bluuebunny/crossref_metadata_2025 huggingface dataset:
Antinomies of the Twenty-First-Century Neobaroque: Cormac McCarthy and Demian Schopf
Authors: Kaup Monika
Published: October 2018

Cormac McCarthy’s novel The Road (2006) and Chilean artist Demian Schopf’s photographic exhibits embody the Baroque’s notorious contradictory nature: the baroque is at once joyful and sad. One wing of baroque expression, with historical roots in the Catholic religious baroque, is closely associated with the melancholic contemplation of ruin, death, and catastrophe. At the other end of the spectrum, there is the Deleuzian principle of becoming-minor, the program of the rebellious consumption of tradition and of re-creating existing forms. In The Road, McCarthy memorializes post-apocalyptic ruin in a grand baroque style reminiscent of Robert Burton and Sir Thomas Browne. Conversely, Schopf’s portraits of harquebus-brandishing angels and Andean dancers in colorful costumes embodying Christian and pagan figures recover the Andean mestizo baroque, one of the major expressions of the transculturating New World baroque. McCarty’s post-apocalyptic baroque meditates on death, extinction and finitude; Schopf’s joyful baroque celebrates the creativity of culture and its evolution toward greater diversity.
Relational Work and Consumption
Authors: Bandelj Nina , Gibson Christopher W.
Published: October 2018

This chapter reviews to what extent, and in what ways, contemporary studies of consumption have addressed how people create, maintain, and transform meaningful social relations as they engage in consumption. The chapter presents the origins, definitions, and applications of the relational work concept, which puts negotiation of meaningful social-economic relations at its core. It then proceeds to identify four streams of research where attention to relational work can advance our understanding of consumption, including how consumers (a) earmark their money, (b) build trust or repair mistrust in exchanges, (c) negotiate power and inequality through consumption practices, and (d) walk the terrain of morally tinged commodification.
The Humours in Humour
Authors: Steggle Matthew
Published: October 2018

Did Shakespeare believe in the four humours? And did he write ‘humours comedy’? To address these questions, this chapter suggests that humoral theory is intimately bound up with early modern ideas of selfhood, not merely as a metaphor, but as a literal understanding of the processes at work in cognition, emotion, and selfhood. A Midsummer Night’s Dream, in particular, is taken as a case study for how Shakespearean comedy understands the relationship between mind and body. Next, it re-examines the idea of ‘humours comedy’, arguing that we should see the true Shakespearean ‘comedy of humours’ in plays that celebrate not the fixity of identity, but its fluidity within a sentient body conceived of in terms of humours theory. The chapter takes as its closing case study The Comedy of Errors, suggesting that it, and Shakespearean comedy more generally, engages through the humours ideas of selfhood as mutable, communicable, and liquid.
Going Radical
Authors: Hutto Daniel D. , Myin Erik
Published: October 2018

E-approaches to cognition—enactive, embodied, ecological—conceive of minds as fundamentally relational and interactive. They are often heralded as offering a new paradigm for thinking about the mental. Yet only the most radical versions of E-approaches—those that seek not to complement but to replace traditional cognitivist accounts of mind—have any prospect of ushering in a truly revolutionary rethink of the nature of cognition. This chapter considers whether such a conceptual revolution might really be in the cards. It identities the major options proposed by E-theorists, rating each in terms of degree of radicality. It reminds readers of the hard problem of content and reviews the range of options for handling it. It argues that “going radical” is one of the most attractive ways of dealing with the hard problem of content and that it is worth exploring the positive research program that going radical opens up.
Governance Networks
Authors: Hendriks Carolyn M. , Boswell John
Published: October 2018

This chapter explores the relationship between deliberative democracy and governance networks, defined as policy partnerships of interdependent actors from public, private, and societal sectors. While many networks are built and operate around core deliberative democratic norms, such as trust, reciprocity, and loyalty, they can threaten others such as openness, publicity, democratic legitimacy, and accountability. The chapter considers the roles and risks that governance networks offer for public deliberation understood in broader systemic terms. It argues that networks play a number of important systemic functions: they generate ideas, inform deliberation, and provide opportunities for discursive connectivity. But empirical research reveals that networks can also pose pathologies for deliberative systems; they can be elite, exclusive, and dominated by special interests. A number of practical strategies are offered for how deliberative systems can boost the deliberative and democratic credentials of governance networks.
Deliberation in Sociology
Authors: Schneiderhan Erik , Khan Shamus
Published: October 2018

Sociology has long been interested in the study of deliberation; it is a “big idea” that might guide the organization of modern social life. While in some strands of sociology it still is, this chapter argues that sociological work on deliberation has by and large moved away from big ideas toward a narrow project that is somewhat disconnected from the world outside the ivory tower. The chapter presents the best sociology has to offer scholars of deliberation, with a focus on ideas and practice. Specifically, the chapter advocates an approach to deliberation that engages with the relational turn of sociology, focusing less on decision-making outcomes and more on social relations and dynamics.
Deliberative Democracy and Multiculturalism
Authors: Deveaux Monique
Published: October 2018

Deliberative democracy is widely associated with a public sphere that is more inclusive of cultural and religious minority groups than that established by a model of politics as interest aggregation. But it has also been criticized for stipulating unjust terms for this political inclusion, and for being insufficiently responsive to identity group-based claims. Such challenges have prompted much internal debate about the validity and the practical consequences of different norms and mechanisms of deliberative democracy. This chapter argues that models of public deliberation less beholden to Habermasian discourse ethics are able to offer a more promising response to these multicultural challenges.
Deliberative Constitutionalism
Authors: Kong Hoi L. , Levy Ron
Published: October 2018

Deliberative constitutionalism incorporates insights from constitutional and deliberative democratic theory in order to present a more complete picture of constitutional practice than either of its source disciplines can offer. This chapter identifies some of the hybrid theory’s novel contributions. Kong and Levy claim that a constitution’s overriding objective should be to create an institutional framework for rigorous and inclusive public deliberation that helps a polity work through specific social controversies (e.g. same-sex marriage). The authors therefore argue that the hybrid theory brings to the general normative claims of deliberative democratic theory a specifically institutional and legal focus. They also argue that deliberative constitutionalism redirects longstanding debates in constitutional theory away from the standard courts–legislatures axis. The chapter examines what deliberative constitutionalism might entail for an assortment of actors (e.g. judges and ordinary citizens) and constitutional features (e.g. domestic and international rights, and federalism) in democracy and governance.
The Forms of Deliberative Communication
Authors: Polletta Francesca , Gardner Beth
Published: October 2018

As deliberative democratic theory has moved from a macro theory of democratic legitimacy to prescriptions for institutional design, questions about what constitutes deliberative communication have taken on increasing practical importance. At the same time, empirical data has accumulated to answer those questions. We review findings on the kinds of talk that produce either mutually-agreed upon decisions or better understanding of the issues at stake, equality among speakers, and impacts on policies or participants after the forum is over. Deliberative talk in facilitated settings today does not resemble the abstract, dispassionate reason-giving imagined by many theorists of deliberation. However, precisely for that reason, deliberative talk today is producing some of the benefits claimed for it.
Indigenous Spheres of Deliberation
Authors: Hébert Martin
Published: October 2018

Indigenous peoples’ rights to self-determination and self-government are recognized by several international instances. Deliberation plays a key role in the exercise of these rights, and its forms are as diverse as the cultures and social structures of which it is part. However, efforts to understand commonalities and differences between contexts and experiences have led to discussions of what Rodolfo Stavenhagen has termed the “indigenous situation.” This chapter looks at some ways in which self-identified Indigenous peoples have maintained, repurposed, and developed practices of political deliberation within such contexts of colonialism, nation-state formation, and capitalist expansion. A particular emphasis is put on the various scales at which deliberation takes place, be it in community life, regional organizations, or national and international political movements.
Deliberative Systems
Authors: Parkinson John
Published: October 2018

The deliberative systems approach focuses on “deliberative” as an adjectival quality of democratic systems, whether small-scale or large, rather than on “deliberation” as a noun. But how systems come to merit that adjective rather than any other is still an open question. This chapter addresses that by way of four subsidiary questions, which result in claims that deliberation is just one of several communicative modes in a democracy; that practices and systems need to be seen in light of power relations, especially agenda power; that systems are often better seen as processes, not venues, dynamic things occupied by purposive agents and not just formal, static relationships between institutions; and that the deliberative quality of a system might be best thought of in summative rather than additive terms. The chapter is, above all, a call to repoliticize deliberative scholarship.
Psychosis High-Risk States
Authors: Madeira Luís , Bonoldi Ilaria , Nelson Barnaby
Published: October 2018

Psychosis High-Risk states are today a major field of research in psychiatry allowing early intervention (including primary prevention) of severe psychotic disorders. Psychosis High-Risk criteria select different clinical features and appear to be different center-wise and country-wise. As several of the phenomena accounting for symptoms are subjective in nature, both original and recent inputs from research in phenomenological psychopathology are great candidates for adding to the conceptual validity of High-Risk states. These subjects show a disturbed grip on reality–perplexity, derealization, and depersonalization—as well as a diminished presence in the world and involuntarily ruminating on things they previously ignored. Special sets of phenomena are presented including Truman symptoms, anomalous subjective self and world experiences, and abnormal bodily phenomena. Contemporary predictive and translational research will ultimately integrate phenomenological data with the neurocognitive and neurobiological models of mental disorders.
Cultural Distance: A Computational Approach to Exploring Cultural Influences on Music Cognition
Authors: Morrison Steven J. , Demorest Steven M. , Pearce Marcus T.
Published: October 2018

Although music is a universal phenomenon, the structural features that characterize specific music traditions reflect the unique cultures in which those traditions reside. Consequently, encounters with music from other cultures can present difficulties if the structures and patterns of that music are too different from those of one’s home culture. This chapter proposes cultural distance as a way to conceptualize the cognitive dimension of cross-cultural music interactions. It hypothesizes that an individual’s efficacy at processing a particular culture’s music depends on the degree to which the statistical patterns of pitch and rhythm in that tradition resemble those of one’s own music. The chapter employs a computational model (IDyOM) to determine the intervallic and rhythmic patterns within culture-specific music corpora and the extent of difference between cultures and between specific pieces within a culture. This computational approach offers a more fine-grained correlational means for modeling similarities and differences in cross-cultural music cognition research.
When Extravagance Impresses: Recasting Esthetics in Evolutionary Terms
Authors: Merker Bjorn
Published: October 2018

The “developmental stress hypothesis”—an extension of Zahavi’s “handicap principle” to account for the complexity and repertoire size of learned birdsong—harbors far-reaching implications for our understanding of human song and music, implications explored in this chapter. The assessment of song quality in species with vocal learning is proposed to engage a Bayesian-type neural mechanism whose emotional dimension spans from boredom, to interest/curiosity, and further—via a hedonic reversal—to being impressed or moved, with awe and a sense of sublimity at its high end. Music therefore achieves its psychological impact not by carrying language-like “meaning,” nor by being a “language of emotions,” but through its interaction with a basic perceptual/cognitive mechanism operating within the constraints of cultural traditions of learned patterned lore. The principles underpinning this analysis extend beyond music to human esthetics generally.
Acoustic Structure and Musical Function: Musical Notes Informing Auditory Research
Authors: Schutz Michael
Published: October 2018

Music’s continual temporal changes make it a useful stimulus for studying cognitive and neural processes unfolding over time. Although this dynamic nature is widely recognized on a macro level, the importance of temporal changes in individual notes is less widely discussed. For example, textbooks often focus on power spectra—time invariant summaries of spectral information—to explain differences in timbre between musical instruments. Unfortunately, this approach overlooks the importance of dynamic fluctuations in individual notes’ overtones. This chapter highlights the under-recognized importance of temporal structure in musical sounds by synthesizing a diverse range of research on musical acoustics and perception. It concludes by contrasting the rich temporal dynamics of musical sounds with the temporally invariant tones common in auditory perception research—which exhibit significant shortcomings regarding ecological validity. Although this creates barriers for generalizing outcomes from experiments with simplistic tones, it also offers exciting new topics for future research.
Letters and Journals
Authors: Clemit Pamela
Published: October 2018

Romanticism was not just about the high points of insight and emotion: people lived ordinary lives, nourished by bonds of reciprocity. If people were separated by distance, reciprocity was sustained by letters. Letters were not only a vehicle for exchange of information and opinions: they played an important role in upholding and reaffirming a set of relations. They brought people together, strengthened family relationships, and helped to build social networks. The generic boundaries between letters and journals were fluid: the impetus for journal writing was often reciprocal exchange or collaboration. Letters and journals were compositions, in which writers constructed narratives of their lives. They were not the background to creative work, but creative work in themselves. Many different interests contributed to the preservation of Romantic-period letters and journals. The story of the survival of these personal documents is also a story of the transmission of value.
Post-traumatic stress disorder in veterans
Authors: Haveman-Gould Bradley , Newman Chelsea
Published: October 2018

Post-traumatic stress disorder (PTSD) affects about 20% of US military veterans and is a major cause of mortality in these men and women. The incidence of PTSD has persisted over the last decade with the Iraq and Afghanistan wars, yet treatment and adherence remain inadequate in part due to clinician lack of knowledge about cognitive processing therapy and prolonged exposure, the proven gold standards in treatment. This article reviews the most current and successful PTSD treatment options and identifies risk factors for patient nonadherence in hopes of reducing the rate of veteran suicide related to PTSD.
Characteristics of Patients With Opioid Use Disorder Associated With Performing Overdose Reversals in the Community: An Opioid Treatment Program Analysis
Authors: Katzman Joanna G. , Greenberg Nina H. , Takeda Mikiko Y. , Moya Balasch Monica
Published: October 2018

Objective:

The primary outcome of this study is to identify characteristics of study participants in a large opioid treatment program (OTP) for opioid use disorder (OUD) who used take-home naloxone to perform 1 or more opioid overdose (OD) reversal(s) in the community.

Methods:

This 6-month prospective cohort study provided take-home naloxone and opioid OD education for 287 study participants with OUD. Characteristics associated with use of the take-home naloxone were determined from among 16 variables using multivariable logistic regression.

Results:

The study participants who had greater odds of using the take-home naloxone to perform OD reversals, compared to those who did not use the take-home naloxone, (a) received emergency room care themselves for OD (OR = 4.89, 95% CI 1.54–15.52, P = 0.007), (b) previously witnessed someone else OD (OR = 5.67, 95% CI 1.24–25.87, P = 0.025), (c) tested positive for 2 or more illicit substances at their 6-month urine analysis (OR = 5.26, 95% CI 1.58–17.54, P = 0.007) or were missing their 6-month urine analysis (OR = 3.46, 95% CI 1.42–8.43, P = 0.006). In addition, they had greater odds of being (d) less than 30 years old (OR = 2.80, 95% CI 1.02–7.66, P = 0.045), and (e) Hispanic (OR = 3.98, 95% CI 1.41–11.21, P = 0.009).

Conclusions:

This study prospectively identified several characteristics of patients enrolled in an OTP with increased odds of using take-home naloxone in their social networks. Future harm reduction efforts may benefit by using targeted characteristics to identify those most likely to use naloxone in their communities.
Topical Estrogen Prescription Fill Rates for Women With a History of Breast Cancer Who Are Taking Hormone Therapy
Authors: Huntley Joseph H. , Richter Lee A. , Blackford Amanda L. , Aliu Oluseyi , Pollack Craig E.
Published: October 2018

OBJECTIVE:

To evaluate how often women with a history of breast cancer who are taking hormone therapy (HT) filled prescriptions for topical estrogens and whether this frequency varied over time and by type of HT used.

METHODS:

We performed a retrospective cohort study using medical and outpatient drug claims from a large commercial claims database for the years 2010–2015. Women younger than age 65 years taking HT for breast cancer were classified as users of 1) tamoxifen only, 2) aromatase inhibitor(s) only, or 3) any other or multiple HTs. Our outcome variable was filling a prescription for topical estrogen in a given year. We used multivariable logistic regression models estimated with generalized estimating equations to determine whether the fill rate varied over time and by HT category adjusting for age, receipt of surgical or radiation treatment, types of outpatient health care provider visits, and comorbidities.

RESULTS:

We identified 352,118 records from 176,012 unique patients (mean age 54.3 years, range 18–64 years) who met eligibility criteria. Aromatase inhibitors were used more commonly (56.0% of patient-years) than tamoxifen (38.8%). Overall, 3.0% (range 2.9–3.1%) of women filled any topical estrogen prescription in a given calendar year. More than half of filled topical estrogen prescriptions were for tablets (57.0%) with the remainder for creams (25.8%) and rings (17.3%). In adjusted analyses, the fill rate for women taking tamoxifen was significantly less (2.4%; 95% CI 2.3–2.5%) than for women taking aromatase inhibitors (3.3%; 95% CI 3.2–3.4%). There was a small but statistically significant increase in fill rates across years (odds ratio 1.03, 95% CI 1.02–1.04).

CONCLUSION:

A small proportion of women with a history of breast cancer who were taking HT filled a topical estrogen prescription, with significant differences by type of HT. More evidence is needed to inform national guidelines regarding safety and appropriate use of topical estrogens in this patient population.
Hereditary Cancer Risk Assessment and Genetic Testing in the Community-Practice Setting
Authors: DeFrancesco Mark S. , Waldman Richard N. , Pearlstone Melissa M. , Karanik Dana , Bernhisel Ryan , Logan Jennifer , Alico Lindsey , Adkins Royce T.
Published: October 2018

OBJECTIVE:

To evaluate the feasibility and results of incorporating routine hereditary cancer risk assessment, counseling, and follow-up genetic testing in the community obstetrics and gynecology practice setting without referral to a genetic counselor.

METHODS:

This prospective process intervention study was conducted with two obstetrics and gynecology practice groups (five sites). The intervention included baseline process assessment, refinement of clinic-specific patient screening workflows and tools, and training in hereditary cancer risk screening and follow-up. Outcomes related to hereditary cancer assessment and testing were measured during an 8-week postintervention period. Patients and health care providers were surveyed about satisfaction with the process. Data also were collected during the 8 weeks before the intervention to assess the effects of screening process improvements.

RESULTS:

A total of 4,107 patients were seen during the postintervention period, and 92.8% (3,811) were assessed for hereditary cancer risk. Among those assessed, 906 of 3,811 (23.8%) women met National Comprehensive Cancer Network guidelines for genetic testing, and 813 of 906 (89.7%) eligible patients were offered genetic testing. A total of 165 of 4,107 (4.0%) women completed genetic testing and received a final test result. This represents a fourfold increase over genetic testing immediately before the intervention (1.1%) and an eightfold increase over the previous year (0.5%). Testing identified pathogenic variants in 9 of 165 (5.5%) tested women. All health care providers (15/15) reported that they will continue to use the established hereditary cancer risk assessment process. In addition, 98.8% (167/169) of patients who submitted a sample for genetic testing and completed a patient satisfaction survey stated that they were able to understand the information provided, and 97.6% (165/169) expressed satisfaction with the overall process.

CONCLUSION:

It is feasible to incorporate hereditary cancer risk assessment, education, and testing into community obstetrics and gynecology practices. As a result, multigene panel testing identified significant cancer risks that otherwise would not have been recognized.
External Use of an Oxidized Regenerated Cellulose Agent in the Treatment of Labial Agglutination in Postmenopausal Women
Authors: Wyman Allison M. , Lafranchise Elizabeth , Lynch Catherine
Published: October 2018

BACKGROUND:

Vulvovaginal diseases affect women of all ages. Vaginal atrophy and vulvar lichen sclerosus are common etiologies for chronic vulvovaginal pruritus and labial agglutination in both prepubertal and postmenopausal women.

CASES:

We present two cases of a novel approach in management of symptomatic labial agglutination in postmenopausal women. At the time of surgical intervention, an oxidized regenerated cellulose gauze was sutured in place within the operative field of separation of the labia minora and clitoral hood adhesions. At more than 18-months’ follow-up, no recurrence of agglutination has been noted.

CONCLUSION:

The use of an oxidized regenerated cellulose agent may create an effective barrier to recurrence of labial agglutination in postmenopausal women.
Characterization of Risk Factors and Timing of Venous Thromboembolism in Patients With Uterine Serous Carcinoma
Authors: Gressel Gregory M. , Turker Lauren , Dioun Shayan M. , McGinn Aileen P. , Nevadunsky Nicole S.
Published: October 2018

OBJECTIVE:

To characterize risk factors and timing of venous thromboembolism in women with uterine serous carcinoma.

METHODS:

A retrospective cohort study was performed including all women diagnosed with uterine serous carcinoma from 1999 to 2016 at our institution. Clinicopathologic data and information regarding timing of venous thromboembolism were abstracted from the medical record. Logistic regression and Cox proportional hazards modeling were used to examine the association between covariates and risk and timing of venous thromboembolism.

RESULTS:

Seventy of the 413 included patients (17%) developed venous thromboembolism, with a median time from presentation to venous thromboembolism of 7.2 months (interquartile range 1.0–24.8) and from surgery to venous thromboembolism of 13.2 months (interquartile range 3.5–33.6). Fifty-nine of the 70 patients (84%) who developed venous thromboembolism were diagnosed either before surgery or greater than 6 weeks postoperatively. Twenty-two of the 70 patients (31%) who developed clots were on chemotherapy at the time of diagnosis. Venous thromboembolism was highly associated with cancer stage and presence of hypertension (P<.01). Cox proportional hazards modeling revealed that only cancer stages III and IV (hazard ratio [HR] 3.20, 95% CI 1.54–6.64 and HR 8.68, 95% CI 4.50–16.73, respectively) and hypertensive or cardiovascular diseases (HR 2.29, 95% CI 1.08–4.85 and HR 1.82, 95% CI 1.05–3.13) were associated with time to venous thromboembolism.

CONCLUSION:

Patients with uterine serous carcinoma are at high risk of developing venous thromboembolism even many months after their cancer diagnosis. This study generates the hypothesis that venous thromboembolism prophylaxis may be beneficial in patients with uterine serous carcinoma during other time points along the continuum of disease rather than only in the postoperative period, especially for those with advanced cancer.
Novel Approach to Reduction of an Incarcerated Uterus
Authors: Gardner Bennett , Kozakiewicz Melissa L. , Whitecar Paul W. , Nitsche Joshua F. , Brost Brian C.
Published: October 2018

BACKGROUND:

Incarceration of the pregnant uterus is a rare condition and can lead to bladder obstruction, renal failure, or uterine rupture. We present a novel, noninvasive technique to reduce an incarcerated uterus.

METHOD:

With conscious sedation, the patient was placed in all-fours position. The physician's hands were placed on the patient's abdomen and pressure applied until the uterine fundus was palpated. Gentle, steady fundal pressure on both sides was directed toward the maternal chest (bilateral mediocephalad pressure) elevating the uterus out of the pelvis. This approach successfully reduced the gravid incarcerated uterus and was well tolerated by the patient and fetus.

EXPERIENCE:

The author's experience with this method is limited to this case. Prior experience with reduction of the incarcerated uterus has been with methods previously described in the literature.

CONCLUSION:

In conjunction with conscious sedation and all-fours positioning, transabdominal manipulation of the uterine fundus with bilateral mediocephalad pressure may facilitate reduction of an incarcerated uterus. This method may obviate the need for more invasive procedures.
Cesarean Scar Pregnancy, Incidence, and Recurrence
Authors: Grechukhina Olga , Deshmukh Uma , Fan Linda , Kohari Katherine , Abdel-Razeq Sonya , Bahtiyar Mert Ozan , Sfakianaki Anna K.
Published: October 2018

OBJECTIVE:

To describe the treatment and subsequent pregnancy outcomes in patients with cesarean scar pregnancies at a single institution over 5 years.

METHODS:

This is a case series of all cesarean scar pregnancies diagnosed from May 2013 to March 2018 at Yale-New Haven Hospital. Data were collected on each patient using electronic medical record review and included patient demographics; medical, surgical, and obstetric history; pregnancy characteristics; treatment modalities used; response to therapy; complications; and subsequent pregnancy outcomes.

RESULTS:

Thirty cases of cesarean scar pregnancies were diagnosed in 26 patients, including one recurrence in one patient and three recurrences in another. Forty-six percent of cesarean scar pregnancies were in Hispanic women. The median number of prior cesarean deliveries was two. Mean gestational age at the time of diagnosis was 46 days (SD±10). Fetal cardiac activity was detected in 18 cases. Three patients initially were erroneously diagnosed with a viable intrauterine pregnancy and failed medical termination. Others opted for termination through systemic methotrexate alone (n=4), systemic and local methotrexate (n=12), systemic and local methotrexate with potassium chloride injected into the gestational sac (n=3), potassium chloride injection with laparotomy and wedge resection (n=1), methotrexate with bilateral uterine artery embolization (n=2), or intrauterine balloon (n=4). Five patients who underwent expectant management or methotrexate therapy had retained products of conception and required hysteroscopy and curettage. One patient opted for hysterectomy after failed curettage. After complete resolution of cesarean scar pregnancies, there were 10 subsequent spontaneous conceptions in eight patients, including four recurrent cesarean scar pregnancies, four term pregnancies, and one spontaneous abortion. One viable normally located pregnancy is ongoing.

CONCLUSION:

There is a wide array of treatment modalities available for cesarean scar pregnancies. Women with a cesarean scar pregnancy are at risk for its recurrence in the future, although normal pregnancy after a cesarean scar pregnancy is also possible. Safe outcomes depend on timely diagnosis and multidisciplinary care by skilled clinicians.
Simultaneous bilateral neck of femur fractures in an adolescent secondary to hypocalcaemic seizure
Authors: Chandankere Vidyasagar , Mulpur Praharsha , Maryada Venkateshwar Reddy , Pendyala Sudhakar R. , Annapareddy Guravareddy V.
Published: October 2018

We present a rare case of a previously healthy 16-year-old boy who sustained simultaneous bilateral femoral neck fractures after a single first-time seizure episode. He was diagnosed to have severe vitamin D deficiency and secondary hyperparathyroidism. Symptomatic hypocalcemia was the cause of seizures. Both fractures were treated surgically and united at 3 months. Bilateral femoral neck fractures after seizures are very rare, especially in children. Severe vitamin D deficiency may cause seizures and also weakening of bone, predisposing to fractures without significant trauma. We recommend that paediatric cases of femoral neck fractures after seizures should be investigated for underlying metabolic disease.
Agreement of radiographic measurements and patient-reported outcome in 61 patients with Legg–Calvé–Perthes disease at mean follow-up of 28 years
Authors: Hailer Yasmin D. , Penno Eva
Published: October 2018

It is unclear how patient-reported outcome in patients with Legg–Calvé–Perthes disease (LCPD) is correlated with radiographic outcome. It was therefore the aim of our long-term follow-up to evaluate the agreement of patient-reported outcome measures (PROM) with radiographic outcome in patients with a history of unilateral LCPD and a femoral head involvement of more than 50%. We further investigated to what extent the functional outcome (range of motion and Trendelenburg sign) correlates with PROM and radiographic outcome. At a mean follow-up of 28 years (15–42), 61 patients were investigated clinically and by plain radiography to evaluate the sphericity deviation score, femoral head enlargement and femoral neck growth inhibition. The patients also completed questionnaires for generic measures of health-related quality-of-life (ED-5D, EQ-visual analogue scale), the joint-specific Harris hip score and the nonarthritic hip score questionnaire. The radiographic measures sphericity deviation score, femoral head enlargement and femoral neck growth inhibition were strongly correlated with the joint-specific PROMs (Harris hip score and nonarthritic hip score) but not with EQ-5D and EQ-visual analogue scale. Inferior range of flexion and abduction and a positive Trendelenburg sign were associated with an inferior patient-reported outcome. Our findings highlight the importance of supporting femoral head re-modelling and containment and balancing trochanteric and femoral neck growth in patients with LCPD. To capture the whole picture of the outcome after LCPD, future studies should include a combination of radiographic measurements and joint-specific and generic outcome scores. Level of Evidence: Level III.
Utilization of Time-driven Activity-based Costing to Determine the True Cost of a Single or 2-level Anterior Cervical Discectomy and Fusion
Authors: Schroeder Gregory D. , Hilibrand Alan S. , Kepler Christopher K. , McKenzie James C. , Nicholson Kristen J. , Stawicki Christie , Paul Jonathan , Kumar Priyanka , Hollern Douglas A. , Murphy Hamadi , Milhouse Paul W. , Kurd Mark F. , Woods Barret I. , Radcliff Kris E. , Anderson David G. , Vaccaro Alexander R. , Rihn Jeffery A.
Published: October 2018

Study Design:

This is a prospective case series.

Objective:

To determine the actual cost of performing 1- or 2-level anterior cervical discectomy and fusion (ACDF) using actual patient data and the time-driven activity-based cost methodology.

Summary of Background Data:

As health care shifts to use value-based reimbursement, it is imperative to determine the true cost of surgical procedures. Time-driven activity-based costing determines the cost of care by determining the actual resources used in each step of the care cycle.

Materials and Methods:

In total, 30 patients who underwent a 1- or 2-level ACDF by 3 surgeons at a specialty hospital were prospectively enrolled. To build an accurate process map, a research assistant accompanied the patient to every step in the care cycle including the preoperative visit, the preadmission testing, the surgery, and the postoperative visits for the first 90 days. All resources utilized and the time spent with every member of the care team was recorded.

Results:

In total, 27 patients were analyzed. Eleven patients underwent a single-level ACDF and 16 underwent a 2-level fusion. The total cost for the episode of care was $29,299±$5048. The overwhelming cost driver was the hospital disposable costs ($13,920±$6325) which includes every item used during the hospital stay. Intraoperative personnel costs including fees for the surgeon, resident/fellow, anesthesia, nursing, surgical technician, neuromonitoring, radiology technician and orderlies, accounted for the second largest cost at $6066±$1540. The total cost excluding hospital overhead and disposables was $9071±$1939.

Conclusions:

Reimbursement for a bundle of care surrounding a 1- or 2-level ACDF should be no less than $29,299 to cover the true costs of the care for the entire care cycle. However, this cost may not include the true cost of all capital expenditures, and therefore may underestimate the cost.
Combination of High-Calorie Delivery and Organ Failure Increases Mortality Among Patients With Acute Respiratory Distress Syndrome
Authors: Peterson Sarah J. , McKeever Liam , Lateef Omar B. , Freels Sally , Fantuzzi Giamila , Braunschweig Carol A.
Published: October 2018

Objectives:

Among critically ill patients, the benefits of nutrition support may vary depending on severity of organ dysfunction. The objective of the current article was to explore the relationship between organ failure and calories exposure with hospital mortality during the first week of acute respiratory distress syndrome.

Design:

Retrospective observational study.

Setting:

Single-center ICU.

Patients:

Adults admitted to the ICU with a diagnosis of acute respiratory distress syndrome.

Interventions:

Calorie delivery from enteral nutrition, parenteral nutrition, propofol, and dextrose containing fluids were collected for 7 days following intubation. Sequential Organ Failure Assessment score was calculated at ICU admit and for the same 7 days to describe organ dysfunction; four different Sequential Organ Failure Assessment variables were created 1) Sequential Organ Failure Assessment at ICU admit, 2) average Sequential Organ Failure Assessment for the first 7 days following intubation, 3) the highest Sequential Organ Failure Assessment for the first 7 days following intubation, and 4) change in Sequential Organ Failure Assessment from intubation to 7 days later.

Measurements and Main Results:

A total of 298 patients were included. Sequential Organ Failure Assessment at ICU admit, average Sequential Organ Failure Assessment for the first 7 days following intubation, highest Sequential Organ Failure Assessment for the first 7 days following intubation, change in Sequential Organ Failure Assessment from intubation to 7 days later, and calorie delivery the first 7 days following intubation were all associated with increased likelihood of mortality. Compared with patients with low organ failure and low-calorie delivery, those with high-calorie delivery and low organ failure, low-calorie delivery and high organ failure, and the combination of both high organ failure with high-calorie delivery were associated with an incremental increase in the likelihood or mortality.

Conclusions:

Organ failure appears to modify the relationship between calorie exposure and ICU outcome. Additional research is needed to identify appropriate thresholds for safe calorie exposure with increased organ failure.
Primary Localized Cutaneous Amyloidosis Affecting Female Individuals of a Pakistani Pedigree
Authors: Bhoyrul Bevin , Ng Alicia , Laws Philip M. , Mathew Bipin , Shanmugam Sangeetha
Published: October 2018

Primary localized cutaneous amyloidosis is a group of rare conditions where amyloid deposition is limited to the skin without systemic manifestations. Most cases are sporadic; however, mutations in the oncostatin M receptor (OSMR) and interleukin-31 receptor A (IL31RA) genes can cause a familial form of the condition in up to 10% of cases. Here, we describe a family in which 8 female individuals are affected by either macular amyloidosis or amyloidosis cutis dyschromica. To the best of our knowledge, a sex-specific expression or the coexistence of 2 different phenotypes of primary localized cutaneous amyloidosis in 1 pedigree has not yet been reported.
Influence of Gestational Age and Working Memory on Math Skills in Children Aged 8 to 9 Years
Authors: Brown Stephanie , Quach Jon , Anderson Peter J. , Mensah Fiona , Roberts Gehan
Published: October 2018

Objective:

Prematurity affects children's functioning in domains such as cognitive skills and math skills. However, there is limited research examining math skills as gestational age (GA) increases weekly. We aimed at determining, in a population-based cohort of children aged 8 to 9 years, the association between the GA spectrum and math skills and working memory's (WM's) role in this relationship.

Methods:

Children aged 8 to 9 years in 2014 (n = 1761), from 44 primary schools in a metropolitan city, were recruited through the Memory Maestros study in 2012. GA was measured using the parent report. Math skills were measured using the Wide Range Achievement Test 4 math computation subtest (mean, 100; SD, 15), and WM was measured using 2 subtests of the Automated Working Memory Assessment. The method of analysis was multivariate linear regression, with adjustment for both WM measures and social risk indicators as potential confounders.

Results:

A total of 1168 children (66%) had analyzable data. Compared with children of ≤34-week gestation, there was a mean difference increase of 0.48 in math standard scores per weekly increase in GA (95% confidence interval, 0.11–0.85%; p = 0.01). This equates to a difference of 6.29 (0.42 SD) standard math scores between the ≤34- and ≥42-week group. The relationship was independent of WM.

Conclusion:

Weekly increases in GA beyond 34 weeks are associated with higher mathematics achievement scores for children aged 8 to 9 years, independent of the child's WM. This assists with identification of individuals at risk of poorer math skills.
What Is the Risk of Anal Carcinoma in Patients With Anal Intraepithelial Neoplasia III?
Authors: Lee Grace C. , Kunitake Hiroko , Milch Holly , Savitt Lieba R. , Stafford Caitlin E. , Bordeianou Liliana G. , Francone Todd D. , Ricciardi Rocco
Published: October 2018

BACKGROUND:

The risk of anal carcinoma after previous diagnosis of anal intraepithelial neoplasia III is unclear.

OBJECTIVE:

The purpose of this study was to estimate the risk of anal carcinoma in patients with anal intraepithelial neoplasia III and to identify predictors for subsequent malignancy.

DESIGN:

This was a retrospective review using the Surveillance, Epidemiology, and End Results registry (1973–2014).

SETTING:

The study was composed of population-based cancer registries from the United States.

PATIENTS:

Patients who were diagnosed with anal intraepithelial neoplasia III were included.

MAIN OUTCOME MEASURES:

The primary outcome was rate of subsequent anal squamous cell carcinoma. Predictors for anal cancer were identified using logistic regression and Cox proportional hazard models.

RESULTS:

A total of 2074 patients with anal intraepithelial neoplasia III were identified and followed for a median time of 4.0 years (interquartile range, 1.8–6.7 y). Of the cohort, 171 patients (8.2%) subsequently developed anal cancer. Median time from anal intraepithelial neoplasia III diagnosis to anal cancer diagnosis was 2.7 years (interquartile range, 1.1–4.5 y). Fifty-two patients (30.4%) who developed anal carcinoma were staged T2 or higher. Ablative therapies for initial anal intraepithelial neoplasia III were associated with a reduction in the risk of anal cancer (OR = 0.3 (95% CI, 0.1–0.7); p = 0.004). Time-to-event analysis revealed that the 5-year incidence of anal carcinoma after anal intraepithelial neoplasia III was 9.5% or ≈1.9% per year.

LIMITATIONS:

The registry did not record HIV status, surveillance schedule, use of high-resolution anoscopy, or provider specialty.

CONCLUSIONS:

In the largest published cohort of patients with anal intraepithelial neoplasia III, ≈10% of patients were projected to develop anal cancer within 5 years. Nearly one third of anal cancers were diagnosed at stage T2 or higher despite a previous diagnosis of anal intraepithelial neoplasia III. Ablative procedures were associated with a decreased risk of cancer. This study highlights the considerable rate of malignancy in patients with anal intraepithelial neoplasia III and the need for effective therapies and surveillance. See Video Abstract at http://links.lww.com/DCR/A764.
Developing an Inclusive and Welcoming LGBTQ Clinic
Authors: NISLY NICOLE L. , IMBOREK KATHERINE L. , MILLER MICHELLE L. , DOLE NANCY , PRIEST JACOB B. , SANDLER LEONARD , KRASOWSKI MATTHEW D. , HIGHTOWER MAIA
Published: October 2018

People who identify as lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) are underserved and face barriers to knowledgeable health care. Most health systems are ill prepared to provide care that addresses the needs of the LGBTQ community. Basic steps to developing an LGBTQ welcoming health care program are presented. It can be adapted to diverse health care models, from obstetrics and gynecology and other primary care services whether public or private and to hospitals and specialty clinics. This LGBTQ inclusive health care model was developed in collaboration with the LGBTQ community, a multidisciplinary team of health care providers, and professionals of Law and Information Technology.
CHARACTERISTICS AND CLASSIFICATION OF TYPE 3 NEOVASCULARIZATION WITH B-SCAN FLOW OVERLAY AND EN FACE FLOW IMAGES OF OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Authors: Kataoka Keiko , Takeuchi Jun , Nakano Yuyako , Fujita Ai , Kaneko Hiroki , Ito Yasuki , Terasaki Hiroko
Published: October 2018

Purpose:

To study B-scan flow overlay and en face flow optical coherence tomography angiography (OCT-A) images of Type 3 neovascularization (NV) and to characterize a staging system for Type 3 NV based on the OCT-A findings.

Methods:

We retrospectively collected data on consecutive treatment-naive eyes with Type 3 NV. All eyes underwent fluorescein angiography, indocyanine green angiography, structural spectral domain OCT, and OCT-A (AngioPlex). Localization and extension of abnormal flows detected by B-scan flow overlay and en face OCT-A images were assessed.

Results:

Of 24 eyes of 22 patients with Type 3 NV, B-scan flow overlay images showed that 4.2% had telangiectatic flow in the deep retinal layer without outer plexiform layer disruption (Stage 1), 8.3% had downward intraretinal flow and subretinal flow without retinal pigment epithelium disruption (Stage 2), and 87.5% had downward flow and retinal pigment epithelium disruption (Stage 3). Of the Stage 3 eyes, 95.2% showed flow signal penetrating at the site of the retinal pigment epithelium disruption on the B-scan flow overlay images.

Conclusion:

We showed the characteristics of Type 3 NV using B-scan flow overlay and en face OCT-A images. B-scan flow overlay OCT-A images seem useful to improve the detection and accurate diagnosis of Type 3 NV.
Correlates of Endothelial Function in Older Adults With Untreated Obstructive Sleep Apnea and Cardiovascular Disease
Authors: Imes Christopher C. , Baniak Lynn M. , Choi JiYeon , Luyster Faith S. , Morris Jonna L. , Ren Dianxu , Chasens Eileen R.
Published: October 2018

Background:

Obstructive sleep apnea (OSA) is a highly prevalent and consequential sleep disorder in older adults. Untreated moderate to severe OSA substantially increases the risk for hypertension and cardiovascular disease (CVD), which can be attributed to the accelerated progression of atherosclerosis and endothelial dysfunction.

Objective:

The aim of this study was to identify factors that can function as correlates of endothelial function in older adults with untreated, moderate to severe OSA and CVD or CVD risk factors.

Methods:

A subsample (N = 126) of adults aged 65 years and older from the HeartBEAT study were included in the analyses. Univariate analyses and multiple linear regression models were conducted to establish which demographic and CVD risk factors were the best correlates of endothelial function.

Results:

In the univariate analyses, sex, employment status, body mass index, waist circumference, hip-to-waist ratio, neck circumference, diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, total cholesterol to high-density lipoprotein cholesterol ratio, plasminogen activator inhibitor-1, calcium channel blocker use, and β-blocker use were associated with endothelial function at a level of P < .10. In the most parsimonious model, male sex (b = −0.305, P < .001), calcium channel blocker use (b = −0.148, P < .019), and body mass index (b = −.014, P < .037) were negatively associated with endothelial function after adjusting for the other covariates.

Conclusions:

The authors identified correlates of endothelial function in older adults with untreated OSA and CVD or CVD risk factors, which are different than the correlates in middle-aged adults with the same conditions.