bluuebunny/crossref_metadata_2025 huggingface dataset:
Approaches to Explaining Regional Conflict and Peace
Authors: Sakuwa Kentaro
Published: February 2018

The pattern of international conflict and peace differs from region to region. Regions differ from each other not only in terms of the simple presence or absence of war but also the degree to which war or any sort of military conflict is likely in the long run. Arguments have been offered to explain the spatial heterogeneity in war and peace. One approach to explaining regional peace is additive—the peacefulness of international politics is essentially analyzed and explained at either monadic or dyadic level variation. Notably, the dyadic approach to international conflict and peace has been dominant in the contemporary international relations. For example, two states that are economically dependent, both democratic, with vastly different levels of capabilities, and involved in neither a territorial dispute nor rivalry are likely to develop peaceful relationships. From this perspective, the regional degree of peace is explained by summing up the peacefulness of dyads within a region.

Although this approach to regional peace has been dominant in the field, other approaches go beyond this simple additive approach. The first such explanations base their theoretical arguments on dyadic or monadic mechanisms, but focus on regionwide conditions such as consistency between national and state borders. Regional conflict and peace are ultimately explained by these regional historical conditions. The second group of explanations draw on the notion of spatial contagion through such mechanisms as domestic instability and war expansion in which international and civil wars provide opportunities for further conflict in the neighborhood in various ways. Conflict diffuses through spatial contagion and war joining, which in turn produces a zone of conflict. The third strand of explanations involve more explicit analyses of interdependence between units—states or dyads—which does not necessarily have to take place in the spatial context but often so. For example, pacifying international trade may result from “flying geese” learning and socialization processes within a neighborhood, thus making a whole region peaceful. Furthermore, studies that draw on techniques of network analysis tend to directly model dyad-to-dyad interdependence as an important source of conflict and peace. In short, there are various approaches to explain the regional variation of international conflict and peace from both additive monadic or dyadic approaches and more complex approaches that assume regional clustering of material conditions and interdependence between micro-units in space.
School Climate
Authors: Payne Allison Ann , Gottfredson Denise C.
Published: February 2018

School violence, drug use, bullying, theft, and vandalism are costly and interfere with academic achievement. Beyond the cost of personal injury and property damage and loss, school crime is costly because it interferes with academic achievement and reduces the ability of schools to carry out their educational mission. Fear of victimization influences students’ attendance, such that students are more likely to avoid school activities or places, or even school itself, due to fear of attack or harm. Teachers in disorderly schools also spend a large proportion of their time coping with behavior problems rather than instructing students, resulting in lower levels of student academic engagement, academic performance, and eventually graduation rates. Student misbehavior is also one of the primary sources of teacher turnover in schools.

Responses to school crime have become increasingly formal since the 1990s, with greater recourse to arrest and a turn toward juvenile courts rather than school-based discipline, furthered by zero-tolerance policies and increased hiring of uniformed officers to police the schools. The shift has been from administrative discretion to mandatory penalties and from in-school discipline to increasing use of suspension or arrest. At the same time, there has been a considerable investment in the use of surveillance cameras and metal detectors. There is no evidence to suggest that this tightening of school discipline has reduced school crime.

By contrast, considerable evidence supports the effectiveness of alternative strategies designed to prevent youth crime and delinquency. Several school-based programs targeting student factors such as self-control, social competency, and attachment to school have been demonstrated in rigorous research to be effective for reducing crime and delinquency. In addition, several aspects of the way schools are organized and managed influence crime and disorder.

The term “school climate” encompasses several school characteristics that influence crime and disorder. Evidence supports the importance of the discipline management of a school, including both the fairness and consistency of rules and rule enforcement as well as the clarification and communication of behavioral norms in reducing crime and disorder in schools. The social climate within the school, specifically the existence of a positive and communal climate among all members of the school community, is also important. Research demonstrates that is possible to manipulate these aspects of school climate. Rigorous research shows that efforts to increase clarity and consistency of rule enforcement and to clarify norms for behavior are effective for reducing crime and disorder. More research is needed to test a fully comprehensive intervention aimed at creating a more communal social climate, but preliminary studies suggest positive effects.

Several challenges to creating more positive school climates are discussed, and possible solutions are suggested.
Democracy and Justice in Mathematics and Science Curriculum
Authors: Valero Paola , Orlander Auli Arvola
Published: February 2018

How mathematics and science curricula connect to democracy and justice is understood through the examination of different perspectives of mathematics and science education as political. Although frequently conceived of as neutral, these school subjects have been central in recent modern education for governing the making of rational, science-minded citizens who are necessary for social, political, and economic progress. Three main perspectives are identified in the existing research literature. A perspective of empowerment highlights the power that people can acquire by learning and using mathematics and science. A perspective of disadvantage focuses on how the pedagogies of mathematics and science intersect with categories such as ability, gender, class, ethnicity, and race to generate and reproduce marginalization. A perspective of subjectivation examines the effects of mathematics and science curricula within the context of historical and cultural processes for the making of desired modern, rational, and techno-scientific types of citizens, thus creating categories of inclusion and exclusion. All together, these perspectives point to the ways in which mathematics and science, as privileged forms of knowing in contemporary school curricula, simultaneously operate to include or exclude different types of students.
Visual Culture in Imperial China
Authors: Murray Julia K.
Published: February 2018

The study of visual culture in imperial China is a young and heterogeneous field that encompasses a large and shifting array of visual materials and viewing practices. Because of the many political and social changes over the course of roughly two millennia, scholars have generally focused on specific forms and shorter periods, often defined by dynasty, instead of proposing comprehensive theories or all-inclusive overviews. The most recent dynasties, Ming and Qing, have received the majority of the scholarly attention to visual culture as such, but much research on earlier periods also sheds light on the roles of the visual and visual experience. In contrast to scholarship on modern and contemporary Chinese visual culture, which typically draws upon European and American theoretical models, studies concerned with the imperial era more often use methodologies and interpretive frameworks from art history and anthropology. Major foci of interest, whose relative importance varies by period, are the imperial court and its projects to perpetuate and project imperial authority, concerns with and techniques for creating auspicious environments in earthly life and in tomb contexts, structures and practices associated with Buddhism and Daoism within religious institutions and in lay communities, uses of writing and representational images to embody the values of the Confucian-educated elite, woodblock illustration and consumerism in urban culture, rural forms of visual culture, vernacular images and erotica, and the assimilation of elements of foreign visual culture.
Contraband Camps and the African American Refugee Experience during the Civil War
Authors: Manning Chandra
Published: February 2018

In May 1861, three enslaved men who were determined not to be separated from their families ran to Fort Monroe, Virginia. Their flight led to the phenomenon of Civil War contraband camps. Contraband camps were refugee camps to which between four hundred thousand and five hundred thousand enslaved men, women, and children in the Union-occupied portions of the Confederacy fled to escape their owners by getting themselves to the Union Army. Army personnel had not envisioned overseeing a massive network of refugee camps. Responding to the interplay between the actions of the former slaves who fled to the camps, Republican legislation and policy, military orders, and real conditions on the ground, the army improvised. In the contraband camps, former slaves endured overcrowding, food and clothing shortages, poor sanitary conditions, and constant danger. They also gained the protection of the Union Army and access to the power of the US government as new, though unsteady, allies in the pursuit of their key interests, including education, employment, and the reconstitution of family, kin, and social life. The camps brought together actors who had previously had little to no contact with each other, exposed everyone involved to massive structural forces that were much larger than the human ability to control them, and led to unexpected outcomes. They produced a refugee crisis on US soil, affected the course and outcome of the Civil War, influenced the progress of wartime emancipation, and altered the relationship between the individual and the national government. Contraband camps were simultaneously humanitarian crises and incubators for a new relationship between African Americans and the US government.
Japantown and the Fillmore District
Authors: Lai Clement
Published: February 2018

Many Asian American neighborhoods faced displacement after World War II because of urban renewal or redevelopment under the 1949 Housing Act. In the name of blight removal and slum clearance this Act allowed local elites to procure federal money to seize land designated as blighted, clear it of its structures, and sell this land to private developers—in the process displacing thousands of residents, small businesses, and community institutions. San Francisco’s Fillmore District, a multiracial neighborhood that housed the city’s largest Japanese American and African American communities, experienced this postwar redevelopment. Like many Asian American neighborhoods that shared space with other communities of color, the Fillmore formed at the intersection of class inequality and racism, and it was this intersection of structural factors that led to substandard urban conditions. Rather than recognize the root causes of urban decline, San Francisco urban and regional elites argued that the Fillmore was among the city’s most blighted neighborhoods and advocated for the neighborhood’s destruction in the name of the public good. They also targeted the Fillmore because their postwar plans for remaking the city’s political economy envisioned the Fillmore as (1) a space to house white- collar workers in the postwar economy and (2) as an Asian-themed space for tourism that connected the city symbolically and economically to Japan, an important U.S. postwar ally. For over four decades these elite-directed plans for the Fillmore displaced more than 20,000 residents in two phases, severely damaging the community. The Fillmore’s redevelopment, then, provides a window into other cases of redevelopment and aids further investigations of the connection between Asian Americans and urban crisis. It also sheds light on the deeper history of displacement in the Asian American experience and contextualizes contemporary gentrification in Asian American neighborhoods.
The United States in the 1920s
Authors: Murphy Paul V.
Published: February 2018

Americans grappled with the implications of industrialization, technological progress, urbanization, and mass immigration with startling vigor and creativity in the 1920s even as wide numbers kept their eyes as much on the past as on the future. American industrial engineers and managers were global leaders in mass production, and millions of citizens consumed factory-made products, including electric refrigerators and vacuum cleaners, technological marvels like radios and phonographs, and that most revolutionary of mass-produced durables, the automobile. They flocked to commercial amusements (movies, sporting events, amusement parks) and absorbed mass culture in their homes, through the radio and commercial recordings. In the major cities, skyscrapers drew Americans upward while thousands of new miles of roads scattered them across the country. Even while embracing the dynamism of modernity, Americans repudiated many of the progressive impulses of the preceding era. The transition from war to peace in 1919 and 1920 was tumultuous, marked by class conflict, a massive strike wave, economic crisis, and political repression. Exhausted by reform, war, and social experimentation, millions of Americans recoiled from central planning and federal power and sought determinedly to bypass traditional politics in the 1920s. This did not mean a retreat from active and engaged citizenship; Americans fought bitterly over racial equality, immigration, religion, morals, Prohibition, economic justice, and politics. In a greatly divided nation, citizens experimented with new forms of nationalism, cultural identity, and social order that could be alternatively exclusive and pluralistic. Whether repressive or tolerant, such efforts held the promise of unity amid diversity; even those in the throes of reaction sought new ways of integration. The result was a nation at odds with itself, embracing modernity, sometimes heedlessly, while seeking desperately to retain a grip on the past.
Urban Tourism in the U.S. since 1800
Authors: Souther J. Mark
Published: February 2018

Prior to the railroad age, American cities generally lacked reputations as tourist travel destinations. As railroads created fast, reliable, and comfortable transportation in the 19th century, urban tourism emerged in many cities. Luxury hotels, tour companies, and guidebooks were facilitating and shaping tourists’ experience of cities by the turn of the 20th century. Many cities hosted regional or international expositions that served as significant tourist attractions from the 1870s to 1910s. Thereafter, cities competed more keenly to attract conventions. Tourism promotion, once handled chiefly by railroad companies, became increasingly professionalized with the formation of convention and visitor bureaus. The rise of the automobile spurred the emergence of motels and theme parks on the suburban periphery, but renewed interest in historic urban core areas spurred historic preservation activism and adaptive reuse of old structures for dining, shopping, and entertainment. Although a few cities, especially Las Vegas, had relied heavily on tourism almost from their inception, by the last few decades of the 20th century few cities could afford to ignore tourism development. New waterfront parks, aquariums, stadiums, and other tourist and leisure attractions facilitated the symbolic transformation of cities from places of production to sites of consumption. Long aimed at the a mass market, especially affluent and middle-class whites, tourism promotion embraced market segmentation in the closing years of the 20th century, and a number of attractions and tours appealed to African Americans or LGBTQ communities. If social commentators often complained that cities were developing “tourist bubbles” that concentrated the advantages of tourism in too-small areas and in too few hands, recent trends point to a greater willingness to disperse tourist activity more widely in cities. By the 21st century, urban tourism was indispensable to many cities even as it continued to contribute to uneven development.
Mexico in World Expositions and Fairs
Authors: Douglas Susan
Published: February 2018

Mexico’s involvement in world’s fairs and other international expositions is examined. From 1867 to 1929, governments promoted nationalism and industrialization through world’s fairs in Europe and international expositions in America. Mexico, which had recently achieved independence from Spain, became involved in these fairs to bolster its economy and image, competing with other nations to sell local goods and offer investment opportunities to foreigners. Since 1850, Mexicans have encouraged commerce and industry while enthusiastically marketing their country as a tourist “wonderland.” Accounts of Mexico’s participation in world’s fairs draw attention to the imperialism embedded in such events, suggesting that they were deeply problematic. Defined as cultural palaces and trade shows, fairs have chronicled changing ideas about nationalism, modernity, and, more recently, branding. In the wake of the Mexican Revolution, Mexicans have recognized their strategic importance, although a persistent theme in the literature is that these are inherently tiresome and expensive undertakings and a significant drain on economic and political life.
The Colonial Economy of New Spain
Authors: Baskes Jeremy
Published: February 2018

For three centuries New Spain was one of the great jewels of Spain’s colonial empire, producing wealth for immigrants and the Crown. The brunt of the labor was performed by indigenous Mexicans, often under duress, but natives also succeeded in seizing opportunities to promote their interests. It is tempting to portray the economic history of Mexico as a simple story of domination of colonial subjects by their European rulers, and indeed historians have often resorted to this straightforward rendition. This article, while certainly presenting the conventional wisdom, presents a more complex story, highlighting debates among historians on a wide range of issues, from the experiences of indigenous people to the profitability of colonialism. What follows is a general presentation of New Spain’s economy.
Alexander Romance
Authors: Stoneman Richard
Published: February 2018

The Alexander Romance is a fictionalized life of Alexander III of Macedon (Alexander the Great, 356–323 bce), originating in the 3rd century BC, though the earliest evidence for its circulation in textual form is from the 3rd century ce. Originally written in Greek (in which there are five recensions), it was translated into Latin in the 4th century ce, and from the 5th century, into every language of Europe and the Middle East. It narrates Alexander’s birth to Olympias, as son of the last Pharaoh, Nectanebo II, of Egypt; his upbringing; his campaigns (in a strange order); his encounter with Queen Candace of Meroe; and particularly his adventures in India and beyond, including his encounter with the naked philosophers of Taxila; his death, and his will. Later versions (recensions L, gamma) include a meeting with the Amazons and his invention of a diving bell and a flying machine.
Resistance Training Augments Cerebral Blood Flow Pulsatility: Cross-Sectional Study
Authors: Nakamura Nobuhiro , Muraoka Isao
Published: February 2018

BACKGROUND

Increased central arterial stiffness and/or decreased compliance reduces buffer function and increases cerebral blood flow (CBF) pulsatility, which leads to increased cerebral microvascular damage, resulting in the augmentation of the risk of cerebrovascular diseases. Resistance-trained men showed higher central arterial stiffness and lower arterial compliance than age-matched, sedentary men. This study examined the effect of increased central arterial stiffness and/or decreased arterial compliance on CBF pulsatility.

METHODS

The study participants included 31 young healthy men (15 resistance-trained men, aged 21 ± 1 years; and 16 controls, aged 23 ± 1 years). β-Stiffness index and arterial compliance were measured in the right carotid artery as index of central arterial stiffness and compliance, respectively. The pulsatility index (PI) was measured in the middle cerebral artery as index of CBF pulsatility.

RESULTS

β-Stiffness index and PI were significantly higher in the resistance-trained group than in the control group (β-stiffness index: 5.3 ± 0.3 vs. 3.5 ± 0.3 a.u., P < 0.05, PI: 0.80 ± 0.02 vs. 0.70 ± 0.02, P < 0.05). The resistance-trained group showed significantly lower arterial compliance than the control group (0.16 ± 0.01 vs. 0.23 ± 0.01 mm2/mm Hg, P < 0.05). Positive and negative correlations were observed between β-stiffness index and PI (r = 0.39, P < 0.05), and between arterial compliance and PI (r = −0.59, P < 0.05), respectively.

CONCLUSIONS

The resistance-trained group showed higher central arterial stiffness and PI and lower arterial compliance. Central arterial stiffness and arterial compliance were associated with PI. Increased arterial stiffness and decreased arterial compliance with resistance training impair buffer function, resulting in increased CBF pulsatility.

CLINICAL TRIAL REGISTRATION

Trial Number UMIN000023816

URL: http://www.umin.ac.jp/icdr/index.html

Official scientific title of the study: effect of increase arterial stiffness by resistance training on cerebral hemodynamic
SubRecon: ancestral reconstruction of amino acid substitutions along a branch in a phylogeny
Authors: Monit Christopher , Goldstein Richard A
Published: February 2018

Existing ancestral sequence reconstruction techniques are ill-suited to investigating substitutions on a single branch of interest. We present SubRecon, an implementation of a hybrid technique integrating joint and marginal reconstruction for protein sequence data. SubRecon calculates the joint probability of states at adjacent internal nodes in a phylogeny, i.e. how the state has changed along a branch. This does not condition on states at other internal nodes and includes site rate variation. Simulation experiments show the technique to be accurate and powerful. SubRecon has a user-friendly command line interface and produces concise output that is intuitive yet suitable for subsequent parsing in an automated pipeline.

Availability and implementation

SubRecon is platform independent, requiring Java v1.8 or above. Source code, installation instructions and an example dataset are freely available under the Apache 2.0 license at https://github.com/chrismonit/SubRecon.
Updating the 97% identity threshold for 16S ribosomal RNA OTUs
Authors: Edgar Robert C
Published: February 2018

Motivation

The 16S ribosomal RNA (rRNA) gene is widely used to survey microbial communities. Sequences are often clustered into Operational Taxonomic Units (OTUs) as proxies for species. The canonical clustering threshold is 97% identity, which was proposed in 1994 when few 16S rRNA sequences were available, motivating a reassessment on current data.

Results

Using a large set of high-quality 16S rRNA sequences from finished genomes, I assessed the correspondence of OTUs to species for five representative clustering algorithms using four accuracy metrics. All algorithms had comparable accuracy when tuned to a given metric. Optimal identity thresholds were ∼99% for full-length sequences and ∼100% for the V4 hypervariable region.

Availability and implementation

Reference sequences and source code are provided in the Supplementary Material.

Supplementary information

Supplementary data are available at Bioinformatics online.
Japanese anti- versus pro-influenza vaccination websites: a text-mining analysis
Authors: Okuhara Tsuyoshi , Ishikawa Hirono , Okada Masafumi , Kato Mio , Kiuchi Takahiro
Published: February 2018

Anti-vaccination sentiment exists worldwide and Japan is no exception. Health professionals publish pro-influenza vaccination messages online to encourage proactive seeking of influenza vaccination. However, influenza vaccine coverage among the Japanese population is less than optimal. The contents of pro- and anti-influenza vaccination websites may contribute to readers’ acceptance of one or the other position. We aimed to use a text-mining method to examine frequently appearing content on websites for and against influenza vaccination. We conducted online searches in January 2017 using two major Japanese search engines (Google Japan and Yahoo! Japan). Targeted websites were classified as ‘pro’, ‘anti’ or ‘neutral’ depending on their claims, with author(s) classified as ‘health professionals’, ‘mass media’ or ‘laypersons’. Text-mining analysis was conducted, and statistical analysis was performed using a chi-squared test. Of the 334 websites analyzed, 13 content topics were identified. The three most frequently appearing content topics on pro-vaccination websites were vaccination effect for preventing serious cases of influenza, side effects of vaccination, and efficacy rate of vaccination. The three most frequent topics on anti-vaccination websites were ineffectiveness of influenza vaccination, toxicity of vaccination, and side effects of vaccination. The main disseminators of each topic, by author classification, were also revealed. We discuss possible tactics of online influenza vaccination promotion to counter anti-vaccination websites.
Human Coronavirus NL63 Molecular Epidemiology and Evolutionary Patterns in Rural Coastal Kenya
Authors: Kiyuka Patience K , Agoti Charles N , Munywoki Patrick K , Njeru Regina , Bett Anne , Otieno James R , Otieno Grieven P , Kamau Everlyn , Clark Taane G , van der Hoek Lia , Kellam Paul , Nokes D James , Cotten Matthew
Published: February 2018

Background

Human coronavirus NL63 (HCoV-NL63) is a globally endemic pathogen causing mild and severe respiratory tract infections with reinfections occurring repeatedly throughout a lifetime.

Methods

Nasal samples were collected in coastal Kenya through community-based and hospital-based surveillance. HCoV-NL63 was detected with multiplex real-time reverse transcription PCR, and positive samples were targeted for nucleotide sequencing of the spike (S) protein. Additionally, paired samples from 25 individuals with evidence of repeat HCoV-NL63 infection were selected for whole-genome virus sequencing.

Results

HCoV-NL63 was detected in 1.3% (75/5573) of child pneumonia admissions. Two HCoV-NL63 genotypes circulated in Kilifi between 2008 and 2014. Full genome sequences formed a monophyletic clade closely related to contemporary HCoV-NL63 from other global locations. An unexpected pattern of repeat infections was observed with some individuals showing higher viral titers during their second infection. Similar patterns for 2 other endemic coronaviruses, HCoV-229E and HCoV-OC43, were observed. Repeat infections by HCoV-NL63 were not accompanied by detectable genotype switching.

Conclusions

In this coastal Kenya setting, HCoV-NL63 exhibited low prevalence in hospital pediatric pneumonia admissions. Clade persistence with low genetic diversity suggest limited immune selection, and absence of detectable clade switching in reinfections indicates initial exposure was insufficient to elicit a protective immune response.
Gradual External Ventricular Drainage Weaning Reduces The Risk of Shunt Dependency After Aneurysmal Subarachnoid Hemorrhage: A Pooled Analysis
Authors: Jabbarli Ramazan , Pierscianek Daniela , RÖlz Roland , Reinhard Matthias , Darkwah Oppong Marvin , Scheiwe Christian , Dammann Philipp , Kaier Klaus , Wrede Karsten H , Shah Mukesch , Zentner Josef , Sure Ulrich
Published: February 2018

BACKGROUND

Chronic posthemorrhagic hydrocephalus necessitating shunt placement is a common complication of subarachnoid hemorrhage (SAH).

OBJECTIVE

To evaluate the role of external ventricular drainage (EVD) weaning on risk of shunt dependency after SAH.

METHODS

Two German university hospitals with different EVD management regimes (rapid weaning [RW] vs gradual weaning [GW]) pooled the data of their observational cohorts containing altogether 1171 consecutive SAH patients treated between January 2005 and December 2012. Development and timing of shunt dependency in SAH survivals were the endpoints of the study.

RESULTS

The final cohort consisted of 455 and 510 SAH survivors treated in the centers with RW and GW, respectively. Mortality rates, as well as baseline demographic, clinical, and radiographic parameters, showed no differences between the centers. Patients with GW were less likely to develop shunt dependency (27.5% vs 34.7%, P = .018), Multivariate analysis confirmed independent association between RW regime and shunt dependency (P = .026). Shunt-dependent SAH patients undergoing GW required significantly longer time until shunting (mean 29.8 vs 21.7 d, P < .001) and hospital stay (mean 39 vs 34.4 d, P = .03). In addition, patients with GW were at higher risk for secondary shunt placement after successful initial weaning (P = .001). The risk of cerebrospinal fluid infection was not associated with the weaning regime (15.3% vs 12.9%, P = .307).

CONCLUSION

At the expense of longer treatment, GW may decrease the risk of shunt dependency after SAH without an additional risk for infections. Due to the risk of secondary shunt dependency, SAH patients with GW require proper posthospital neurological care.
Current State of the Opioid Epidemic as it Pertains to Pediatric Orthopaedics From the Advocacy Committee of the Pediatric Orthopaedic Society of North America
Authors: Raney Ellen M. , van Bosse Harold J.P. , Shea Kevin G. , Abzug Joshua M. , Schwend Richard M.
Published: February 2018

Introduction:

The opioid epidemic in the United States has reached crisis proportions. Urgent response is needed. Hydrocodone in combination with acetaminophen is the most prescribed drug in the United States. The most common source of opioids available for misuse is the unused portions of postoperative prescriptions. Among high school seniors, 80% of those who reported nonmedical use of prescription opioids previously had legitimate prescriptions but recreationally used leftover doses. Roughly one-quarter of patients do not take any of their postoperatively prescribed opioids and the remainder take one-third to two-thirds of the prescribed doses.

Methods:

A summary of the literature is presented beginning from historical perspective to current status and pertinent strategies in dealing with this complicated problem. This review includes data from an electronic survey of the members of the Pediatric Orthopaedic Society of North America (POSNA) with regard to the prescriptions they would provide for 7 treatment scenarios.

Results:

Strategies for the preoperative, intraoperative, and postoperative phases of management of pain as well as strategies for education, research, and advocacy are presented. The Pediatric Orthopaedic Society of North America survey yielded 264 respondents. The 3 most commonly used opioid medications were hydrocodone, oxycodone, and acetaminophen with codeine, in that order, for most of the scenarios. The time period covered by postoperative prescriptions varied considerably.

Conclusions:

The magnitude of this problem is overwhelming. Education of care providers, patients and families, standardization of narcotic prescribing practices which incorporate patient characteristics, and appropriate plans for disposal of unused narcotics are immediate concepts to consider in correcting this problem. Long-term issues to tackle will be changing patient a family expectations, legislation, and obtaining additional resources directed towards this issue.
Single Lymphaticovenular Anastomosis for Early-Stage Lower Extremity Lymphedema Treated by the Superior-Edge-of-the-Knee Incision Method
Authors: Seki Yukio , Kajikawa Akiyoshi , Yamamoto Takumi , Takeuchi Takayuki , Terashima Takahiro , Kurogi Norimitsu
Published: February 2018

Background:

Surgical treatment of lower extremity lymphedema (LEL) remains challenging. Application of the superior-edge-of-the-knee incision method for lymphaticovenular anastomosis (LVA) is reported to have a strong therapeutic effect in patients with LEL because lymph-to-venous flow at the anastomosis is enhanced by knee joint movement during normal walking. We investigated whether a single LVA created by this method is adequate for early LEL.

Methods:

The study involved 10 patients with LEL characterized by stage 2 or 3 leg dermal backflow and treated by a single LVA at the thigh via the superior-edge-of-the-knee incision method. The lymphatic vessel and direction of flow were assessed intraoperatively, and reduction in lymphedema volume was assessed postoperatively.

Results:

Use of our incision method yielded a single anastomosis in all patients with stage 2 leg dermal backflow and in all patients with stage 3 leg dermal backflow. The lymphatic vessel was 0.65 ± 0.08 mm in diameter (0.65 ± 0.09 and 0.65 ± 0.09 mm, respectively; P = 1.000). No venous reflux occurred in any patient. Mean follow-up was 7.70 ± 3.30 months (9.60 ± 3.29 and 5.80 ± 2.17 months, respectively; P = 0.068). Mean reduction in the LEL index was 20.160 ± 9.892 (22.651 ± 12.272 and 17.668 ± 7.353, respectively; P = 0.462).

Conclusion:

A single LVA created by the superior-edge-of-the-knee incision method can be expected to have a strong therapeutic effect in patients with stage 2 or 3 leg dermal backflow.
Surgical Treatment for Kirner’s Deformity—Single Osteotomy through a Palmar Approach
Authors: Horii Emiko , Otsuka Junko , Koh Shukuki
Published: February 2018

Background:

Patients with Kirner’s deformity often seek medical attention for aesthetic improvement when they reach the age of approximately 10 years, when the deformity becomes evident. The operative technique described in textbooks is the palmar opening-wedge with multiple osteotomies through a mid-lateral incision, which is technically demanding. The purpose of this article was to introduce our surgical technique of a single transverse osteotomy through a palmar approach and to present the short-term outcomes of this technique.

Methods:

The surgical outcomes of 7 digits in 4 children were retrospectively reviewed. The deformed distal phalanx was approached with an oblique incision of the pulp, and the palmar cortex was incised at the apex of the curvature. The dorsal cortex was only partially incised and broken manually when correcting the deformity by a palmar opening-wedge. The dorsal aspect of the phalanx was not exposed, and the nail plate was left intact. The fragments were fixed with Kirschner wires.

Results:

There was no postoperative complication, and the osteotomy sites all healed uneventfully. None of the patients complained about scar pain or hypersensitivity of the finger pulp. The patients and their parents were satisfied with the aesthetic results.

Conclusions:

A single palmar opening-wedge osteotomy at the apex sufficiently corrected the main curvature, and the subtle curvature remaining at the tip of the phalanx did not affect the appearance. This technique is simple and easy; therefore, it is recommended as a reliable procedure for patients with Kirner’s deformity who are approaching puberty.
A Qualitative Study of Experiences of Participants in Cardiac Rehabilitation
Authors: Yates Bernice C. , Vazquez Hernandez Mari L. , Rowland Sheri A. , Bainter Denise E. , Schulz Paula , Hanson Corrine K.
Published: February 2018

Purpose:

Maintenance of lifestyle changes after cardiac rehabilitation (CR) is suboptimal. In addition, partners of cardiac patients are invited to participate in CR educational sessions and implicitly expected to assist patients with their lifestyle changes. The purpose of this study was to qualitatively examine patient and partner perceptions of phase 2 CR 3 mo after completion of the program.

Methods:

A purposive sample of 11 couples (patients post–heart surgery and their spouses) was interviewed following completion of CR. Semistructured, in-person interviews were conducted with patients and spouses separately. Data were analyzed using line-by-line coding to identify themes.

Results:

Themes were identified in relation to program elements of CR. Exercise themes were as follows: (1) benefitted from exercise and (2) felt held back. Education themes were as follows: (1) received basic education and (2) needed more personalized information. CR environment themes were as follows: (1) developed confidence; (2) made social comparisons; and (3) helped to have partner there.

Conclusion:

Overall, participant perceptions of exercise, education, and the CR environment were very positive. Nevertheless, there is a need to improve educational efforts within CR to rely less on “canned” presentations and more on participants developing their own self-management methods to maintain a healthy lifestyle after CR.
Parent and Professional Perceptions of Inclusion in Childcare
Authors: Weglarz-Ward Jenna M. , Santos Rosa Milagros
Published: February 2018

Many families seek quality, inclusive care for their young children with disabilities. A key to successful inclusion is understanding the needs of families and professionals who serve them. This review examined literature about the inclusion of young children with disabilities in childcare programs and collaboration among early childhood professionals from the perspectives of parents and professionals. Twenty-five studies were selected through searches of online databases, leading researchers, and journals on the topic. Study participants included childcare providers across all program types, special educators, specialized therapists, and parents. Topics addressed included professionals' experiences of inclusion and collaboration, factors that influenced these experiences, quality of care for young children with disabilities, and parental decisions regarding childcare. The results indicated that more research is needed specific to infants and toddlers with disabilities in childcare settings as well as the experiences of parents and providers. This greater understanding would bridge the gaps between policy, research, and practice.
Incidence and Outcomes of Postoperative Atrial Fibrillation After Left Ventricular Assist Device
Authors: Deshmukh Amrish , Bhatia Ankit , Anyanwu Emeka , Ota Takeyoshi , Jeevanandam Valluvan , Uriel Nir , Tung Roderick , Ozcan Cevher
Published: February 2018

This study sought to determine the incidence, predictors, and outcomes of postoperative atrial fibrillation (POAF) in patients undergoing implantation of left ventricular assist devices (LVADs). A retrospective analysis of all patients who underwent LVAD implantation from 2013 to 2014 was conducted. Postoperative AF, survival, and thrombotic complications were evaluated after surgery. A total of 47 patients (mean age, 56.4 ± 12.5 years; 33 male) were included and followed for a median of 331 days. Within 30 days of surgery, 13 (28%) patients developed POAF at mean 7.9 ± 8.5 days. Obstructive lung disease was a predictor of POAF (p = 0.01). Postoperative AF was not associated with increased mortality, length of stay, or thrombotic complication within 30 days. Postoperative AF was predictive of recurrent new AF (24 vs. 5.5%) after 30 days of LVAD implantation. Also, POAF was associated with increased risk of ischemic stroke and device thrombosis during follow-up (p = 0.01). These results show that unlike in other cardiac surgery, POAF does not have a negative impact on early postoperative morbidity or mortality. However, POAF is a predictor for future AF, ischemic stroke, and device thrombosis.
Finding the Fertile Phase
Authors: Barron Mary Lee , Vanderkolk Kaitlin , Raviele Kathleen
Published: February 2018

Purpose:

To investigate if generic Wondfo ovulation sticks (WLH) are sufficiently sensitive to the luteinizing hormone (LH) surge in urine when used with the Marquette Fertility Algorithm. The electronic hormonal fertility monitor (EHFM) is highly accurate in detecting the LH surge but cost of the monitor and the accompanying test sticks has increased over the last several years. The EHFM is sensitive to detect the LH surge at 20 milli-international units per milliliter (mIU/mL); the WLH sticks are slightly less sensitive at 25 mIU/mL.

Study Design and Methods:

A convenience sample of women using the Marquette Method of Natural Family Planning with the EHFM to avoid pregnancy were recruited (N = 54). Each participant used the EHFM every morning after cycle day 6 and tested morning and evening urine with the WLH stick until the day following detection of the LH surge on the EHFM.

Results:

Forty-two women provided 219 cycles. Frequency of LH surge detection was 182/219 (83.1%) for EHFM and 203/219 (92.7%) for WLH sticks. Agreement between the EHFM and the WLH on the day of the LH surge was 97.7%. High fertility readings providing a warning of peak fertility at least 5 days before peak was 67% for the WLH; the EHFM was 47.7%. Paired sample correlations for high fertility was .174 (p = .014) and paired sample differences t was -4.729 (p = .000).

Clinical Implications:

The WLH stick is sufficiently sensitive to use in place of the EFHM for determining peak fertility and with the Marquette Fertility algorithm. Even with minimal use, WLH sticks cost about half the price of the monitor strips and provide more flexibility of use. Cost differences increase with the number of sticks used per cycle. Further research with a larger sample is needed to verify results.
Is Screening for Chlamydia and Gonorrhea in Men Who Have Sex With Men Associated With Reduction of the Prevalence of these Infections? A Systematic Review of Observational Studies
Authors: Tsoumanis Achilleas , Hens Niel , Kenyon Chris Richard
Published: February 2018

Background

Neisseria gonorrhoeae (gonorrhea) could become untreatable in the near future. Indeed, while the treatment of symptomatic gonorrhea in core groups, such men who have sex with men (MSM), is crucial for gonorrhea control programs, screening for and treating asymptomatic gonorrhea/Chlamydia trachomatis(chlamydia) in MSM may contribute to antibiotic resistance in gonorrhea. In this systematic review, we aim to assess if there is evidence that screening MSM for gonorrhea/chlamydia is associated with a decline in the prevalence of these infections.

Methods

We conducted a systematic review in PubMed and Web of Science for relevant studies including uncontrolled observational studies and reported the results following the PRISMA guidelines. The change in estimated prevalences for chlamydia and gonorrhea across the different time points for 3 anatomical sites (oral, urethral and anal) were collected and examined.

Results

Twelve studies met our entry criteria. We were able to statistically assess the change in prevalence in 10 of 12 studies. In 3 studies, there was a significant increase in chlamydia prevalence, whereas for gonorrhea, 2 studies reported a significant increase and 2 others a decrease. Our review provides little evidence that screening for gonorrhea and chlamydia in MSM has an effect on the prevalence of these infections. No evidence was found that more frequent screening reduces prevalence more effectively than annual screening.

Conclusions

Our study was not able to provide evidence that screening for chlamydia and gonorrhea lowers the prevalence of these infections in MSM. Randomized controlled trials are required to assess the risks and benefits of gonorrhea/chlamydia screening in high- and low-risk MSM.
Androgen Receptors in Resected Ductal Carcinoma In Situ of Breast: Novel Insights With Possible Implications for Testing and Targeted Endocrine Chemoprevention Trials
Authors: Oshilaja Olaronke , Nomani Laila , Calhoun Benjamin C. , Montero Alberto J. , Sturgis Charles D.
Published: February 2018

Mammary ductal carcinoma in situ (DCIS) is classically treated by combinations of excision, radiation, and endocrine therapy, based upon the specific needs of individual patients. Estrogen receptor (ER) status is generally assessed by immunohistochemistry (IHC) in newly diagnosed cases of DCIS, and endocrine therapy in this setting is thought to be chemopreventive. The potential impact of androgens on mammary carcinogenesis has been studied in recent years, and several authors have proposed androgen receptor (AR) IHC testing and targeted antiandrogenic therapy in patients with locally advanced or metastatic triple-negative invasive breast cancer (ie, negative for ER and progesterone receptor and HER-2). Very little has been published on AR in DCIS. We report results of AR IHC on archival tissue blocks from 221 adult female patients, each of whom underwent definitive breast resection of DCIS. Of the 221 cases, 72 (33%) were shown to express AR in their DCIS at or above the 10% threshold often used for invasive carcinoma. AR expression was seen in all grades of DCIS. Of the 72 positive AR cases, 21 (29%) were ER negative, corresponding to 10% (21/221) of all patients. The majority of the AR-positive cases were high grade, and the most common histologic subtype in this subset was a solid growth pattern with apocrine features. Early data from clinical trials evaluating AR antagonists in invasive/metastatic triple-negative breast cancer suggest that some patients may benefit from androgen blockade. IHC testing and potential clinical trials of AR antagonists for chemoprevention in patients with AR-positive and ER-negative DCIS could be considered.
The Amount of Melanin Influences p16 Loss in Spitzoid Melanocytic Lesions: Correlation With CDKN2A Status by FISH and MLPA
Authors: Martinez Ciarpaglini Carolina , Gonzalez Jose , Sanchez Beatriz , Agusti Jaime , Navarro Lara , Nieto Gema , Monteagudo Carlos
Published: February 2018

Aims:

The risk assessment of spitzoid lesions is one of the most difficult challenges in dermatopathology practice. In this regard, the loss of p16 expression and the homozygous deletion of CDKN2A, have been pointed in the literature as reliable indicators of high risk. However, these findings are poorly reproducible, and the molecular bases underlying the loss of p16 expression remain unclear. We aimed to identify the underlying events causing loss of CDKN2A/p16 in spitzoid tumors.

Materials and Methods:

We evaluated the immunohistochemical expression of p16, and the presence of CDKN2A genetic alterations detected through fluorescence in situ hybridization (FISH) and multiplex ligation-dependent probe amplification (MLPA), in a series of 130 Spitz nevi, 20 atypical spitzoid tumors, and 11 spitzoid melanoma.

Results:

We found a significant loss of p16 expression in cases with high amount of melanin content in the 3 groups (P<0.000001) and a similar proportion of p16-negative cases in the group of Spitz nevi and atypical spitzoid tumors. MLPA allowed the recognition of CDKN2A microdeletions, which correlated with p16 loss (P=0.01). MLPA and FISH were more accurate than immunohistochemistry to detect CDKN2A alterations; although contrary to MLPA, FISH fails to recognize CDKN2A microdeletions.

Conclusions:

According to our results, p16 expression may be useful in the study of cases with atypical features and low melanin content, but it has no value in highly pigmented spitzoid lesions.