bluuebunny/crossref_metadata_2025 huggingface dataset:
Quasi-Expressivism about Statements of Law
Authors: Finlay Stephen , Plunkett David
Published: October 2018

Speech and thought about what the law is commonly function in practical ways to guide or assess behavior. These functions have often been seen as problematic for legal positivism in the tradition of H.L.A. Hart. One recent response is an expressivist analysis of legal statements. This paper advances a rival, positivist-friendly account of legal statements which the authors call “quasi-expressivist”. It combines a descriptivist, “rule-relational” semantics with a pragmatic account of the expressive and practical functions of legal discourse. This approach is at least as well-equipped as expressivism to explain the practical features of “internal” legal statements and a fundamental kind of legal disagreement, while handling better “external” legal statements. The chapter develops this theory in a Hartian framework, and also argues (against Kevin Toh’s expressivist interpretation) that Hart’s own views in The Concept of Law are best reconstructed along quasi-expressivist lines.
An Instrumental Legal Moralism
Authors: Edwards James
Published: October 2018

Many writers defend or attack the position nowadays known as legal moralism. According to the most common formulation, legal moralists endorse the following thesis: the fact that φ‎ing is morally wrong is a reason to criminalize φ‎ing. This chapter considers a different kind of legal moralism, here called instrumental legal moralism (ILM). According to ILM: the fact that criminalizing φ‎ing will probably prevent moral wrongs is a reason to criminalize φ‎ing. Section I draws some relevant distinctions. In doing so, it clarifies the difference between ILM and the act-centred legal moralism (ALM) commonly discussed in the literature. Sections II–IV consider two prominent arguments for ALM: the retributivist argument, offered by Michael Moore, and the answerability argument, offered by Antony Duff. The chapter shows that, contrary to the intentions of these authors, both arguments in fact support ILM.
The hydrogen atom and the periodic table
Authors: Solymar L. , Walsh D. , Syms R. R. A.
Published: October 2018

Investigates the energy levels in a configuration when a heavy positive particle (proton) and a light negative particle (electron) are present. The wave functions and permissible energy levels are derived from Schrödinger's equation. The role of quantum numbers is discussed. Electron spin and Pauli’s exclusion principle are introduced. The properties of the elements in the periodic table are discussed, based on the properties of the hydrogen atom. Exceptions when such a simple approach does not work are further discussed.
Bonds
Authors: Solymar L. , Walsh D. , Syms R. R. A.
Published: October 2018

Mechanical properties of bonds are discussed, with the aid of a simple phenomenological model in which the variation of energy as a function of distance between the elements is described in terms of polynomials. The properties of various kinds of bonds (ionic bond, metallic bond, covalent bond, van der Waals bond) are explained with the aid of simple models. Carbon is discussed with two examples: bonds between 60 atoms that lead to the formation of a three-dimensional molecule known as Buckminsterfullerene, and the alternative sheet-shaped configuration known as graphene, that has recently become the centre of interest. A general theory for finding the energy levels is introduced, relying on Feynman’s coupled wave equations. There is a brief reference to nuclear forces, followed by a discussion of the hydrogen molecule. The relationship between coupling and the splitting of the energy levels is discussed with an analogy to coupled resonant circuits.
The band theory of solids
Authors: Solymar L. , Walsh D. , Syms R. R. A.
Published: October 2018

The solution of Schrodinger’s equation is discussed for a model in which atoms are represented by potential wells, from which the band structure follows. Three further models are discussed, the Ziman model (which is based on the effect of Bragg reflection upon the wave functions), and the Feynman model (based on coupled equations), and the tight binding model (based on a more realistic solution of the Schrödinger equation). The concept of effective mass is introduced, followed by the effective number of electrons. The difference between metals and insulators based on their band structure is discussed. The concept of holes is introduced. The band structure of divalent metals is explained. For finite temperatures the Fermi–Dirac function is combined with band theory whence the distinction between insulators and semiconductors is derived.
Semiconductors
Authors: Solymar L. , Walsh D. , Syms R. R. A.
Published: October 2018

Both intrinsic and extrinsic semiconductors are discussed in terms of their band structure. The acceptor and donor energy levels are introduced. Scattering is discussed, from which the conductivity of semiconductors is derived. Some mathematical relations between electron and hole densities are derived. The mobilities of III–V and II–VI compounds and their dependence on impurity concentrations are discussed. Band structures of real and idealized semiconductors are contrasted. Measurements of semiconductor properties are reviewed. Various possibilities for optical excitation of electrons are discussed. The technology of crystal growth and purification are reviewed, in particular, molecular beam epitaxy and metal-organic chemical vapour deposition.
Magnetic materials
Authors: Solymar L. , Walsh D. , Syms R. R. A.
Published: October 2018

Macroscopic and microscopic theories of magnetic polarization are discussed. The origin of domains, domain walls, and of the hysteresis curve and the contrast between soft and hard magnetic materials are explained. The more important elements of the quantum theory of magnetism are discussed. The principles of the alignments in antiferromagnetic and ferromagnetic materials are explained. Magnetic resonance phenomena are discussed. Magnetoresistance and spintronics and their device prospects are also discussed at some length.
Lasers
Authors: Solymar L. , Walsh D. , Syms R. R. A.
Published: October 2018

Two-state and three-state systems are introduced. The properties of gaseous, solid state, and dye lasers are discussed and particular attention is devoted to semiconductor lasers. Reducing the dimensions leading to wells, wires, and dots is shown to have advantages. Quantum cascade lasers working in the THz region are discussed. The phenomena of Q switching, cavity dumping, and mode locking are explained. Parametric oscillators and optical fibre amplifiers are discussed. Masers are briefly mentioned. Laser noise is discussed. Awide variety of applications are mentioned. The curious phenomenon of laser cooling is explained. The basic principles of holographic recording and display are described.
Superconductivity
Authors: Solymar L. , Walsh D. , Syms R. R. A.
Published: October 2018

The Meissner effect is discussed. The latent heat of transition is derived by a thermodynamic approach. The concept of surface energy is introduced, leading to the distinction between Type I and Type II superconductors. The differential equation for the superconducting wave function is derived. The energy gap and the phenomenon of tunnelling are discussed. The difference between superconducting tunnelling and Josephson tunnelling is explained. The significance of high transition temperature superconductors is discussed. It is shown that an important application of superconductors is to produce high-field magnets.
Epilogue
Authors: Solymar L. , Walsh D. , Syms R. R. A.
Published: October 2018

The virtues of the profession of engineering are extolled. The views of one of the greatest electrical engineers (Rudolf Kompfner) of the last century are quoted as follows: “The feeling one experiences when he obtains a new important insight when a crucial experiment works, when an idea begins to grow and bear fruit, these mental states are indescribably beautiful and exciting. Nomaterial reward can produce effects even distantly approaching them. Yet another benefit is that an inventor can never be bored. There is no time when I cannot think of a variety of problems. All waiting to be speculated about, perhaps tackled, perhaps solved. All one has to do is to ask the questions, why? How? And not be content with the easy, the superficial answer.”
Indonesian Law
Authors: Lindsey Tim , Butt Simon
Published: October 2018

This book explains Indonesia’s complex legal system and how it works. Covering a wide range of substantive topics from public to private law, including commercial, criminal, and constitutional law, it is the first comprehensive survey of Indonesian law in English. Offering clear answers to practical problems of current law, each chapter sets out relevant laws and leading court decisions, accompanied by an explanation of how the law works in practice, with an analytical critique. The book begins with an account of Indonesia’s Constitution and the key state agencies, before moving to the lawmaking process, decentralization, the judicial system and court procedure, and the legal profession (advocates, notaries, and legal aid). Part II covers traditional customary law (adat), land law, and environmental law, including forest law. Part III focuses on criminal law and procedure, including investigation, arrest, trial, sentencing, and appeals. It also covers human rights law and the law on corruption. Part IV deals with civil law, and covers civil liability, contracts, companies and other business vehicles, labour, foreign investment, taxation, insolvency, banking, competition, and media law. The book concludes in Part V with an account of Indonesia’s complex family law and inheritance system for both Muslims and non-Muslims. The book has an extensive glossary of legal terms, and detailed tables of legislation and court decisions, designed as unique resources for lawyers, policymakers, and researchers.
The Twang Factor in Country Music
Authors: Neal Jocelyn R.
Published: October 2018

The term twang in instrumental and vocal contexts carries powerful associations within country and western music. Revered by some and disdained by others, twang indexes rural traditions, untrained singers, and, consequently the pride in this cultural heritage. This chapter explores the sonic properties of twang in both instruments and the human voice, the cultural implications and reception of twang, and the deemphasis on twang in Nashville’s country music scene in the 1950s. It presents a case study of two contrasting recordings by Jim Reeves (one with liberal use of twang and one without), examines the sonic character of country albums from Ray Charles and Connie Francis, and investigates the contemporary politics of twang in country music.
Conceived in Harlesden: Candidate-Centred Campaigning in British General Elections
Authors: Milazzo Caitlin , Townsley Joshua
Published: October 2018

Recent decades have seen an increasing trend towards the personalisation of election campaigns, even in systems where candidates have few structural incentives to emphasise their personal appeal. In this article, we build on a growing literature that points to the importance of candidate characteristics in determining electoral success. Using a dataset composed of more than 3700 leaflets distributed during the 2015 and 2017 general elections, we explore the conditions under which messages emphasising the personal characteristics of prospective parliamentary candidates appear in British general election campaign materials. Even when we account for party affiliation, we find that there are important contextual and individual-level factors that predict the use of candidate-centred messaging.
Dirac cohomology, the projective supermodules of the symmetric group and the Vogan morphism
Authors: Calvert Kieran
Published: October 2018

We derive an explicit description of the genuine projective representations of the symmetric group Sn using Dirac cohomology and the branching graph for the irreducible genuine projective representations of Sn. Ciubotaru and He [D. Ciubotaru and X. He, Green polynomials of Weyl groups, elliptic pairings, and the extended index. Adv. Math., 283:1–50, 2015], using the extended Dirac index, showed that the characters of the projective representations of Sn are related to the characters of elliptic-graded modules. We derive the branching graph using Dirac theory and combinatorics relating to the cohomology of Borel varieties ℬe of g and are able to use Dirac cohomology to construct an explicit model for the projective representations. We also describe Vogan’s morphism for Hecke algebras in type A using spectrum data of the Jucys–Murphy elements.
The Costs of Agglomeration: House and Land Prices in French Cities
Authors: Combes Pierre-Philippe , Duranton Gilles , Gobillon Laurent
Published: October 2018

We develop a new methodology to estimate the elasticity of urban costs with respect to city population using French house and land price data. After handling a number of estimation concerns, we find that the elasticity of urban costs increases with city population with an estimate of about 0.03 for an urban area with 100,000 inhabitants to 0.08 for an urban area of the size of Paris. Our approach also yields a number of intermediate outputs of independent interest such as the share of housing in expenditure, the elasticity of unit house and land prices with respect to city population, and within-city distance gradients for house and land prices.
Effects of supplement type and narasin inclusion on supplement intake by Bos indicus beef bulls grazing a warm-season forage
Authors: Cappellozza Bruno I , Lasmar Pedro V F , Reis Flávea T , Oliveira Leane , Hoe Fernanda , Boehler Ryan M , Leibovich Jose , Starkey Robert , Simas José , Cooke Reinaldo F
Published: October 2018

This study aimed to evaluate the effects of supplement type and narasin inclusion on the frequency and supplement intake of grazing Bos indicus beef bulls. Four hundred animals were ranked by initial BW (383 ± 35 kg) and allocated into one of four paddocks of Brachiaria brizantha cv. Marandú (100 animals/paddock). Paddocks were randomly assigned to receive either a mineral salt (MIN) or a protein-energetic supplement (PREN) containing or not narasin (N) for a 90-d period. An individual electronic data capture system with 11 feed bunks was used to individually measure supplement intake and meal frequency in each paddock. The evaluations and analysis of individual intake, frequency of visits to the feeder, and intake per visit (I/V) were performed every 15 d and classified as periods (PR1 through PR6). All data were analyzed as a 2 × 2 factorial design with the PROC MIXED procedure of SAS. A supplement type × N × PR interaction was observed (P < 0.0001) for daily supplement intake. No differences were observed between MIN, whereas PREN had a greater (P ≤ 0.03) supplement intake on PR1 and PR3, but a reduced supplement intake on PR6 compared with PREN + N (P = 0.02). Moreover, no supplement type × N interaction (P = 0.47) or N (P = 0.44) effects were observed for daily supplement intake in the present study. A supplement type × N × PR interaction was detected (P < 0.0001) for the frequency of visits in the feeders. Throughout the experimental period, animals from the MIN + N had a greater (P ≤ 0.02) frequency of visits compared with MIN cohorts. A supplement effect was detected for I/V (P = 0.02), whereas neither a narasin effect (P = 0.74) nor interactions (P ≥ 0.16) were observed. Animals offered PREN had a greater I/V when compared with MIN cohorts (145 vs. 846 g/d for MIN and PREN, respectively; SEM = 16.1). When these data are reported as percentage of days visiting the feeder within each PR, MIN and MIN + N animals visited the feeder for 25.8% and 35.9% of the days, respectively. Conversely, no differences were observed (P = 0.65) in the overall mean visits per PR between PREN and PREN + N (12.8 vs. 12.3 d for PREN and PREN + N, respectively; SEM = 0.195). As percentage of days visiting the feeder, PREN and PREN + N visited the feeder for 85.1% and 81.9% of the days, respectively. In summary, narasin inclusion did not reduce supplement intake, regardless of supplement type, but increased the frequency of visits to the feeder for the MIN treatment.
Mineral status of California beef cattle1
Authors: Davy Josh S , Forero Larry C , Shapero Matthew W K , Rao Devii R , Becchetti Theresa A , Koopman Rivers Carissa , Stackhouse Jeffery W , DeAtley Kasey L , McNabb Bret R
Published: October 2018

Optimal mineral nutrition is required for cattle reproduction, immune function, and structural development. Formal evaluation of the current mineral status of California beef cattle is currently lacking. In 2017, a survey was initiated that evaluated a panel of 10 different minerals in 14 counties across California. Samples were collected from 555 cattle at 50 different ranches. Region of the state significantly affected herd mineral status. Herd use of supplements was also significant, and increased most blood levels of the mineral(s) targeted for supplementation. Forage source was idiosyncratic on its effect of mineral status. Previous blood survey data showed selenium to be widely deficient in California cattle in the 1970s and 1980s, but in this case, it was generally adequate in all areas of California. This indicates a good producer understanding of where supplementation is needed. Copper deficiency was more widespread in the southern region when compared with further north. Zinc deficiency was seen ubiquitously statewide, with 36% of animals being deficient. Manganese has been largely ignored in California. This study is the first known documentation of manganese levels in the state. Sampling found 92% of cattle fell below critical manganese levels. However, further research to better define manganese critical levels is probably warranted. The status of other minerals is presented.
The Medical Education Partnership Initiative: Strengthening Human Resources to End AIDS and Improve Health in Africa
Authors: Kilmarx Peter H. , Katz Flora , Razak Myat Htoo , Palen John , Cheever Laura W. , Glass Roger I.
Published: October 2018

Faced with a critical shortage of physicians in Africa, which hampered the efforts of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the Medical Education Partnership Initiative (MEPI) was established in 2010 to increase the number of medical graduates, the quality of their education, and their retention in Africa. To summarize the accomplishments of the initiative, lessons learned, and remaining challenges, the authors conducted a narrative review of MEPI—from the perspectives of the U.S. government funding agencies and implementing agencies—by reviewing reports from grantee institutions and conducting a search of scientific publications about MEPI. African institutions received 11 programmatic grants, totaling $100 million in PEPFAR funds, to implement MEPI from 2010 to 2015. The National Institutes of Health (NIH) provided an additional 8 linked and pilot grants, totaling $30 million, to strengthen medical research capacity. The 13 grant recipients (in 12 countries) partnered with dozens of additional government and academic institutions, including many in the United States, forming a robust community of practice in medical education and research. Interventions included increasing the number of medical school enrollees, revising curricula, recruiting new faculty, enhancing faculty development, expanding the use of clinical skills laboratories and community and rural training sites, strengthening computer and telecommunications capacity, and increasing e-learning. Research capacity and productivity increased through training and support. Additional support from NIH for faculty development, and from PEPFAR for health professions education and research, is sustaining and extending MEPI’s transformative effect on medical education in select African sites.
The Social Media Editor at Medical Journals: Responsibilities, Goals, Barriers, and Facilitators
Authors: Lopez Melany , Chan Teresa M. , Thoma Brent , Arora Vineet M. , Trueger N. Seth
Published: October 2018

Purpose

To determine the responsibilities of journal social media editors (SMEs) and describe their goals and barriers and facilitators to their position.

Method

The authors identified SMEs using an informal listserv and snowball sampling. Participants were interviewed (June–July 2016) about their position, including responsibilities; goals; barriers and facilitators; and attitudes and perceptions about the position. Themes were identified through a thematic analysis and consensus-building approach. Descriptive data, including audience metrics and 2016 impact factors, were collected.

Results

Thirty SMEs were invited; 24 were interviewed (19 by phone and 5 via e-mail). SMEs generally had a track record in the social media community before being invited to be SME; many had preexisting roles at their journal. Responsibilities varied considerably; some SMEs also served as decision editors. Many SMEs personally managed journal accounts, and many had support from nonphysician journal staff. Consistently, SMEs focused on improving reader engagement by disseminating new journal publications on social media. The authors identified goals, resources, and sustainability as primary themes of SMEs’ perspectives on their positions. Editorial leadership support was identified as a key facilitator in their position at the journal. Challenges to sustainability included a lack of tangible resources and uncertainty surrounding, or a lack of, academic credit for social media activities.

Conclusions

Many of the participating SMEs pioneered the use of social media as a platform for knowledge dissemination at their journals. While editorial boards were qualitatively supportive, SMEs were challenged by limited resources and lack of academic credit for social media work.
Drug Misuse and Hepatitis C Virus Infection Profiles for Three Generations of Patients Being Monitored for Prescription Drug Adherence
Authors: McClure Fred Leland , Niles Justin K. , Kaufman Harvey W. , Gudin Jeffrey
Published: October 2018

Objectives:

Two epidemics in the United States are related: opioid drug injection and hepatitis C virus (HCV) infection. This study quantifies the relationship between illicit/prescription drug misuse and HCV infection in 3 population generations: baby boomers (born 1945–1965, inclusive), pre-baby boomers, and post-baby boomers.

Methods:

This retrospective study included prescription drug consistency (March–December 2015) and HCV (2011–2015) patient test results performed at a large national clinical reference laboratory. HCV positivity, drug use consistency/inconsistency with prescribed drug information, type of inconsistent use, and inconsistent use of individual drug classes were assessed.

Results:

This study evaluated 39,231 prescription drug monitoring and HCV sets of test results from 18,410 patients. Of these patients, 25.1% tested positive for HCV and 57.3% demonstrated drug test results that were inconsistent with the prescribed medication(s). The types of drug test inconsistency differed substantially between HCV-positive and -negative patients, particularly testing positive for both non-prescribed drugs and prescribed drugs. Specimens from HCV-positive baby boomer and post-baby boomers demonstrated non-prescribed use of opioids and many other drug classes more often than from HCV-negative patients.

Conclusions:

The rates of inconsistent drug test results and types of drugs misused suggest that HCV-positive patients are more likely than HCV-negative patients to display high-risk behavior, even beyond opioid use. This difference is most pronounced in the post-baby boomer generation. Healthcare professionals should consider these patterns and how they differ by generation when monitoring for both prescription and illicit drugs, the results of which can impact treatment decisions including prescribing analgesics.
Prenatal Opioid Exposure, Neonatal Abstinence Syndrome/Neonatal Opioid Withdrawal Syndrome, and Later Child Development Research: Shortcomings and Solutions
Authors: Jones Hendrée E. , Kaltenbach Karol , Benjamin Tara , Wachman Elisha M. , O’Grady Kevin E.
Published: October 2018

The opioid epidemic has brought with it an increasing focus on the incidence of Neonatal Abstinence Syndrome (NAS) (also known as Neonatal Opioid Withdrawal Syndrome) in neonates prenatally exposed to opioids, and recently, in the putative long-term effects of NAS on child development. The purpose of the present paper is three-fold: (1) outline shortcomings regarding the current research relating NAS to child development; (2) propose solutions to minimize these shortcomings; and (3) recommend an alternative conceptual framework to understanding developmental problems in later childhood presumed to be a result of NAS. The paper focuses on issues regarding definitions of the population of interest, choice of comparison groups, matching practices, statistical analyses, and an implicit single-cause fallacy related to NAS. It offers possible solutions to the problems identified in each of these areas. Use of a NAS or Neonatal Opioid Withdrawal Syndrome diagnosis as a main indicator of adverse developmental outcomes poses potential radiating harm to the child and the family and misses the opportunity to see the complexities of interpersonal, intrapersonal, and environmental factors that contribute to the long-term developmental trajectories of children.
Do Academic Health Care Systems Really Value Education? A Survey of Academic Plastic Surgeons
Authors: Sun Helen H. , Pourtaheri Navid , Janis Jeffrey E. , Becker Devra B.
Published: October 2018

Background:

Although education is critical to the mission of academic medical centers in the United States, it is often not quantified and monetized as are their research and clinical missions. We undertook this survey to assess the perceived valuation of educational endeavors of plastic surgeon faculty at the U.S. academic medical centers.

Methods:

A survey using Qualtrics software (Qualtrics, Provo, UT) was distributed to faculty members of the American Council of Academic Plastic Surgeons by electronic mail in February 2015. A total of 16 questions included both demographic information and Likert-item questions of perception of valuation of educational activities. For analysis, responses were grouped according to an adapted Net Promoter Score including “unsupportive” (0–6), “neutral” (7–8), and “supportive” (9–10).

Results:

Sixty-five surveys were completed out of a total of 406, with an overall response rate of 16%. Kruskal-Wallis statistical analysis demonstrated that region and rank were not significant in perception of hospital or departmental support for educational activities. Respondents rated their departments as more supportive than their institutions (P < 0.05), and average perceived value rating of institutions was “unsupportive.” Financial support was associated with higher ratings with respect to support of institutions and departments. Mid-career faculty displayed a trend toward lower ratings of perception of support.

Conclusions:

The majority of respondents perceived their institutions and departments as unsupportive of educational effort. Direct compensation to physicians for teaching efforts may improve faculty retention in academia and reduce physician burnout.
Surgical Algorithm for Neuroma Management: A Changing Treatment Paradigm
Authors: Eberlin Kyle R. , Ducic Ivica
Published: October 2018

Successful treatment of the painful neuroma is a particular challenge to the nerve surgeon. Historically, symptomatic neuromas have primarily been treated with excision and implantation techniques, which are inherently passive and do not address the terminal end of the nerve. Over the past decade, the surgical management of neuromas has undergone a paradigm shift synchronous with the development of contemporary techniques aiming to satisfy the nerve end. In this article, we describe the important features of surgical treatment, including the approach to diagnosis with consideration of neuroma type and the decision of partial versus complete neuroma excision. A comprehensive list of the available surgical techniques for management following neuroma excision is presented, the choice of which is often predicated upon the availability of the terminal nerve end for reconstruction. Techniques for neuroma reconstruction in the presence of an intact terminal nerve end include hollow tube reconstruction and auto- or allograft nerve reconstruction. Techniques for neuroma management in the absence of an intact or identifiable terminal nerve end include submuscular or interosseous implantation, centro-central neurorrhaphy, relocation nerve grafting, nerve cap placement, use of regenerative peripheral nerve interface, “end-to-side” neurorrhaphy, and targeted muscle reinnervation. These techniques can be further categorized into passive/ablative and active/reconstructive modalities. The nerve surgeon must be aware of available treatment options and should carefully choose the most appropriate intervention for each patient. Comparative studies are lacking and will be necessary in the future to determine the relative effectiveness of each technique.
Communication Course for Pediatric Providers Improves Self-efficacy
Authors: Grome Luke J. , Banuelos Rosa C. , Lopez Michelle A. , Nicome Roger K. , Leaming-Van Zandt Katherine J.
Published: October 2018

Background:

Communication is essential to building a trusting, clinician-patient relationship. Multiple studies have demonstrated the effects of experiential communication training on patient experience and provider well-being and resiliency. To date, no studies have described an organization-wide communication training program for pediatric clinicians. The objective of this study was to evaluate the impact of a pediatric-focused communication course on provider satisfaction, self-efficacy, and burnout.

Methods:

Texas Children’s Hospital, in collaboration with the Academy on Communication in Healthcare, designed and implemented a pediatric focused communication course entitled Breakthrough Communication. Pre, immediate-post, and 3-month postcourse completion online surveys were sent to participants 1 day before, 1 day after, and 3 months after course completion. Participant demographic information, self-assessment of communication skills, the Maslach Burnout Inventory Human Services Survey, and postcourse satisfaction data were collected.

Results:

Participants reported high course satisfaction and improved self-efficacy in all measured skill sets both following and 3 months after course completion. Trends indicating a reduction in provider burnout improved in 2 of the 3 Maslach Burnout Inventory domains; however, statistical significance was not achieved.

Conclusions:

A pediatric-focused communication course was well received by multi-specialty clinicians within a large, academic health care organization. This course enhanced clinician self-efficacy with newly learned pediatric encounter specific communication skills.
Simple-safe-sure Fluid Drainage Just above Breast Tissue Expander using 18-Gauge Blunt Cannula
Authors: Kagaya Yu , Arikawa Masaki , Kageyama Daisuke , Sekiyama Takuya , Akazawa Satoshi
Published: October 2018

The presence of seroma after breast tissue expander (TE) insertion for a long duration can cause infection and purulency; thus, obvious fluid collection around TEs should be drained as early as possible. However, due to the risk of puncture, it may not be possible to completely drain the fluid if it is located above the TE. To manage such cases, we used an 18-gauge blunt cannula and achieved good results. Among 98 cases in which breast reconstruction was performed with a TE, 5 patients had symptoms of infection with fluid collection just above the TE. In all 5 cases, resolution of the infection was observed in an outpatient setting without the removal or puncture of the inserted TE, by performing a drainage technique using an 18-gauge blunt cannula. An 18-gauge blunt cannula minimized the risk of expander rupture during drainage and enabled the complete aspiration of fluid, even when it was located just above the TE; thus, the resolution of infection with the preservation of the expander was possible in cases that would otherwise have been impossible to treat without the removal of the TE. This drainage procedure using an 18-gauge blunt cannula is considered to be simple, safe, and sure, with benefits that exceed the risk; thus, there should be no reason to hesitate in performing this drainage procedure, even in cases involving slight fluid collection around the TE.
EFFECTIVENESS OF EN BLOC REMOVAL OF FIBRINOGEN-RICH COMPONENT OF CYSTOID LESION FOR THE TREATMENT OF CYSTOID MACULAR EDEMA
Authors: Imai Hisanori , Otsuka Keiko , Tetsumoto Akira , Miki Akiko , Nakamura Makoto
Published: October 2018

Purpose:

To introduce the methodology and outcomes of en bloc removal of the component of cystoid lesion during pars plana vitrectomy as a novel approach for the treatment of cystoid macular edema and show evidence that the component is an aggregation of fibrinogen by mass spectrometry analysis.

Methods:

The surgical en bloc extraction of the component of cystoid lesion was performed for cystoid macular edemas secondary to diabetic retinopathy and retinal vein occlusion. Perioperative change of best-corrected decimal visual acuity, and the central retinal thickness and the continuity of subfoveal ellipsoid zone and external limiting membrane on optical coherence tomography were evaluated. Mass spectrometry was performed for the identification of protein constituting the component.

Results:

Six eyes from six patients were included in the study. In all cases, central retinal thickness was improved after the surgery and remained stable during the follow-up period. Best-corrected decimal visual acuity and the continuity of ellipsoid zone and external limiting membrane were kept in all cases during the follow-up period. The mass spectrometry analysis disclosed that the component was composed of fibrinogen.

Conclusion:

The en block removal of the component of cystoid lesion combined with pars plana vitrectomy may be a promising option for treatment of cystoid macular edema. The component of cystoid lesion is presumably a fibrinogen aggregate.
Management Algorithm for Fungal Keratitis: The TST (Topical, Systemic, and Targeted Therapy) Protocol
Authors: Sharma Namrata , Sahay Pranita , Maharana Prafulla K. , Singhal Deepali , Saluja Gunjan , Bandivadekar Pooja , Chako Jacob , Agarwal Tushar , Sinha Rajesh , Titiyal Jeewan S. , Satpathy Gita , Velpandian Thirumurthy
Published: October 2018

Purpose:

To evaluate the efficacy of the topical, systemic and targeted therapy (TST) protocol in management of fungal keratitis.

Method:

All cases of treatment-naive smear- or culture-proven fungal keratitis presenting between June 2013 and May 2017 were recruited. The TST protocol included initial treatment with topical natamycin 5% with addition of oral ketoconazole or voriconazole in ulcers with size >5 mm, depth >50%, or impending perforation. Topical voriconazole 1% was included in case of poor response at 7 to 10 days. Intrastromal or intracameral antifungal injections were administered in case of poor response to combination therapy. Penetrating keratoplasty was performed in case of poor response to any of the regimen.

Results:

The study included 223 cases of fungal keratitis with a mean age of 43.6 ± 15.3 years and a male-to-female ratio of 1.8:1. The mean area of the ulcer and infiltrate at presentation was 25.52 ± 19 and 25.7 ± 14.4 mm2, respectively. Corrected distance visual acuity at presentation was 2.05 ± 0.43 logMAR that improved to 1.6 ± 0.4 logMAR at 3 months. Fusarium (42.2%) was the most common microorganism isolated, followed by Aspergillus (32.8%). The mean healing time was 41.5 ± 22.2 days, with a final scar size of 14.6 ± 8.2 mm2. The treatment success rate with the TST protocol was 79.8%. Corneal perforation developed in 7% of cases (n = 15), and keratoplasty was performed for 20.2% of cases (n = 45).

Conclusions:

The TST protocol provides a stepwise treatment algorithm for management of cases of fungal keratitis with varying severity.
Descemet Membrane Endothelial Keratoplasty (DMEK) Graft Dislocation Into the Vitreous Cavity
Authors: Vasquez-Perez Alfonso , Brennan Nicholas , Ayoub Tariq , Allan Bruce , Larkin Daniel F. P. , da Cruz Lyndon
Published: October 2018

Purpose:

To present our experience of Descemet stripping endothelial keratoplasty (DMEK) graft luxation into the vitreous cavity in 2 cases.

Methods:

DMEK was performed in 2 patients with aphakic bullous keratopathy. The indications for keratoplasty were endothelial failure caused by chronic intermediate uveitis and glaucoma in 1 case and decompensated previous penetrating keratoplasty in the other. Both cases had enlarged pupils and had previously undergone pars plana vitrectomy. In both cases, the DMEK graft dislocated into the vitreous cavity during unfolding maneuvers and could not be retrieved during the same procedure.

Results:

No signs of retinal detachment were observed during follow-up (6 months and 1 year). Although visualization of the graft was not possible on examination, B-scan confirmed the presence of the lenticule lying over the retina. One case underwent repeat DMEK, and 1 case underwent repeat penetrating keratoplasty. In 1 case, the graft was retrieved after a month and sent for histopathology. In both cases, corneal transparency and corrected visual acuity improved to full potential after the final procedure. Histopathology of the retrieved graft showed only endothelial cell loss and no fibrocellular proliferation.

Conclusions:

The risk of fibrous proliferation and retinal detachment after posterior dislocation of DMEK grafts may be less than in grafts including corneal stroma, but pars plana vitrectomy and retrieval of the dislocated corneal transplant are still indicated after revision corneal transplant surgery where visual symptoms or signs of fibrotic change around the dislocated graft are evident.
Secukinumab-Associated Crystalline Corneal Deposition
Authors: Power Barry , Pilson Qistina , Fulcher Timothy
Published: October 2018

Purpose:

To describe the first reported case of corneal crystalline deposition associated with the monoclonal antibody secukinumab (Cosentyx; Novartis, Basel, Switzerland) and the subsequent follow-up of the case.

Methods:

Case report.

Results:

An 18-year-old man was referred for a corneal opinion 1 year after commencing secukinumab monoclonal antibody therapy for ankylosing spondylitis. Crystalline corneal deposits were identified at a routine optometrist appointment. The same optometrist had documented normal anterior segment examination 2 years earlier. On examination, anterior stromal refractile crystals were visible in both corneas extending out to the limbus. The patient's best-corrected distance visual acuity was 20/20 bilaterally, and he was asymptomatic. Family history and systemic workup for other causes of crystal deposition were negative. By a process of elimination of other etiologies, we concluded that the monoclonal antibody secukinumab was responsible for the deposition. At the 1-year point of treatment with secukinumab, the patient remains asymptomatic and is still undergoing therapy.

Conclusions:

To the best of the authors' knowledge, this is the first report of corneal crystal deposition attributed to secukinumab. The number of monoclonal antibodies in use across multiple medical disciplines is increasing, and corneal specialists may see this presentation more frequently in the future. These drugs provide critical disease-modifying treatment to patients with debilitating systemic pathology. It is important that we understand the natural history of their side effects to allow their full utilization.
Challenges in Conducting Ethnography Among Hidden Populations in Rural South India
Authors: von Gaudecker Jane R.
Published: October 2018

International qualitative researchers confront many challenges while conducting studies among hidden populations. This article describes challenges experienced as a US-based researcher and native Indian woman conducting a focused ethnography among women with epilepsy in rural south India. The 5 challenges encountered during this research were (1) obtaining ethical approvals to conduct the study, (2) recruiting hidden participants, (3) being a halfie, (4) addressing a sensitive topic with a vulnerable population, and (5) managing researcher distress and intrapersonal conflicts. The article also details strategies used to confront these challenges.
Unique Stroke Symptoms in Women: A Review
Authors: Colsch Renee , Lindseth Glenda
Published: October 2018

Background: Research suggests that there is a delay in recognizing unique stroke symptoms in women by both healthcare professionals and the general population. The purpose of this review was to identify and summarize the most relevant literature regarding recognition and assessment of unique stroke symptoms in women. Methods: Literature review using PubMed, CINAHL, ERIC, MEDLINE, PsycINFO, and Google Scholar was used to search literature describing unique stroke symptoms. Results: Unique stroke symptoms, female sex, and race are associated with delayed recognition, treatment, misdiagnosis, and outcomes. Women experience unique symptoms of nausea/vomiting, headache, dizziness, and cognitive dysfunction more often than men. Stroke assessment tools and registries recognize 1 to 4 of the 11 unique stroke symptoms in women, no study directly assesses the sensitivity and specificity of these unique symptoms, and all studies included women and men. Conclusions and Nursing Implications: Current assessment tools and registries are not sensitive and specific to measuring unique stroke symptoms in women. Accurately identifying unique stroke symptoms in women may reduce presentation and treatment time, minimizing misdiagnoses and poor patient outcomes.
Tissue perfusion alterations correlate with mortality in patients admitted to the intensive care unit for acute pulmonary embolism
Authors: Urbina Tomas , Bigé Naïke , Nguyen Yann , Boelle Pierre-Yves , Dubée Vincent , Joffre Jérémie , Abdallah Idriss , Baudel Jean-Luc , Maury Eric , Guidet Bertrand , Ait-Oufella Hafid
Published: October 2018

We aimed to assess the relationship between alterations of tissue perfusion parameters at admission (highly predictive of mortality in septic shock) and outcome in patients admitted to the intensive care unit (ICU) for acute pulmonary embolism (PE). We conducted a retrospective study to analyze the association between arterial lactate level, skin mottling and urinary output, and 28-day mortality.

Over a 22-year period, 317 patients with PE were identified but we finally analyzed 108 patients whose main diagnosis for ICU admission was acute PE. At admission, the sequential organ failure assessment score was 2 (0–6) and the simplified acute physiology score II was 29 (16–43). Thirty patients (28%) received vasopressors and 37 patients (34%) received thrombolytic therapy. Day 28 mortality rate was 25% (n = 27). When compared to 28-day survivors, nonsurvivor patients had higher lactate level (4.5 [2.3–10.3] mmol/L vs 1.4 [1–2.9] mmol/L, P < .0001), more frequent mottling around the knee area (56% vs 25%, P = .003) and a lower urinary output (during the first 6 hours) (0.35 [0–1] mL/kg/h vs. 0.88 [0.62–1.677] mL/kg/h, P = .0002). Mortality increased with the number of tissue perfusion alterations present upon admission, 8% for none, 21% for 1, 28% for 2, and finally reached 85% for 3 tissue perfusion alterations (P < .0001). In a multivariate analysis, the relationship between the number of tissue perfusion alterations and 28-day mortality was maintained after adjustment on the presence of shock and right ventricular dilation at admission.

In ICU patients admitted for acute PE, tissue perfusion alterations correlated with 28-day mortality independently of blood pressure and right ventricular dilation.
The clinical and economic consequences of practice style variations in common surgical interventions
Authors: Nouhi Mojtaba , Hadian Mohamad , Olyaeemanesh Alireza
Published: October 2018

Background:

Surgical intervention is one of the common therapeutic interventions applied to a vast class of diseases. Unwarranted variation in practice style in different locations is considered as practice style variations (PSVs), which cause undesirable effects on patient health status and economic consequences. The magnitude of the variations in surgical interventions and its effects on clinical outcomes of patients and also utilization of resources have been investigated in recent years. But the findings show considerable heterogeneities in magnitude and consequences. We develop a protocol to systematically review the current literature of PSV to explain the magnitude of PSV and its clinical and economic consequences.

Method:

This systematic review will include observational and experimental studies to investigate magnitude and consequences of PSV in common surgical interventions, cardiovascular disease, urological, and ophthalmological diseases. Source of information is scientific databases, theses, clinical trials registrations website, and grey literature. A comprehensive electronic search will be conducted through PubMed, Web of Science, EBSCO, EMBASE, and Scopus databases. Studies are assessed systematically by 2 investigators. Methodological quality of the included studies is evaluated by the STROBE and CONSORT checklists. In case of data availability, we will pool findings of included studies by meta-analysis techniques in the CMA software. Subgroup analyses are based on the type of the interventions and selected diseases.

Results:

This study has ethical approval from ethical committee of Iran University of Medical Sciences, ethic code: IR.IUMS.REC1395.9221504203. The results will be published in a peer-reviewed journal.

Conclusion:

A systematic review is considered as an appropriate scientific method for reaching a consensus on magnitude as well as consequences of PSV. Results of this study will help clinical experts to attain more knowledge about PSV and encourage them to use some tools such as clinical guidelines and shared decision making to alleviate its consequences.
Right main bronchial pleomorphic adenoma
Authors: Zhu Zhixing , Lian Xihua , Yang Dongyong
Published: October 2018

Rationale:

Tracheobronchial benign tumors are uncommon; particularly, bronchial pleomorphic adenoma is one of the rarest benign tumors that develop in bronchus (only 7 reported cases, among which only 4 cases of pleomorphic adenoma were seen arising from right main bronchus).

Patient concerns:

In this report, a 38-year-old woman suffered from progressive shortness of breath for 5 years due to right main bronchial pleomorphic adenoma.

Diagnoses:

The patient was diagnosed as right main bronchial pleomorphic adenoma based on chest computed tomography enhanced scan, bronchoscopy, and histological examination.

Interventions:

An electrosurgical snare was performed to resect the neoplasm and several APC were administered at the sites of the resection to provide hemostasis and further coagulate for the residual neoplasm.

Outcomes:

The patient was free of symptoms and the lumen of right main bronchus was clear during the follow-up period for 10 months without any procedure-related complications.

Lessons:

Bronchial pleomorphic adenoma is extremely rare, however, we should take it into consideration if a patient suffered from shortness of breath without an exact cause.