bluuebunny/crossref_metadata_2025 huggingface dataset:
The European Union in International Politics: Baptism by Fire. By Roy H. Ginsberg. Lanham, MD: Rowman and Littlefield, 2001. 256p. $79.00 cloth, $27.95 paper.
Authors: Dudek Carolyn Marie
Published: May 2019

Since the Cold War, the United States as well as other countries have struggled with the “new world order.” Further integration of the European Union, mostly in economic and political ways, has given it recognition as an actor within the international arena. During the crisis that followed the dissolution of Yugoslavia, the international community witnessed the EU's failure to bring a speedy end to the genocide and violence in the region. The EU's inability and lack of efficacy in the situation tarnished its image and prompted it to begin working toward the creation of a European Common Foreign and Defense Identity. More recent events of September 11, as well as increased violence between Israel and the Palestinians, once again beg the question: What is the role of an integrated Europe? As the United States takes on its war against terrorism, it looks to its closest allies in Europe to be supportive and to help in the endeavor. Actions or opinions from individual member states, however, seem to gain more public attention in the United States than those from the EU as a single entity acting in the global arena.
Money and Power in Europe: The Political Economy of European Monetary Cooperation. By Matthias Kaelberer. Albany: State University of New York Press, 2001. 254p. $49.50.
Authors: Loedel Peter Henning
Published: May 2019

The puzzle of European monetary cooperation—namely, why sovereign nation-states would relinquish monetary autonomy in return for some measure of exchange rate stability—has produced a growing body of highly informed and theoretically strong works on European integration. Matthais Kaelberer's account fits nicely into this mold. The author argues convincingly that European monetary cooperation—especially Germany's leading contribution to the European Monetary Union (EMU)—is the result of a structural conflict of interest between weak and strong currency countries over the rules of monetary cooperation. In laying out his “structural” argument, Kaelberer's analysis, as he notes in his own words, “complements rather than substitutes for other explanations of European monetary cooperation” (p. 6). In making this claim, his work will not settle the extremely lively theoretical debate on European integration, and European monetary cooperation more specifically. However, it is an important contribution to the literature and fills in some of the theoretical void involving concepts of “leadership” and “asymmetry” of power that help explain European integration.
Alliance Politics, Kosovo, and NATO's War: Allied Force or Forced Allies? Edited by Pierre Martin and Mark R. Brawley. New York: Palgrave, 2001. 246p. $49.95.
Authors: Menon Anand
Published: May 2019

The obvious advantage of edited collections, such as this interesting book, is that they allow a range of authors with a huge cumulative breath of knowledge about a subject to cover virtually all aspects of it. This they certainly do in Alliance Politics, Kosovo, and NATO's War, examining the way in which both NATO as a whole and its most important members reacted to and handled the Kosovo crisis of 2000.
Manipulating the Market: Understanding Economic Sanctions, Institutional Change and the Political Unity of White Rhodesia. By David M. Rowe. Ann Arbor: University of Michigan Press, 2001. 256p. $52.50.
Authors: Drury A. Cooper
Published: May 2019

One of the big questions concerning economic sanctions is why they so often fail. A widely accepted answer to this question argues that economic sanctions increase the political solidarity within the target nation because the targeted public rallies behind its leader in the face of external pressure (Johann Galtung, “On the Effects of International Economic Sanctions, with Examples from the Case of Rhodesia,” World Politics 19 [1967]: 378–416). David M. Rowe calls this explanation into question and shows that the unity behind the white regime in Rhodesia was politically constructed by the government and not a spontaneous rally effect generated by nationalism or racial unity.
Resistance and Rebellion: Lessons from Eastern Europe. By Roger D. Petersen. Cambridge: Cambridge University Press, 2001. 338p. $59.95.
Authors: Kubik Jan
Published: May 2019

The most challenging task in today's comparative politics is crafting a fruitful combination of a general theory of political behavior with a nontrivial and sufficiently rich portrayal of that behavior's social, cultural, and historical context. At the same time, a consensus is emerging that holism is out, individualism is in, and the discipline's intellectual effort should be primarily focused on the reconstruction of the rules (mechanisms) governing the strategizing behavior of individuals in various social and cultural contexts. Macro-historical-structural explanations are largely out of favor. Given this intellectual climate, the premium is placed on studies that employ rational choice/game theoretical framework and test its applicability and limitations in the study of non-Western political systems. Such tests of applicability inevitably involve a confrontation between slim and parsimonious game-theoretic models and detail-rich ethnographic or historical reconstructions. Sometimes such confrontations end up in fruitless, mutual acrimony; recently, however, they have led to many instances of cross-fertilization and productive revisions of both sides' analytical assumptions.
Environmental Leadership in Developing Countries: Transnational Relations and Biodiversity Policy in Costa Rica and Bolivia. By Paul F. Steinberg. Cambridge, MA: MIT Press, 2001. 280p. $65.00 cloth, $24.95 paper.
Authors: Stricker Pamela
Published: May 2019

Much of the literature on environmental policymaking in the Global South focuses on the role of transnational linkages, wherein ideas regarding environmental management are transplanted by intergovernmental organizations and nongovernmental organizations in the North to governments in the South. The perception that environmental management concepts are primarily transferred in this way stems in part from the resonance that Ronald Inglehart's work on postmaterialist societies and environmental activism has had on the field, as well as a paucity of studies examining the dynamics of the domestic political players in the creation of natural resource management policies in the South. Paul Steinberg's work, Environmental Leadership in Developing Countries, addresses this particular puzzle and takes on the too-oft accepted notion that domestic policy entrepreneurs play a small supporting role at best in bringing about environmental policies in the Global South.
Laura Briggs. Reproducing Empire: Race, Sex, Science, and U.S. Imperialism in Puerto Rico. Berkeley: University of California Press, 2002.
Authors: Paul-Emile Kimani
Published: May 2019

Reproducing Empire is an invitation to reconceptualize gender, sex, and reproduction as an analytical framework for understanding Puerto Rico. In this complex and multivalent work, Laura Briggs repositions ideologies of family, sexuality, and reproduction as central to U.S. imperial enterprises. In so doing, she focuses a powerful lens on how discourses of sex, science, race, reproduction, deviance, and domesticity have shaped and propelled U.S. colonialism, in both form and substance.
Timothy Mitchell, Rule of Experts: Egypt, Techno-Politics, Modernity. Berkeley: University of California Press, 2003.
Authors: Feldman Ilana
Published: May 2019

That ’modernity' is not simply a Western export to the rest of the world has been much noted recently. Only rarely, though, has the relationship between local and global, colonizers and colonized, and the West and ’the rest' in the production of modernity been so rigorously explored as it is in Timothy Mitchell's new book, Egypt, Techno-Politics, Modernity. With precise, careful analysis of such phenomenon as the economy, capitalism, and expertise, Mitchell illuminates how the world in which we live came to acquire its particular shape.
Sami Zubaida, Law and Power in the Islamic World. New York: I. B. Tauris, 2004, 248 pp., $55, £35, ISBN 1-86064-865-7.
Authors: Kaufmann Eric
Published: May 2019

Sami Zubaida's Law and Power in the Islamic World is a fascinating politico-social history of the relations between Islamic law and the procession of political masters who have ruled the Middle East since the Prophet's death. One message is clear: the notion of an omnipotent shariءa, passed from caliph to caliph for fourteen centuries, is a myth held by both Islamist radicals and their Western critics.
Merchants, Mining, and Concessions on Nicaragua's Mosquito Coast: Reassessing the American Presence, 1893–1912
Authors: GISMONDI MICHAEL , MOUAT JEREMY
Published: May 2019

This article reassesses the influence of American business on US foreign policy towards Nicaragua, 1893–1912. It describes three episodes that involved American interests in Nicaragua – the Reyes uprising of 1899, the Emery claim of 1903–1909, and the US & Nicaragua Mining Company claim of 1908–1912 – as evidence for a different interpretation of US policy, one which stresses how the influence and material interests of American ‘men on the spot’ framed the ways in which the State Department came to understand American aims in Nicaragua. Earlier accounts of ‘Dollar Diplomacy’ do not adequately acknowledge the significant political consequences of American merchant activity on the Mosquito Coast.
In the Name of Anticommunism: Chinese practices of ideological accommodation in the early Cold War Philippines
Authors: KUNG CHIEN-WEN
Published: May 2019

This article builds on work by social and cultural historians of the Cold War such as Heonik Kwon and Masuda Hajimu by showing how three groups of Chinese actors helped create the locally specific reality of Chinese anticommunism in the Philippines during the late 1940s and early 1950s. It argues that, in a climate thick with Sinophobia and fears of communism, but largely devoid of actual Chinese Reds, anticommunism for the Chinese was only secondarily about rooting out subversives, ideological authenticity, and supporting Chiang Kai-shek's counterattack against mainland China. As a social phenomenon, it was primarily a diverse and flexible repertoire of practices, from crime to civic associationism, that Chinese elites and their challengers employed to bolster their reputations as anticommunists, enrich themselves, and pursue vendettas against their ‘communist’ enemies. By focusing on these practices of what I call ideological accommodation, the article intervenes in scholarship on the Chinese diaspora after the Second World War by showing that anticommunism was essential to how the overseas Chinese adapted to being resident ‘aliens’ in post-colonial Philippine society.
Glycans in the roles of parasitological diagnosis and host–parasite interplay
Authors: Veríssimo Carolina De Marco , Graeff-Teixeira Carlos , Jones Malcolm K. , Morassutti Alessandra L.
Published: May 2019

The investigation of the glycan repertoire of several organisms has revealed a wide variation in terms of structures and abundance of glycan moieties. Among the parasites, it is possible to observe different sets of glycoconjugates across taxa and developmental stages within a species. The presence of distinct glycoconjugates throughout the life cycle of a parasite could relate to the ability of that organism to adapt and survive in different hosts and environments. Carbohydrates on the surface, and in excretory-secretory products of parasites, play essential roles in host–parasite interactions. Carbohydrate portions of complex molecules of parasites stimulate and modulate host immune responses, mainly through interactions with specific receptors on the surface of dendritic cells, leading to the generation of a pattern of response that may benefit parasite survival. Available data reviewed here also show the frequent aspect of parasite immunomodulation of mammalian responses through specific glycan interactions, which ultimately makes these molecules promising in the fields of diagnostics and vaccinology.
Personally salient, emotionally negative task contexts provoke goal neglect in depression
Authors: Werner-Seidler Aliza , Dahm Theresa , Golden Ann-Marie , Manly Tom , Dalgleish Tim
Published: May 2019

Background

Goal neglect refers to a dissociation between intended and actual action. Although commonly associated with frontal brain damage, this phenomenon is also characteristic of clinical depression. To date, tests of goal neglect typically require individuals to switch between subtasks populated with neutral stimuli. This study examined the impact of affective and personally salient stimulus contexts on goal neglect in clinical depression.

Methods

Participants were randomly allocated to either positively or negatively-valenced versions of the Affective Six Elements Test (A-SET). We hypothesised that depressed individuals (n= 30) would exhibit an overall impairment in A-SET performance by neglecting entire subtasks and allocating suboptimal time to each task, relative to never-depressed peers (n= 30), with effects being strongest for the negatively-valenced version.

Results

Findings showed that depressed individuals exhibited specific deficits, relative to controls on these measures in the negative A-SET only, with a magnitude comparable to that found in brain injured patients.

Conclusions

Individuals with depression are impaired in their ability to monitor performance and implement strategies that are optimal for the purpose of pursuing an overarching goal when the task context is negatively-valenced. Potential mechanisms are discussed.
The Power of Silence and Limits of Discourse at Oliver Wendell Holmes's Breakfast-Table
Authors: Weinstein Michael A.
Published: May 2019

Mark Gibian's major study of Oliver Wendell Holmes, Sr.'s political theory casts Holmes as a democratic pluralist in the line of Richard Rorty who instantiates his commitment in the literary form of untrammeled table talk. Gibian's thesis can be challenged through a close reading of Holmes's main political work, The Professor at the Breakfast Table, revealing that Holmes's defense of free expression as the core of American national identity is counterpointed by a more fundamental appeal to nondiscursive reconciliation. Treating The Professor as a “dramatized essay” or “proto-novel” opens the possibility that the work's meaning is most fully disclosed by placing conversation in tandem with the deeds and recorded gestures that develop its plot. Through a dramatic reading, Holmes emerges as a humanist balancing aristocratic and democratic principles, rather than as a liberal discourse analyst.
The Body in the Ditch: Alternative Funerary Practices on the Northern Frontier of the Roman Empire?
Authors: Buck Trudi , Greene Elizabeth M. , Meyer Alexander , Barlow Victoria , Graham Eleanor
Published: May 2019

Disarticulated human remains were recovered from a first-century fort ditch at Vindolanda on the north-west frontier of the Roman Empire. Ancient DNA analysis revealed the skeleton to be that of a male individual and forensic taphonomic analysis suggested a primary deposition of the body in a waterlogged environment with no obvious evidence of formal burial. Occurrences of disarticulated human remains outside a cemetery context are often overlooked in Roman bioarchaeology. This discovery adds to the growing body of literature regarding alternative funerary practice in the Empire, highlighting that the concept of burial and disposal of the dead is more complex than ancient historical sources suggest. Details of the DNA analysis are provided in the Supplementary Material available athttps://doi.org/10.1017/S0068113X1900014X.
Bargaining over maternity pay: evidence from UK universities
Authors: Epifanio Mariaelisa , Troeger Vera E.
Published: May 2019

The generosity of maternity pay has been shown to be an important factor for mothers’ attachment to the labour market. In the UK, we can observe that the generosity of maternity leaves across universities varies greatly: some universities top up the statutory maternity pay with longer and better paid leaves, others are either less generous or only entitle academic women to the legal minimum. We want to understand why this is the case. Therefore, this article examines both theoretically and empirically how higher education employers decide about the generosity of the offered occupational maternity pay. We use a bargaining approach to model the supply and demand side of generous maternity benefits in universities with different characteristics and test the implications with a generalised negative binomial model. We find that universities’ income does not account for this variation while differences in terms of costs and benefits for employers do. Most importantly, our results show that more research intense universities with a higher previous share of female professors provide more generous maternity pay. We offer a range of explanations for these findings.
Pride and Prejudice: The Role of Policy and Perception Creation in the Chinese Revolt of 1652 on Dutch Formosa
Authors: Strydom Marné
Published: May 2019

The events of September 1652 on the island of Formosa were one of the bloodiest chapters in the history of Dutch management of the island, and could arguably be viewed as one of the most severe suppressions of a rebellious group in the seventeenth century. The unexpected, ill-prepared uprising of thousands of frustrated, angry and impoverished Chinese farmers and field hands against Dutch colonial management were successfully, yet in the most severe and savage way, suppressed through a military collaboration between the Dutch East India Company (VOC) and the local Aborigines of the island. In total some 3,000 Chinese residents of the island were killed, the ‘hacked-off’ head of the leader ‘displayed on a stake […] to frighten the Chinese as a sign of victory over those dastardly traitors’, while three of his lieutenants were tortured to death by Company officials in an effort to extract confessions and information from them. Indeed severe action towards a section of the Formosan colonial society that was primarily responsible for the economic success of the Dutch settlement enterprise.
Dancing around the Bride: The Inter-Asian Competition for Japanese Copper, 1700–1760
Authors: Shimada Ryuto
Published: May 2019

Adam Smith, the well-known eighteenth-century economist, investigated a number of important themes regarding the Dutch East India Company (Verenigde Oostindbche Compagnie, VOC) as well as its counterpart, the English East India Company. These continue to provide principal topics in the historical study of the VOC. Through a systematic analysis, he came to the conclusion that free trade is more beneficial to the wealth of nations than monopolised trade. In his view, an economy based on the division of production along with competition among market participants was the best precondition for accelerating economic development.
Their Exits and Their Entrances: Getting a Handle on Doors
Authors: Aronson Arnold
Published: May 2019

Aeschylus, father of Greek tragedy, was also the first to realize the potential of drama taking place ‘inside’ and ‘outside’ – a change from his earlier plays which is quite clear from the Oresteia onwards; and although the Elizabethan theatre was unconcerned with the literal representation of place, exits and entrances were no less crucial to its dramaturgy. Along with the proscenium arch came the stage doors actors fought hard to preserve until the nineteenth century, when first the box set and then the dominance of naturalism required doors to be literalized – as essential for slamming in Ibsen as for the complex avoidance strategies of a Feydeau farce. In the following article, Arnold Aronson discusses the role of the door, actual, assumed, and iconic, in world theatre – and takes a lateral look at its significance in the TV sitcom. The author is Professor of Theatre at Columbia University in New York, and author of American Avant-Garde Theatre: a History (Routledge, 2000), American Set Design (TCG, 1985), and The History and Theory of Environmental Scenography (UMI Research Press, 1981). Arnold Aronson served as President of the International Jury for the Prague Quadrennial in 1991 and 1999, and will be Commissioner General of the 2007 Quadrennial. A version of this essay was presented at Brown University at the conference held in 2003 in honour of Don B. Wilmeth.
Gail M. Williamson, David R. Schaffer, and Patricia A. Parmelee, (Eds.). Physical Illness and Depression in Older Adults: A Handbook of Theory, Research, and Practice. New York: Plenum, 2000.
Authors: Cappeliez Philippe , Rivard Vicky
Published: May 2019

Cet ouvrage nous aide à mieux comprendre les relations complexes entre la santé physique et la dépression au sein de la population âgée. Les parties les plus intéressantes du livre s'attachent à discuter de l'influence de variables potentiellement responsables de la médiation des liens bidirectionnels entre la santé physique et la dépression chez les aîné(e)s, et des implications de ces découvertes pour une meilleure identification et des traitements plus adéquats de la dépression parmi les patient(e)s médicaux(ales) âgé(e)s. Malgré une organisation des chapitres qui laisse à désirer une perspective nettement médicale sur le sujet, cet ouvrage représente une contribution importante à notre compréhension de la dépression à l'âge adulte avancé.
Phyllis Braudy Harris (Ed.). The Person with Alzheimer Disease: Pathways to Understanding the Experience. Baltimore, MD: The Johns Hopkins University Press, 2002.
Authors: Jonas-Simpson Christine
Published: May 2019

Il est grand temps, essentiel en fait, que nous accordions toute l'importance qu'il mérite au témoignage des personnes atteintes de démence. Cet ouvrage, s'appuyant sur le point de vue des personnes qui vivent avec la maladie, vient enrichir la masse croissante de connaissances sur la démence. Pour répondre à la question « Comment vit-on chaque jour avec une maladie mentale comme la maladie d'Alzheimer (MA)? », l'auteure choisit de donner la parole à des personnes atteintes de démence. L'ouvrage reconnaît la contribution de ces personnes au corpus de connaissances sur la démence, il relate leur expérience et dénonce les stigmates associés à la maladie: à savoir que ces personnes sont des coquilles vides qui représentent un fardeau pour la société. Au contraire, nous dit l'auteure, ce sont elles les « vrais experts », et nous devons les écouter. Cet ouvrage est un outil indispensable pour tous les fournisseurs de services de santé et ceux qui s'occupent de personnes atteintes de démence, mais aussi pour les enseignants, les chercheurs, les décideurs et le personnel des sociétés d'Alzheimer. Ceux qui vivent avec la démence auront le sentiment d'être compris en lisant le récit d'autres personnes dans leur situation. L'ouvrage apporte une contribution précieuse à la recherche sur la démence, il nous fait mieux comprendre la maladie du point de vue des « experts » – ceux qui vivent avec la démence.
The International Journal of Legal Information and the IALL: An Introduction to the Cumulative Index
Authors: Danner Richard A.
Published: May 2019

The International Journal of Legal Information is the official publication of the International Association of Law Libraries (IALL). As noted in its current statement of purpose, the Journal “serves the global community of law librarians, legal scholars, and practitioners through the publication of original articles, conference papers, bibliographies, book reviews, and documents concerning law and law-related information.” It is also a significant source of information about the history of the IALL and the major figures of international law librarianship who have participated in its programs and activities. Much of the history of the Association, which was established in 1959, is recorded within the Journal in presidential columns, editorials, memorials, and reports on meetings and conferences.
Operando XRD study of LiMn1.5Ni0.5O4 high-voltage cathode under high-rate charge-discharge reaction
Authors: Konya T. , Shiramata Y. , Nakamura T.
Published: May 2019

Structural variation of LiMn1.5Ni0.5O4 spinel cathode during the Li+ extraction/insertion reaction was studied using operando X-ray diffraction. It was found that the reaction in the voltage range from 3.5 to 4.9 V consisted of two consecutive two-phase reactions, where three spinel phases of LiMn1.5Ni0.5O4, Li0.5Mn1.5Ni0.5O4 and Mn1.5Ni0.5O4 were identified and the lattice volume change in the whole reaction was evaluated as 6%. The reactions were symmetric and reversible under low-current conditions, but some asymmetries were detected during high current operation. Furthermore, a two-phase reaction between cubic and tetragonal phases was observed in the low-voltage reaction at 2.1–3.5 V, where the lattice volume change was approximately 4.9%. The rate-determining step was discussed based on these operando results.
Crisis Clever System (CCS) – tracking experience of crisis management for decision support
Authors: Loriette Sophie , Matta Nada , Sediri Mohamed , Hugerot Alain
Published: May 2019

During a crisis situation, the ability of emergency department to take reliable and quick decisions is the main feature that defines the success or failure of this organization in the course of its crisis management. Decision makers spend time on identifying the decisions that will be taken for the whole of the crisis management, and on anticipating the preparation of these decisions, ensuring that they have time to properly prepare all decisions to be taken and, be able to implement them as fast as possible. However, the context and the characteristics of the crisis make the decision process complicated because there is no specific methodology to anticipate these decisions and properly manage collaboration with the other protagonists. There is also the pressure of time, a significant stress and, the emotional impact on the decision maker that lead to losing objectivity in decision making. We understand so that the right decision will be greatly facilitated and enhanced by the development of an adequate tool and process for decision-making. This tool must respect methods of the emergency department considered, and highlight the importance of experience feedback referencing to past cases, especially success and failures. We propose in this paper, software in order to handle experience feedback as a support for decision-making in crisis management “Crisis Clever System”. Several dimensions are considered in this study, from one side: organization, communication and problem-solving activities and from the other side the presentation and finding of experience feedback thanks to an analogy technique.
Animals as Social Actors: Cases of Equid Resistance in the Ancient Near East
Authors: Recht Laerke
Published: May 2019

This paper examines the concept of animals as social actors in the ancient Near East through a case study of human–equid relations. In particular, examples where equids may be seen as expressing resistance, as depicted in the iconography of the third and second millenniabc, are analysed. The first part of the paper discusses how animals have been perceived in scholarly debates in philosophy, archaeology and human–animal studies. It is argued that an acknowledgement of animals as social actors can improve our understanding of the human past, and the relation of humans to their broader environment. The second part of the paper presents three examples from the ancient Near East where equids may be interpreted as pushing back or resisting the boundaries placed by humans, resulting in a renegotiation of the relationship.
Improving Inclusive Practices in Secondary Schools: Moving from Specialist Support to Supporting Learning Communities
Authors: Deppeler Joanne , Loreman Tim , Sharma Umesh
Published: May 2019

Much of current inclusive education provision in Australian secondary schools relies on ‘specialist’ support from outside the classroom. Students with diverse abilities are placed within the regular classroom and additional specialist services such as therapy, counselling, psychological assessment and special education teaching are required to support their placement. This form of support often relies upon a diagnostic – prescriptive approach where the specialist assumes responsibility for and has a central role in shaping practices. In this paper, we raise issues regarding this model of specialist support in enacting effective inclusive practices in secondary schools. We suggest that one alternative is to shift the focus from the students who are different, to the community of learners in the school. This alternative approach uses collaborative and evidence-based practices to support inclusive ideals and grounds improvement efforts in changes in teachers’ knowledge as well as the cultural and organisational conditions of the school. The purpose of this paper is to prompt further discussion amongst professional community regarding the unique challenges and issues of inclusive practices in secondary schools.
Looking to the Future: Towards a Common Sense of Purpose
Authors: Ainscow Mel
Published: May 2019

The articles in this journal focus on what is, arguably, the biggest challenge facing school systems throughout the world, that of educational inclusion. It is hardly surprising that this is particularly challenging in secondary schools. Within such schools, internal factors, such as size and organisational complexity, clearly complicate attempts to foster more flexible and responsive arrangements. At the same time, external factors, not least the effects of competition between schools and parental choice, create particularly intensive pressures to achieve improved results in tests and examinations.
A simple method of treating seromas involving modified Blalock-Taussig shunts
Authors: Cheng Lik C. , Chiu Clement S. W.
Published: May 2019

We treated seromas developing in two patients in relation to left-sided modified Blalock-Taussig shunts by reattaching the original graft to the descending aorta. We postulate that seromas may develop because of the large area of contact between the graft and blood. Shortening the length of the Gore-Tex graft may therefore be a feasible treatment.
Rheumatic fever in the 21st century
Authors: Mota Cleonice
Published: May 2019

In this issue of the Journal, we publish three important papers concerned with rheumatic fever. So as to put these contributions in their world-wide perspective, I asked Cleonice Mota, a member of our Editorial Board, if she would prepare the “From the Editor” section for this issue. It is our pleasure to publish her thoughtful introduction, and we thank her for her continuing efforts on our behalf.

Robert H. Anderson
Criteria for judging the improvement in subclinical rheumatic valvitis
Authors: Karaaslan Sevim , Demirören Saadet , Oran Bülent , Baysal Tamer , Başpinar Osman , Uçar Canan
Published: May 2019

Recent technical improvements in cross-sectional echocardiography have made it possible to detect even mild organic regurgitation of the mitral and aortic valves in patients with acute rheumatic fever. To determine the prevalence and prognosis of subclinical valvitis, we have analyzed 104 patients with acute rheumatic fever referred to our institution. Of 53 patients who had no murmur, 22 of them with polyarthritis, 29 with chorea, and 2 with polyarthritis and chorea, 23 (43.4%) had subclinical valvitis. Isolated mitral regurgitation was the most common valvar lesion, seen in 82.6% of the patients. Isolated aortic regurgitation was detected in 4.4% of the cases, and combined mitral and aortic regurgitation in the remaining 13%. During follow-up, the degree of mitral regurgitation improved in 59.1%, decreased in 18.2%, and increased or remained unchanged in 22.7% according to the length of colour jet. According to criterions of velocity, mitral regurgitation improved in 86.4% of the patients, and increased or unchanged in the remaining 13.6%. Mitral regurgitation disappeared completely in 6 of the patients (27.3%) as judged according to both the length of colour jet and the velocity of regurgitation. Aortic regurgitation improved in all the patients with this problem, disappearing completely in two of the four.

Based on this experience, we suggest that not only the disappearance of regurgitation, but also improvements in the echocardiographic diagnostic criterions of regurgitation, such as the length of the colour jet less than 1 cm, or velocity less than 2.5 m/s, or indicative of regurgitation that is either intermittent or of short duration, should also be considered as criterions indicating improvement in valvar regurgitation in patients with subclinical rheumatic valvitis.
Progressive dilation of the diameter of the aortic root in adults with a bicuspid aortic valve
Authors: Dore Annie , Brochu Marie-Claude , Baril Jean-François , Guertin Marie-Claude , Mercier Lise-Andrée
Published: May 2019

Background: To determine the rate of progression of dilation of the aortic root in adults with a bicuspid aortic valve. Methods: We reviewed retrospectively the transthoracic echocardiograms of 50 adults with a bicuspid aortic valve. Each patient had had at least two examinations made 12 months apart. Measurements were taken at four levels: at the basal attachment of the leaflets of the valve within the left ventricular outflow tract, at the widest point of the sinuses of Valsalva, at the sinutubular junction, and in the ascending aorta 1 cm beyond the sinutubular junction. Results: Progressive dilation occurred at all levels, ranging from 0.3 mm/yr at the basal attachment within the left ventricular outflow tract to 1.0 mm/yr, 1 cm beyond sinutubular junction. These rates of dilation were greater than the reported rate of 0.8 mm per decade in the normal population. The rate of dilation found in the ascending aorta 1 cm beyond the sinutubular junction was significantly greater than at the other sites (p = 0.005). The 21 patients with baseline measurements greater than 34 mm had a significantly higher rate of progression (p = 0.007). Sex, age, and the degree of valvar obstruction or regurgitation did not significantly influence the rate of progression of dilation. Conclusion: There is a significantly higher rate of dilation of the aortic root in adults with a bicuspid aortic valve when compared to the normal population. Periodic evaluation of the ascending aorta is essential in these patients, even after replacement of the aortic valve. Other imaging modalities should be considered if the region beyond the sinutubular junction is not well visualized by transthoracic echocardiography.
Circulating blood volumes in pulmonary hypertension associated with erythrocytosis – the effects of therapeutic hemodilution
Authors: Gonçalves Rilvani C. , Buschpigell Carlos Alberto , Lopes Antonio Augusto
Published: May 2019

In the Eisenmenger syndrome, indirect estimation of blood volumes may provide quite inaccurate information when seeking to define therapeutic strategies. With this in mind, we analyzed directly the red cell mass, plasma volume, and total blood volume in patients with pulmonary hypertension associated with congenital cardiac defects and erythrocytosis, comparing the results with the respective estimated volumes, and examining the changes induced by therapeutic hemodilution.

Thus, we studied 17 patients with the Eisenmenger syndrome, aged from 15 to 53 years, in the basal condition, studying 12 of them both before and after hemodilution. We also investigated five individuals with minimal cardiac lesions, aged from 14 to 42 years, as controls. Red cell mass and plasma volumes were measured using [51 chromium]-sodium chromate and [131iodine]-albumin respectively. Hemodilution was planned so as to exchange 10% of the total blood volume, using 40,000 molecular weight dextran simultaneously to replace the removed volume. The mean values of the red cell mass, plasma volume and total blood volume as assessed by radionuclide techniques were 32%, 31% and 32% higher than the respective volumes as estimated using empirical mathematical formulas (p < 0.002). The measured total blood volume was also 19% higher in the patients compared with controls. Following a period of 5 days after hemodilution, we noted a 13% reduction in red cell mass (p = 0.046), and 10% reduction in total blood volume (p = 0.02), albeit with no changes in the plasma volume.

We conclude that direct measurement of blood volumes is useful for proper management of these patients, and provides results that are considerably different from those obtained by empirical estimations.
Do paediatric cardiologists discuss cardiovascular risk factors with patients and their families?
Authors: Lentzner Benjamin J. , Connolly Dana M. , Phoon Colin K. L.
Published: May 2019

Atherosclerotic disease of the heart likely has its origins in childhood. The promotion of cardiovascular health in children, however, has been studied only for those practicing in general paediatrics. We hypothesised that paediatric cardiologists do not consistently discuss cardiovascular risk factors with patients and their families. We therefore, carried out a nationwide survey of paediatric cardiologists to determine how often they discussed atherosclerosis and 4 modifiable risk factors, specifically weight, smoking, diet and nutrition, and physical activity. Only two-fifths reported that they discussed atherosclerotic disease frequently to always. For patients with cardiovascular disease, weight was discussed frequently to always by 59%, smoking by 61%, diet and nutrition by 63%, and physical activity by 92%. In contrast, for patients without cardiovascular disease, weight was discussed frequently to always by 35%, smoking by 46%, diet and nutrition by 39%, and physical activity by 62%. These differences are statistically significant (p < 0.003 by χ2analysis). Cardiovascular risk factors were discussed more consistently as children grew older (p < 0.0001). Respondents stated that, in their opinion, the promotion of cardiovascular health was a role more appropriate for providers of primary care than for paediatric cardiologists (p < 0.0001). Constraints of time, and the perceived role of the cardiologist, were the most common barriers to anticipatory guidance. We suggest that these findings indicate that paediatric cardiologists can assume a more prominent role in preventive cardiology and education, although their precise role or roles, and the optimal methods of anticipatory guidance, remain controversial.
Terminal right heart failure due to complex congenital cardiac disease successfully managed by home peritoneal drainage
Authors: Houlberg Kristian A. N. , McGonigle Richard J. , Marshall Andrew J.
Published: May 2019

A man, aged 32, who had undergone surgical correction of complex congenital cardiac disease, had chronic severe right heart failure. Increasing reliance on diuretics led to deteriorating renal function, and he was rejected as a candidate for cardiac transplantation. By inserting a Tenckhoff catheter, and training him to drain his ascites at home, we achieved a dramatic improvement in both his cardiac and renal function. As far as we can ascertain, this is the first time this technique has been used for such a patient. We discuss the mechanisms of improvement, and suggest that other such patients with congenital cardiac disease might benefit from similar management.
Addressing Adolescent Mental Health after Disasters: The Critical Role of Chronic Stressors
Authors: Newnham Elizabeth , Gao Xue , Nathan Elizabeth , Boyes Mark , Jiao Feng , Guragain Bhushan , Leaning Jennifer
Published: May 2019

Introduction:

Prolonged conditions of chronic stress have the potential to cause mental health difficulties and disrupt developmental processes for children and adolescents. Natural disasters disproportionately affect low-resource areas, yet little is known about the interaction between trauma exposure, chronic stressors, and mental health.

Aim:

To determine the rates of post-traumatic stress disorder (PTSD), depression and anxiety among adolescents affected by earthquakes in China and Nepal, and examine the specific roles of trauma exposure and chronic stressors across the three mental health outcomes.

Methods:

A school-based, cross-sectional study of 4,215 adolescents (53% female, ages 15-19 years) was conducted in disaster-affected areas of southern China and Nepal. Participants completed a series of translated and culturally adapted standardized assessments. Mixed effects logistic regression analyses were conducted for each mental health outcome.

Results:

The overall rate of PTSD was 22.7% and was higher among Nepalese participants (China: 19.4% vs. Nepal: 26.8%, p<0.001), but did not differ between genders (China: p=0.087 and Nepal: p=0.758). In both countries, the level of trauma exposure was a significant risk factor for PTSD, depression, and anxiety (China: OR’s 1.09-1.18 and Nepal: OR’s 1.08-1.13). Chronic stressors significantly improved the model and further contributed to mental health outcomes (China: OR’s 1.23-1.26 and Nepal: OR’s 1.10-1.23). Multilevel risk and protective factors across all mental health outcomes will be presented.

Discussion:

While there are limited opportunities to protect adolescents from disaster exposure, there is significant potential to address the effects of ongoing economic insecurity, domestic violence, and school cessation that are likely to worsen mental health outcomes. Programs that identify chronic stressors for adolescents in disaster-affected settings, and work to address poverty and violence, will have cascading effects for mental health, development, and security.
Examining the National Profile of Chronic Disaster Health Risks in Australia
Authors: Reifels Lennart , Dückers Michel LA , Blashki Grant
Published: May 2019

Introduction:

Despite a longstanding focus on examining acute health impacts in disaster research, only limited systematic information is available today to further our understanding of chronic physical health risks of disaster exposure. Heterogeneity of studies and disaster events of varying type and scale compounding this challenge highlight the merit of a consistent approach to examining nationally representative population data to understand distinctive profiles of chronic disaster health risks.

Aim:

This epidemiological study examined the full spectrum and national profile of chronic physical health risks associated with natural and man-made disaster exposure in Australia.

Methods:

Nationally-representative population survey data (N=8841) were analyzed through multivariate logistic regression, controlling for sociodemographic variables, exposure to natural and man-made disasters, and other traumatic events. Key outcomes included lifetime national chronic health priority conditions (asthma, cancer, stroke, rheumatism/arthritis, diabetes, heart/circulatory) and other conditions of 6 month or more duration (based on the World Health Organization’s WMH-CIDI chronic conditions module).

Results:

Natural disaster exposure primarily increased the lifetime risk of stroke (AOR 2.06, 95%CI 1.54-2.74). Man-made disaster exposure increased the lifetime risk of stomach ulcer (AOR 2.21, 95%CI 1.14-4.31), migraine (AOR 1.61, 95%CI 1.02-2.56), and heart/circulatory conditions (AOR 2.01, 95%CI 1.07-3.75). Multiple man-made disaster exposure heightened the risk of migraine (AOR 2.98, 95%CI 1.28-6.92) and chronic back or neck conditions (AOR 1.63, 95%CI 1.02-2.62), while multiple natural disaster exposure heightened the risk of stroke (AOR 3.28, 95%CI 1.90-5.67). No other chronic health risks were elevated. Despite the relatively greater chronic health risks linked to man-made disasters, natural disasters were associated overall with more cases of chronic health conditions.

Discussion:

The analysis of nationally-representative population data provides a consistent method to examine the unique national imprint of disaster exposure and distinct profile of disaster health risks to inform future detection, prevention measures, disaster health preparedness, and response planning.
Surge Capacity Planning to Inform the Need for International and Domestic Emergency Medical Team Deployments Following a Severe Wellington, New Zealand Earthquake
Authors: Blanch Charles , Lawrey Emma
Published: May 2019

Introduction:

Wellington, New Zealand has a significant earthquake risk with unique response challenges posed by its geography and limited road, rail, and sea access. In 2014, the World Health Organization (WHO) Emergency Medical Team (EMT) initiative published minimum and technical standards for EMTs in response to failures by responding teams to deliver appropriate and ethical clinical care during a number of disasters (Norton, 2014). The initiative has evolved to develop national and International EMTs in addition to a support capacity building within Ministries of Health to better coordinate clinical capacity during an emergency.

Aim:

Over the last two years, the WHO EMT Coordination Cell (EMTCC) course has trained over 300 health personnel globally to coordinate clinical surge capacity using a three-step Impact Assessment, Needs Assessment, and Tasking process informed by disaster epidemiology and mass casualty ratios.

Methods:

EMTCC planning methodology was applied to the “Wellington Earthquake National Initial Response Plan” (MCDEM, 2017) to develop a Health Action Plan for a significant Wellington earthquake. Known earthquake impact modeling for injuries was applied against predicted capacity in receiving hospitals in the affected region, and the ability to transfer patients nationally to determine unmet response needs. EMT minimum standards and operational insights from recent disasters were then used to determine the number of EMTs required for optimal tasking.

Discussion:

The surge planning methodology provided a theoretical framework for national and local health emergency management staff to engage with clinical colleagues. This allowed likely EMT assistance to be pre-planned, which facilitates further planning with national and local emergency management, border, and registration agencies for rapid entry into NZ, including onward transport and logistical support. While injury treatment ratios had to be refined to reflect NZ context, the methodology proved useful for Ministries of Health to pre-identify the need for international assistance in national emergencies.
Epidemic Thunderstorm Asthma
Authors: McMillan Alison
Published: May 2019

Introduction:

On November 21 and 22 of 2016, Victoria witnessed an unprecedented epidemic thunderstorm asthma emergency event in size acuity and impact. This scenario was never exercised nor contemplated. The event resulted in a 73% increase in calls to the Emergency Services Telecommunications Authority and 814 ambulance cases in the six hours from 6 pm on November 21, 2016. A 58% increase in people presented to public hospital emergency departments in Melbourne and Geelong on November 21 and 22, 2016 (based on the three-year average). 313 calls were made to the nurse on call from people with breathing, respiratory, and allergy problems (compared to an average of 63 calls for the previous month). Tragically, ten deaths are linked to this event.

Methods:

A substantial amount of work has been completed, much of which goes towards addressing the Inspector-General for Emergency Management recommendations following a review of the event, including:

Release of an epidemic thunderstorm asthma campaign and education programs which were rolled out across Victoria for the community and health professionals from September through November 2017;

Development of a new epidemic thunderstorm asthma forecasting system on 1 October 2017 and updated warning protocols during the 2017 grass pollen season;

Implementation of a Real-time Health Emergency Monitoring System to alert the department of demands on public hospital emergency departments on the system; and

Introduction of a new State Health Emergency Response Plan in October 2017 to improve coordination and communications before and during a health emergency.

Discussion:

The presentation will concentrate on the lessons learned more than two years down the track from the event in November 2016.