gautam G. , Wahl Andrew O. , Williams Ned L. , Yashar Catheryn M. , Small William
Published: July 2016

Objectives:

In women with endometrial carcinoma (EC), tumor recurrences tend to occur in the 2- to 3-year period following surgical staging. Management of disease recurrence in EC poses significant challenges. These patients represent a heterogenous group where histologic subtypes, previous adjuvant management, interval since completion of adjuvant therapy, and size and site(s) of disease recurrence all have important implications on salvage therapies and prognosis. No randomized controlled trials have been published to determine optimal management in this group of patients. An expert panel was convened to reach consensus on the most appropriate management options in this group of patients.

Methods:

The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Results:

Five clinical variants were developed to address common scenarios in the management of women with recurrent EC. Group members reached consensus on the appropriateness of specific evaluation and treatment approaches with numerical ratings.

Conclusions:

In combining available medical literature and expert opinions, this manuscript may serve as an aid for other practitioners in the appropriate management of women with recurrent EC.
A Randomized, Comparative Study to Evaluate Efficacy and Safety of Two Injection Volumes of AbobotulinumtoxinA in Treatment of Glabellar Lines
Authors: Punga Anna Rostedt , Alimohammadi Mohammad , Fagrell Dan , Nyberg Frida , Rees Diane , Wong Cindy
Published: July 2016

BACKGROUND

Different volumes of 0.9% NaCl may be used to reconstitute abobotulinumtoxinA yielding an injection volume that ranges from 0.05 to 0.1 mL per injection point for treatment of glabellar lines.

OBJECTIVE

To evaluate the efficacy, safety, and subject satisfaction of 2 different injection volumes to deliver the same unit dose of abobotulinumtoxinA for treatment of glabellar lines.

MATERIALS AND METHODS

This randomized comparative study was conducted using 2 different reconstitution volumes to deliver a fixed unit dose of 10 Speywood units (sU) of abobotulinumtoxinA in either 0.05 mL (labeled volume) or 0.1 mL (twofold volume) per injection point. Evaluations included wrinkle severity, neurophysiological assessment by compound muscle action potential (CMAP), and subject satisfaction.

RESULTS

Use of either injection volume of abobotulinumtoxinA resulted in the early onset of effect, high effectiveness, and long duration of effect. The safety profile and injection pain levels were similar in both groups. The twofold injection volume was shown to be noninferior to the labeled injection volume based on CMAP results.

CONCLUSION

A twofold increase in injection volume to 0.1 mL per injection point to deliver 10 sU of abobotulinumtoxinA is effective and safe.
The Elite Athlete and Strenuous Exercise in Pregnancy
Authors: PIVARNIK JAMES M. , SZYMANSKI LINDA M. , CONWAY MICHELLE R.
Published: July 2016

Highly trained women continue to exercise during pregnancy, but there is little information available to guide them, and their health care providers, in how to maximize performance without jeopardizing the maternal-fetal unit. Available evidence focusing on average women who perform regular vigorous exercise suggests that this activity is helpful in preventing several maladies of pregnancy, with little to no evidence of harm. However, some studies have shown that there may be a limit to how intense an elite performer should exercise during pregnancy. Health care providers should monitor these women athletes carefully, to build trust and understanding.
Exercise in Pregnancy: Guidelines
Authors: ARTAL RAUL
Published: July 2016

In recent years it has been recognized that in all phases of life, including pregnancy, physical activity promotes health benefits and precludes comorbidities, the scientific evidence is indisputable. Several organizations around the world have updated in recent years the guidelines and recommendations for exercise in pregnancy. The December 2015, updated guidelines of the American College of Obstetricians and Gynecologists emphasize that physical activity in pregnancy has minimal risk. Although recommending exercise in pregnancy, the anatomic/physiological changes, absolute and relative contraindications should be considered. Women who exercised regularly before pregnancy, in the absence of contraindications, can continue and engage in moderate to strenuous activities, although information on strenuous activities in pregnancy is still limited. This review summarizes the most recent published and recommended guidelines.
Interocular Comparison of Anterior and Posterior Segment Findings and Laterality in Hyperopic Anisometropia
Authors: Cankurtaran Veysel , Tekin Kemal , Şimşek Mert , Elgin Ufuk , Yilmazbaş Pelin
Published: July 2016

Objectives:

To investigate the laterality and the differences in anterior and posterior segment findings in hyperopic patients with anisometropia between their eyes using spectral domain optical coherence tomography and LenStar LS-900 device.

Methods:

This prospective institutional study included hyperopic anisometropic patients with and without amblyopia, aged between 6 and 40 years. The refractive error and the values of keratometry, axial length (AL), central corneal thickness (CCT), peripapillary retinal nerve fiber layer (RNFL) thickness, and central macular thickness (CMT) obtained using the RK-F1 autorefractor, LenStar LS-900, and Spectralis optical coherence tomography were compared between the higher hyperopic and fellow eyes.

Results:

Eighty of the patients had hyperopic anisometropia with amblyopia and 30 of them had hyperopic anisometropia without amblyopia. The left eyes of the patients in this series were significantly more commonly affected. Axial length and CCT were significantly different between the higher hyperopic and the fellow eyes of all patients. In addition, the mean CMT and RNFL thickness of the higher hyperopic eyes were significantly higher than that of the fellow eyes.

Conclusions:

During the process of emmetropization and development of the retina, higher hyperopic eyes in hyperopic patients with anisometropia and amblyopic eyes may have blurred and abnormal vision, leading to under-development of vision, significantly higher CCT, CMT, and RNFL thickness, more hyperopic refraction, and shorter AL in the affected eye.
A Qualitative Analysis of Children's Emotional Reactions During Hospitalization Following Injury
Authors: Ramsdell Katharine Donlon , Morrison Melissa , Kassam-Adams Nancy , Marsac Meghan L.
Published: July 2016

Children who sustain injuries are at risk for experiencing traumatic stress reactions. Few studies have obtained detailed, qualitative information regarding children's and parents' own understanding of their experiences during the peritrauma period. Understanding children's injury and early hospital experiences is crucial to inform the development of early interventions during the peritrauma period, which speak to these concerns. The primary purpose of this study was to understand child and parent views of the stressors experienced by children hospitalized for an injury. A secondary aim was to identify children's feelings and thoughts about injury- and hospital-related stressors. Ten children and their parents participated in semistructured interviews. Interviews were audio-recorded, transcribed, and coded. Stressors were classified into 5 domains: procedural concerns, uncertainty, sleep and nutrition challenges, being confined to the hospital, and home preparation. Children and parents were more likely to articulate feelings about stressors than thoughts about stressors. Feelings reported by children and parents were predominantly negative. Children and parents may have an easier time expressing feelings than thoughts, which has implications for communicating with medical teams as well as for psychological treatment. Future research should examine how children's perceptions of their injury- and hospital-related experiences relate to later outcomes such as traumatic stress reactions.
Lipid‐based Nutrient Supplements Do Not Affect Gut Bifidobacterium Microbiota in Malawian Infants
Authors: Aakko Juhani , Grześkowiak Łukasz , Asukas Tiia , Päivänsäde Eerika , Lehto Kirsi‐Maarit , Fan Yue‐Mei , Mangani Charles , Maleta Kenneth , Ashorn Per , Salminen Seppo
Published: July 2016

Objectives:

The aim of the study was to assess the effect of nutritional supplementation with lipid‐based nutrient supplements (LNS) and corn‐soy blend flour on Bifidobacterium and Staphylococcus aureus gut microbiota composition in Malawian infants. In addition, the microbiota changes over time were characterized in the study infants.

Methods:

Healthy 6‐month‐old Malawian infants were randomly assigned to 1 of 4 intervention schemes for a 6‐month period. Infants in the control group were not provided with any supplementary food. Infants in other 3 groups received either micronutrient‐fortified corn‐soy blend, micronutrient‐fortified LNS with milk protein base, or micronutrient‐fortified LNS with soy protein base between 6 and 12 months of age. Fecal bifidobacteria and S aureus gut microbiota at 6 and 12 months of age were analyzed by quantitative real‐time polymerase chain reaction method.

Results:

There was no difference in change in bacterial prevalence or counts between the intervention groups during the 6‐month study period. When looking at the total study population, higher counts of total bacteria (P = 0.028), Bifidobacterium genus (P = 0.027), B catenulatum (P = 0.031), and lower counts of B infantis (P < 0.001), B lactis (P < 0.001), B longum (P < 0.001), and S aureus (P < 0.001) were detected in the children's stools at 12 months rather than at 6 months of age.

Conclusions:

The dietary supplementation did not have an effect on the Bifidobacterium and S aureus microbiota composition of the study infants. The fecal bifidobacterial diversity of the infants, however, changed toward a more adult‐like microbiota profile within the observed time.
Emergency Medical Services Provider Pediatric Adverse Event Rate Varies by Call Origin
Authors: Jones David , Hansen Matt , Van Otterloo Josh , Dickinson Caitlin , Guise Jeanne-Marie
Published: July 2016

Objective

Emergency medical services providers may be called to a variety of sites to transport pediatric patients, whether it be a scene call for initial evaluation and care, a clinic for transportation of a patient who has been assessed by medical providers, or a hospital where assessment and stabilization have already begun. We hypothesize that there may be a direct relationship between adverse event rates and adverse event severity in transports from less medically stabilizing origins.

Methods

Emergency medical services records of all critical pediatric transports in an urban Oregon county in 2011 were reviewed and abstracted using a standardized tool. From this, UNSEMs (unintended injury, near miss, suboptimal action, error, management complication) were determined, and the potential severity of the issue was assessed. Then, UNSEMs were compared with the origin of transport using logistic regression.

Results

Four hundred ninety records were abstracted: 59 hospital transports, 48 clinic transports, and 384 scene transports. Furthermore, UNSEMs were noted in 24 hospital transports (40.7%), 33 clinic transports (68.8%), and 263 scene transports (68.5%). Severe UNSEMs were reported on 0 hospital transports (0.0%), 12 clinic transports (25.0%), and 65 scene transports (16.9%). The odds ratio of UNSEM occurrence from a hospital compared with nonmedical scenes was 0.35 (95% confidence interval, 0.20–0.60), and the odds ratio of a severe UNSEM from a hospital compared with nonmedical scenes was 0.09 (95% confidence interval, 0.01–0.63).

Conclusions

In conclusion, UNSEMs involving the emergency medical services care of children are more likely to occur when transport originates from a clinic or scene compared with a hospital.
Children Covered by Medicaid/State Children's Health Insurance Program More Likely to Use Emergency Departments for Food Allergies
Authors: Pruitt Zachary , Pruitt Rebecca Copeland
Published: July 2016

Background

Food allergies (FAs) occur in 4% to 8% of children in the United States, and emergency department (ED) visits account for up to 20% of their costs. In 2010, the National Institute of Allergy and Infectious Diseases established diagnostic criteria and management practices for FAs, and recognition and treatment of FAs for pediatric ED practitioners has been described.

Objective

This study identified trends and factors related to ED visits for pediatric FAs in the United States from 2001 to 2010. It was hypothesized that FAs increased and that differences existed in ED utilization based on age, insurance status, and geography. Low concordance with treatment guidelines for FAs was expected.

Methods

Multivariate logistic regression, using National Hospital Ambulatory Medical Care Survey data, estimated factors associated with ED visits and treatment of FAs and nonspecific allergic reactions. Trends and treatment patters used weighted frequencies to account for the complex 4-stage probability survey design.

Results

An estimated 239,303 (95% confidence interval [CI], 180,322–298,284) children visited the ED for FAs, demonstrating a significant rate increase during the period (53.08, P < 0.001). Logistic regression showed that the odds of ED visits for FAs were significantly associated with Medicaid/State Children's Health Insurance Program insurance (OR, 1.65 [95% CI, 1.01–2.69], P = 0.04), adolescents (OR, 1.92 [95% CI, 1.10–3.35], P = 0.02), and boys (OR, 1.55 [95% CI, 1.03–2.35], P = 0.04). Treatment with epinephrine for anaphylaxis diagnoses occurred in 57.4% of visits (95% CI, 42.3%–66.8%).

Conclusions

Medicaid/State Children's Health Insurance Program–insured pediatric patients had higher odds of visiting ED for recognized FAs and nonspecific allergic reactions and higher odds of receiving epinephrine than privately insured children.
Global Epidemiology of HIV Infection and Related Syndemics Affecting Transgender People
Authors: Poteat Tonia , Scheim Ayden , Xavier Jessica , Reisner Sari , Baral Stefan
Published: July 2016

Introduction:

Transgender populations have been underrepresented in HIV epidemiologic studies and consequently in HIV prevention, care, and treatment programs. Since 2012, there has been a dramatic increase in research focused on transgender people. Studies highlight the burden of HIV and risk determinants, including intersecting stigmas, as drivers of syndemics among transgender populations. This review synthesizes the most recent global epidemiology of HIV infection and describes current gaps in research and interventions to inform prioritization of HIV research for transgender populations.

Methods:

A systematic review was conducted of the medical literature published between January 1, 2012 and November 30, 2015. The data focused on HIV prevalence, determinants of risk, and syndemics among transgender populations.

Results:

Estimates varied dramatically by location and subpopulation. Transfeminine individuals have some of the highest concentrated HIV epidemics in the world with laboratory-confirmed prevalence up to 40%. Data were sparse among trans masculine individuals; however, they suggest potential increased risk for trans masculine men who have sex with men (MSM). No prevalence data were available for transgender people across Sub-Saharan Africa or Eastern Europe/Central Asia. Emerging data consistently support the association of syndemic conditions with HIV risk in transgender populations.

Discussion:

Addressing syndemic conditions and gender-specific challenges is critical to ensure engagement and retention in HIV prevention by transgender populations. Future research should prioritize: filling knowledge gaps in HIV epidemiology; elucidating how stigma shapes syndemic factors to produce HIV and other deleterious effects on transgender health; and understanding how to effectively implement HIV interventions for transgender people.
Longitudinal Study of Retinal Nerve Fiber Layer Thickness and Macular Volume in Patients With Neuromyelitis Optica Spectrum Disorder
Authors: Manogaran Praveena , Traboulsee Anthony L. , Lange Alex P.
Published: July 2016

Background:

Neuromyelitis spectrum disorder (NMOSD) is a rare autoimmune disorder previously thought to be a subtype of multiple sclerosis (MS). NMOSD is characterized by episodes of inflammation and damage to astrocytes that primarily results in damage to optic nerve and spinal cord. The objective of this exploratory study was to use optical coherence tomography (OCT) to measure axonal and neuronal health in NMOSD eyes over time.

Methods:

Nine patients with definite NMOSD were assessed at baseline and follow-up visits (time between visits: 35–55 months). OCT assessment involved a macular volume protocol and a retinal nerve fiber layer (RNFL) thickness scan.

Results:

The temporal, inferior, nasal, or superior quadrant and the mean global RNFL thickness, macular thickness, and volume of each NMOSD patient was unchanged compared with baseline for each eye separately and both together. There also was no change between the 2 time points for the OCT measures for eyes affected and unaffected by optic neuritis and all eyes together except for a significant change in the temporal RNFL quadrant when all NMOSD eyes were pooled together (mean = 2.88 μm, SD = 3.7,P= 0.021).

Conclusions:

Unlike in MS eyes, ongoing RNFL and macular thinning secondary to brain and optic nerve atrophy could not be observed in NMOSD eyes during an observation period of 4 years. This might be an additional marker to distinguish these 2 diseases. However, to confirm this finding, more long-term data are needed to compare these 2 diseases longitudinally.
Cell-type specific open chromatin profiling in human postmortem brain infers functional roles for non-coding schizophrenia loci
Authors: Fullard John F. , Giambartolomei Claudia , Hauberg Mads E. , Xu Ke , Bare Christopher , Dudley Joel T. , Mattheisen Manuel , Pickrell Joseph K. , Haroutunian Vahram , Roussos Panos
Published: July 2016

To better understand the role of cis regulatory elements in neuropsychiatric disorders we applied ATAC-seq to neuronal and non-neuronal nuclei isolated from frozen postmortem human brain. Most of the identified open chromatin regions (OCRs) are differentially accessible between neurons and non-neurons, and show enrichment with known cell type markers, promoters and enhancers. Relative to those of non-neurons, neuronal OCRs are more evolutionarily conserved and are enriched in distal regulatory elements. Our data reveals sex differences in chromatin accessibility and identifies novel OCRs that escape X chromosome inactivation, with implications for intellectual disability. Transcription factor footprinting analysis identifies differences in the regulome between neuronal and non-neuronal cells and ascribes putative functional roles to 16 non-coding schizophrenia risk variants. These results represent the first analysis of cell-type-specific OCRs and TF binding sites in postmortem human brain and further our understanding of the regulome and the impact of neuropsychiatric disease-associated genetic risk variants.