bluuebunny/crossref_metadata_2025 huggingface dataset:
Negation and Negative Dependencies
Authors: Zeijlstra Hedde
Published: April 2023

A universal property of natural language is that every language is able to express negation. However, languages may differ to quite a large extent as to how they express this negation, varying with respect to not only the form of negative elements, but also their position. They also differ in terms of the number of manifestations of negative morphemes: in some languages negation is realized by a single word or morpheme, in other languages by multiple morphemes, a phenomenon known as Negative Concord. Moreover, the syntax and semantics of negation are indissolubly connected to the phenomenon of negative and positive polarity. Negative Polarity Items (NPIs) are items, like English ‘ever’, whose distribution is limited to a number of contexts, which in some sense all count as negative. Positive Polarity Items (PPIs) form the mirror image of NPIs. These are elements, such as English ‘rather’, that are banned from appearing in negative sentences. This book presents an overarching perspective on negation and negative dependencies, based on novel data from language variation, acquisition, and change, developing and exploring the hypothesis that, to the extent that they are applicable to the domain of negation, all known syntactic, semantic, pragmatic, and lexical ways of encoding dependencies should also be attestable in the domain of negation, unless they are ruled out independently (e.g. on functional, formal, or learnability grounds). This hypothesis predicts a pluriform landscape of all kinds of negative dependencies and markers of negation, a prediction that the book will show is borne out.
Intermezzo The landscape of polarity-sensitive elements
Authors: Zeijlstra Hedde
Published: April 2023

NPIs are elements that, like neg-words, require some negative element to be present, but where, unlike in the case of neg-words, this licensing element cannot be covertly present. This already shows that the set of elements that are sensitive to the presence of negation is not homogeneous. This chapter outlines that the landscape of NPIs, as well as that of PPIs, is, in fact, much more heterogeneous than has often been thought. NPIs do not form a homogeneous category but rather reflect a landscape of heterogeneous elements that, for different syntactic, semantic, pragmatic, or lexical reasons, can appear only in contexts that, in one way or another, count as negative. In this sense, the landscape of NPIs and PPIs shows convergence: different lexical, syntactic, semantic, and/or pragmatic properties converge towards a restricted distribution with respect to negativity.
Conclusions and open questions
Authors: Zeijlstra Hedde
Published: April 2023

This penultimate chapter presents the final conclusions of this book, showing that the central hypothesis—that, to the extent that they are applicable to negation, all known syntactic, semantic, pragmatic, and lexical ways of encoding dependencies should be attestable among the domain of negation and negative dependencies, unless they are ruled out independently—is confirmed. Syntactic negative dependencies, semantic negative dependencies, pragmatic negative dependencies, and lexical negative dependencies have been attested. The approach does account for a whole series of negative dependencies, ranging from NC and split-scope effects to various types of NPIs and PPIs, and constitutes the attested landscape of negative elements and their dependents. This chapter summarizes the most important conclusions of the entire book and addresses a number of questions concerning the domain of negation and negative dependencies.
Inuktitut and the concept of word-level prominence
Authors: Arnhold Anja , Elfner Emily , Compton Richard
Published: April 2023

This chapter addresses the question of word prominence in Eastern Canadian Inuktitut, a part of the Inuit dialect continuum constituting a branch of the Inuit-Yupik-Unangan language family. The Inuit language is an extreme example of polysynthesis, with productive noun and verb incorporation that can be applied recursively, along with extensive word-internal modification. The main analysis is based on original data from South Baffin Island (Qikiqtaaluk Nigiani) Inuktitut, but the chapter also examines the literature on other varieties from across the language family. We present acoustic analyses of three potential correlates of stress or prominence: duration, fundamental frequency and intensity. Duration of syllables increased at the end of the word, while fundamental frequency and intensity dropped at the right word edge. Word-internally, no alternating or other regular patterns appeared. Comparing these results to hypotheses of what would be expected for metrical stress systems and other types of word prominence, we conclude that there is no indication that South Baffin Island Inuktitut has stress or another type of word-level prominence. Instead, in line with previous research on Inuit prosody, we find that the language regularly marks the borders of words and other prosodic constituents.
Tlingit (anti-)prominence
Authors: Crippen James , Déchaine Rose-Marie , Elfner Emily
Published: April 2023

This chapter explores the expression of prominence and ‘anti-’prominence in the complex words of Tlingit, a Na-Dene language. Tlingit tracks prominence-by-tone and prominence-by-weight, yielding an intricate and finely tuned system of (anti)-prominence. A combination of tone and weight identifies the stem as prominent, indicating that, in Tlingit, the calculus of prominence is additive. Moreover, Tlingit (anti)-prominence is calculated relative to prosodic structures that are isomorphic with syntactic structure. This prosody-syntax alignment—reflected in pervasive verb-noun parallelism—accounts for the finely graded distribution of Tlingit proclitics, prefixes, suffixes, and enclitics relative to tone and weight. These findings have consequences for theories of prominence, as well as for theories of the syntax-phonology interface and the syntax-morphology interface.
A reassessment of word prominence in Mapudungun
Authors: Molineaux Benjamin
Published: April 2023

This chapter examines the word-prominence system of Mapudungun (formerly ‘Araucanian'), rejecting its widespread perfect grid analysis. A reassessment of the literature, alongside analyses of an original dataset, show a system that does not fall squarely within traditional prosodic typology and lacks some canonical features of stress (culminativity, rhythmicity). Despite this, Mapudungun displays obligatoriness of word-level prominence, a definitional feature of stress. A non-iterative, right-aligned, moraic trochee is proposed to bear stress at the word level, while, at the stem level, a second stress surfaces on the final syllable. Such parsings, however, seems to have limited phonological activation. Especially in complex words, prominences appear to be assigned with reference to morphological structure and have limited effect upon the broader phonological system. Finally, it is argued that lack of prominence-based segmental asymmetries, absence of culminativity, as well as the stem-edge marking, conspire to create transparency in the morphological structure of complex words.
Satipo Ashaninka word- and phrase-level prominence
Authors: Mihas Elena , Maxwell Olga
Published: April 2023

The study examines multiple prominence systems in Satipo Ashaninka (Kampa, Arawak), a morphologically complex Amazonian language of Peru. The study’s preliminary results show that the word-level prominence systems include the right edge-oriented primary stress, cued by several phonetic exponents (duration, intensity, and sometimes f0), and the left edge-oriented secondary stress (polar beat), determined on the basis of intensity (and possibly f0, for which the evidence is inconclusive). Both word-level systems are weight-sensitive, occurring in the three-syllable windows. The dominant primary stress patterns are penultimate or antepenultimate, with the ultimate pattern also present. The common location of secondary stress is peninitial. Lexically specified prominence in the form of high tone is found in several inflectional morphemes and pragmatic enclitics. The phrasal pitch accent shows a preference for secondary stress locations.
Polysynthesis, stress uniformity, and the opposite-to-anchor stress system in Ese Ejja
Authors: Rolle Nicholas
Published: April 2023

This chapter presents a study of stress uniformity in Ese Ejja. In morphologically simplex words, inflectional suffixes assign accent to a position in the stem, which is mapped to primary stress. This accent-to-stress algorithm results in an ‘opposite-to-anchor’ system whereby the location of primary stress is toward the left edge but the triggering suffix is toward the right. In contrast to simplex forms, this mapping does not occur with complex forms, e.g. verbs with both inflectional and derivational morphology. Because Ese Ejja is a polysynthetic language, a large number of derivational morphemes can intervene between the root (at left) and triggering suffixes (at right), which may result in ‘long-distance anchor dependencies’. Ese Ejja conspicuously avoids this situation by suspending accent-to-stress mapping in sufficiently complex forms. Instead, a kind of ‘stress uniformity’ is employed whereby complex forms copy the stress from an equivalent simplex form (i.e. [[ROOT]-INFL]x ↔ [[[ROOT]-DERIV]-INFL]x, where x = identical stress). This chapter relates these aspects of Ese Ejja stress to the rarity of opposite-to-anchor systems generally (such as ‘count systems’), and the general bias in stress systems for default-to-same-edge properties.
Phonological and morphological wordhood in Nivkh
Authors: Mattissen Johanna
Published: April 2023

This chapter presents the role of phonological and prosodic features in Nivkh, a polysynthetic language in which accentuation is morphologically driven by morpheme type and position in the morphological word and effected by a characteristic pitch contour. Phonological words in Nivkh are the next level above the syllable and smaller than or co-extensive to morphological words, composite groups are co-extensive to morphological words. As a further domain the determiner group is introduced, which is not an immediate constituent of any other domain. Phonotactics signal the left and right edges of phonological words, fixed types of affixes bracket the morphological word, morphophonemic processes signal the internal cohesion of units below the phonological phrase. As complex morphological words are formed according to the dependent-head synthesis principle, verbal conjunct remnants under coordination cannot be integrated and are phonological, but not morphological words, lacking right-margin suffixes.
Prosody in Turkish
Authors: Özçelik Öner
Published: April 2023

This chapter provides an overview of Turkish prosody, referring to both lower and higher levels of the Prosodic Hierarchy, as well as synthesizing previous research on Turkish stress and prominence. Both regular (word-final) prominence and irregular (non-final) stress are covered, encompassing the well-known cases of both pre-stressing and autostressed suffixes. In addition, novel data are provided, introducing various phenomena, such as the presence of a group of pre-pre-stressing suffixes. In my analysis, there is no algorithm for the Turkish grammar to assign foot structure (i.e. the phonology cannot parse syllables into feet), and regular final ‘stress’ is argued to be intonational prominence falling on the final syllables of Prosodic Words and involves no feet (Özçelik 2017). On the other hand, certain morphemes – those that assign irregular/exceptional stress – come with foot edges in the underlying representation, and are, thus, footed in the surface representation as well, given faithfulness to this information. The grammar (constraint ranking or rules), then, turns these foot edges into well-formed binary feet. Lexical stress, on this account, is thus due to underlying foot edges (following Özçelik 2014), and, crucially, not a result of marking syllables as (exceptionally) accented or having underlying trochees or iambs. The latter half of the chapter then overviews the mechanisms of phrasal and sentential prominence in Turkish, which involve higher levels of the Prosodic Hierarchy and lie at the interface of prosody with syntax. This section additionally presents further evidence for the arguments made here concerning feet (or lack thereof) and lexical stress.
Acca Larentia Gains a Son
Authors: Beard Mary
Published: April 2023

This chapter clarifies the myths of the Roman priesthood by expounding on the status and definition of priests in Rome. The myths primarily formed a medium of debate within the Roman religious system on the nature of priesthood as a whole and the priests? relationship to the divine. Moreover, some myths offer an image of the priesthood as either natural or otherworldly. The chapter then discusses the structural tension in Roman religion, which was focused on the ideological pressure to incorporate religion into the public and political realm and the contrary claim that religion and its officials belonged to the world of gods rather than to that of mortals. It also highlights how the Roman religion stressed the public political aspect of the Roman state cult.
Action and Ritual in Roman Historians
Authors: North John
Published: April 2023

This chapter discusses the accounts of rituals according to Roman historians. It explains the business of historians in antiquity that produces narratives of what happened, explaining the causes of events, or reflecting on the event?s moral issues. Historians are not likely to produce background information about procedures, laws, or social customs unless there was a need to do so. However, exemptions revolve around when rituals go seriously wrong or get more attention than usual. The chapter expounds on the historic importance and rituals of the triple temple on Capitoline Hill. It also looks into the role of Horatius, who was deemed by Livy to be the most important figure within the ritual issue as he held onto the door-post that completed a prayer dedicated to the temple.
Rome and the Great Places of Worship in Italy
Authors: Scheid John
Published: April 2023

This chapter looks into the great places of worship across Italy. It starts with the narrative of Octavian declaring war against Cleopatra following the ritual of the fetiales and the restoration of the priesthood called Caeninensis. Following the conquest of Caenina, the rites of the city had been transferred to Rome and entrusted to the sacerdotes Caeninenses, which functioned similarly to Laurentes Lauinates that served the gods of Lavinium. The chapter also presents the sanctuary of Fortuna Primigenia at Praneste, which had been publicly known for its age and beauty following the Social War. It also considers the sanctuary of Mefitis Utiana and the sanctuary of Apollo Soranus as places of worship. The chapter then explores the initiatives revealing an old tradition of Romans taking over the Italic places of remembrances. Ultimately, Augustus took advantage of the state of dilapidation to have control over symbolic and potentially dangerous sites.
Battle of the Experts: The Strange Career of Meta-Expertise
Authors: Pasquale Frank
Published: April 2023

Sociologists and philosophers have critically examined the interplay between democracy and expertise. This article develops a law and political economy approach to the topic, focusing on the challenge posed to traditional professions by “meta-experts” (who develop standardized algorithmic and quantitative methods to trans-substantively evaluate experts’ performance and value). Law has critical roles to play in adjudicating emerging conflicts between experts and meta-experts. First, lawmakers can confirm or contradict whatever jurisdictional claims they make over a domain. Law is therefore critical to the establishment of practical epistemic authority. Second, administrative law has long addressed the balance of legal regularity, politics, and expertise in the proper functioning of agencies. Both law and political economy pressures shape “battles of the experts,” as economists and coders challenge the authority of other professionals.
The Meaning and Significance of Lay Expertise
Authors: Epstein Steven
Published: April 2023

This chapter revisits and defends the concept of “lay expertise,” analyses its defining characteristics, and specifies a research agenda. It argues that lay experts play a critical role in contemporary struggles around knowledge production, technological development, civic engagement, and democratization. It begins by providing context for understanding lay expertise by tracing the term’s entry into discourse and subsequent spread. Taking into account critiques of the concept, the chapter offers a characterization of key dimensions of lay expertise, emphasizing not only the kinds of participants and the knowledge and values they bring to their work, but also the fundamentally collective character of lay expertise in its prototypical form. Finally, the chapter points to gaps in our understanding of two important topics: Through what pathways does lay expertise develop? And what are the political dilemmas and complications to which its deployment gives rise?
New Objectivity and the Middlebrow
Authors: Gabriel John
Published: April 2023

There is much about the New Objectivity in music that might suggest understanding it as middlebrow. Emerging in the mid- to late 1920s, it combined elements of modern art music composition with jazz and popular culture in the name of accessibility, thus seeming to bring together Andreas Huyssen’s categories of modernism and mass culture. This chapter argues, however, that the New Objectivity’s emphasis on function and its rejection of the ideology of artistic autonomy disqualify it from the category of the middlebrow. It analyzes the New Objectivity as a middlebrow-like relational category between another “Great Divide” described by Huyssen: avant-garde and culture industry. This approach refocuses our attention on the relationship between Dada and the New Objectivity and also provides new insight into how the New Objectivity navigated the shifting cultural landscape of Weimar Republic Germany until its basic premises became untenable in the early 1930s.
Symphonies Serious or for Fun
Authors: Rupprecht Philip
Published: April 2023

Malcolm Arnold’s concert music of the 1940s and 1950s pleased audiences but rankled press critics. The archived verdicts by the Score Reading Panel at the BBC Music Department document mixed opinions of Arnold’s music. Arnold’s characteristic tone—often called humorous and frivolous—confounded critics seeking serious or complex statements. The symphony as a genre takes a relatively high position within a midcentury British field of cultural production. Beyond Bourdieu’s hierarchical model, British cultural theorists from Eliot and Leavis to Hoggart, Williams, and Hall surveyed an interplay of elite and “ordinary” tastes, both susceptible to bureaucratic planning. Adopting a policy of cultural “uplift,” the BBC’s pyramid of radio broadcasting channels—Light, Home, and Third—constructed clearly separate categories of listener. Arnold’s stylistically eclectic Symphony No. 1 was initially rejected for BBC broadcast as a score too vulgar for highbrow or even middlebrow taste.
Imagery Practice in Tantric Buddhism
Authors: Gardiner David L.
Published: April 2023

Both implicitly and explicitly, tantric Buddhist (Vajrayāna) imagery and its practice critique dichotomies such as subject/object, self/world, body/mind, and female/male. Moreover, it functions to proactively replace bifurcated, traumatized experiential frameworks with alternative, more integrated structures for living. The holistic worldview expressed in writings on Vajrayāna meditation intentionally assaults the fundamental patterns of ignorant self-absorption that Buddhist teachings assert to be the source of sentient suffering. Central to this meditation practice is the sustained, creative engagement with religious imagery through visualization. These methods aim to transform the practitioner’s sense of self, both cognitively and somatically, through a therapeutic regime of embodied cognition. A central tool in the Vajrayāna Buddhist path to liberation, imagery manifests not only in rich iconic diversity but also in sophisticated and sublime contemplative exercises that utilize creative visual elements. While the traditions of imagery use in tantric Buddhism are worthy of study from a variety of perspectives, their central role within a clearly articulated soteriological context warrants particular attention. The Vajrayāna employment of imagery in both material and cognitive domains constitutes an ingenious technology that harnesses intention, imagination, and embodiment in remarkable ways.
Memory, Repetition, and Anticipation
Authors: Ó Murchadha Felix
Published: April 2023

This article takes its point of orientation from Edmund Husserl’s discussion of internal time consciousness and shows that the melody is not simply a useful example for Husserl, but rather as a temporal object is highly significant for his discussions of time. Drawing on musical examples, it is shown how melodies make manifest the affective experience of being in the world, independent of any representation of things. This capacity of melody is rooted in its temporal constitution. Hearing a melody is listening to what is to come, as much as it is a retention of what has been. But the future to come is a future experienced as future perfect (what will have been). The temporality of the melody is one of gathering and wholeness, rather than dissipation and loss. In this the melody is indicative of an orientation toward the eternal.
Preparing for the (Non-Existent?) Future of Work
Authors: Korinek Anton , Juelfs Megan
Published: April 2023

This chapter analyzes how to set up institutions that future-proof our society for a scenario of ever-more-intelligent autonomous machines that substitute for human labor and drive down wages. It lays out three concerns arising from such a scenario and evaluates recent predictions and objections to these concerns. Then it analyzes how to allocate work and income if these concerns start to materialize. As the income produced by autonomous machines rises and the value of labor declines, it is optimal to phase out work, beginning with workers who have low labor productivity and job satisfaction, as they have a comparative advantage in enjoying leisure. This is in stark contrast to welfare systems that force individuals with low labor productivity to work. If there are significant wage declines, avoiding mass misery will require other ways of distributing income than labor markets, whether via sufficiently well-distributed capital ownership or via benefits. Recipients could still engage in work for its own sake if they enjoy work amenities, such as structure, purpose, and meaning. If work gives rise to positive externalities, such as social connections or political stability, or if individuals undervalue the benefits of work because of internalities, then there is a role for public policy to encourage work. However, in the long run, it may be more desirable for society to develop alternative ways of providing these benefits.
Opioids and Cognition
Authors: Kleykamp Bethea A. , Clarke Shannon B. , Acquavita Shauna P.
Published: April 2023

Opioid use influences brain activity in ways that can be detrimental to cognitive functioning. This literature review provides an overview of the published literature that has evaluated the effects of opioid use in individuals diagnosed with OUD or in their offspring (e.g., prenatal exposure). The review prioritized existing systematic reviews that have evaluated the effects of opioid use among individuals with OUD across a range of cognitive domains, including attention, memory, and complex psychomotor function (e.g., driving) in adults, and the cognitive consequences of prenatal opioid exposure were also included as evidence. Eight peer-reviewed literature reviews were identified that evaluated the cognitive effects of opioids among individuals diagnosed with OUD. Six reviews were systematic, 1 was a “structured evidence-based review,” and 1 was an expert-guided review. Five of the reviews evaluated a range of different cognitive domains, 2 of the reviews focused on driving performance, and 1 review focused on general cognitive function rather than specific cognitive domains. The individual studies evaluated in the reviews were published between 1944 and 2017, and the number of individual studies included in each review ranged from 16 to 61. Key variables that influence outcomes, clinical implications, health policy implications, and future research direction are discussed. An exemplary case study is also provided.
Genetic Influences in Opioid Use Disorder
Authors: Maher Brion , Rabinowitz Jill A.
Published: April 2023

Genes play a role in both the individual differences in opioid metabolism and in the risk for developing an opioid use disorder (OUD). Like all substance use disorders (SUDs), OUD is a complex trait contributed to by multiple genetic and environmental factors. This chapter reviews the evidence supporting the role of genetic factors influencing OUD risk, from classical (twin, adoption, and family) genetic studies through the molecular era, including linkage and candidate gene association and genome-wide association studies (including polygenic approaches). The pharmacogenomics of OUD treatment, including how medications for OUD (MOUD) may be influenced by genotype, as well as the association between genetic variants and MOUD dose response, are also reviewed. Finally, to aid in understanding, descriptions of the approaches used and technological advances that drove the field are provided.
US Imperialism and International Law
Authors: Coates Benjamin
Published: April 2023

For much of its history, the US empire grew not in spite of international law, but in conjunction with it. At fora like the Hague Peace Conferences, the United States embraced international law when its officials believed that doing so was compatible with their interests. Invoking concepts like the Monroe Doctrine, diplomatic protection, and the standard of civilization provided justifications for war and intervention. Professional groups like the American Society of International Law provided experts who generally supported government contentions. Through innovations like the Drago Doctrine, Latin Americans sought to write non-intervention into international law. After these efforts succeeded in the 1930s and 1940s, Washington turned to covert violence. In the case of US empire in Latin America, international law could serve as both a weapon of the weak and of the strong.
CAT in a cancer setting
Authors: Black Susie , Davies Jason
Published: April 2023

This chapter outlines the potential psychological impacts of cancer on patients, carers, and healthcare staff working in a cancer setting. It explores the benefits of using cognitive analytic therapy (CAT) to understand the impact of cancer and to work therapeutically with individuals and groups to facilitate relational thinking and more adaptive coping. This chapter introduces the generic mapping approach—a generic sequential diagrammatic reformulation (SDR) which provides a conceptualization of common experiences helpful in early containment of distress, which can be personalized over time. The use of this model within cancer services will be described to understand the relational impact of cancer and the rollercoaster of emotions that this can generate. Brief fictitious case studies are used to illustrate the common reciprocal roles (RRs) and reciprocal role procedures (RRPs) that can become problematic as a result of a cancer diagnosis.
CAT and technology
Authors: Nield Cal
Published: April 2023

This chapter considers the application of cognitive analytic therapy (CAT) as we are working increasingly via technologically mediated means. The chapter asks where do we meet in this context? It reviews our own relational stance to technology and the shift toward a more curious and healthier integration of technology into practice. There is a brief overview of some of the opportunities and challenges within online work, acknowledging typical concerns of some practitioners. The chapter will then address specific considerations of ‘digital CAT’, including what CAT might uniquely bring to the online domain and how, going forward, therapists might grasp this opportunity to evolve CAT practice and theory within this ‘disembodied’ context. The chapter introduces the CAT-app (Kellett et al., 2020), Steve Jefferis presents ideas for practice in how to map collaboratively and Tim Sheard shares some thoughts on how to incorporate embodied practice in online CAT. The chapter will reflect on how CAT might thrive, where future opportunities lie, not only to the therapeutic context but also to the potential for CAT to engage more generally in a wider, socially mediated dialogue.
The structure of therapy
Authors: Tee Deborah
Published: April 2023

Cognitive analytic therapy (CAT) is a time-limited, trans-diagnostic relational therapy which seeks to elicit learning and change through a collaborative process of shared meaning-making and discovery. This chapter provides an overview of CAT, introducing key concepts of the approach and structure of therapy. The chapter describes the CAT understanding of developmental psychological structures and how psychological problems arise and are maintained. It examines the suitability and assessment considerations for CAT, with an emphasis on how diagnoses and symptoms are understood as elements embedded within an individual’s relational structures. It summarizes the phases of reformulation, recognition, revision, and endings within a standard sixteen-session model of CAT, with reference to specific CAT tools including the sequential diagrammatic reformulation, reformulation letter, and goodbye letter. Some final remarks on treatment fidelity and therapist competencies, the competence in CAT (CCAT) measure and CAT competency framework, conclude this chapter.
Philosophy of Cultural Evolution
Authors: Lewens Tim
Published: April 2023

Philosophers of science have succeeded in shedding light on basic questions of interest to cultural evolutionists, just as cultural evolutionists have shed light on questions of interest to philosophers. This chapter surveys some of these contributions, before tracing a zigzag pathway of conceptual influence from early work in nonformalized evolutionary epistemology, through to much more mathematically precise and empirically rich research in cultural evolutionary theory. It moves on to expose conceptual diversity in how the notion of cultural selection—central to both programmes of research—is understood. The chapter closes by suggesting ways in which (i) cultural selection and cultural attraction can complement each other in the explanation of adaptation, and (ii) cultural adaptation can sometimes proceed in ways that fail to match the usual pattern of selection explanations.
Venous Ulcer in a 5-Year-Old Girl
Authors: Du Xiaojiong , Wu Zhoupeng
Published: April 2023

BACKGROUND

Agenesis of the inferior vena cava (IVC) is an extremely rare congenital malformation. Although IVC dysplasia can present with symptoms, because of the low prevalence of this disease, it is often omitted from routine examination. Most reports on this topic have described the absence of the IVC; the absence of both a deep venous system and the IVC is even rarer. Chronic venous hypertension and varicosities leading to venous ulcers have been reported in patients with absent IVC that could be surgically bypassed; however, the absence of iliofemoral veins precluded any bypass procedure in the present patient.

CASE PRESENTATION

The authors report a case of IVC below renal vein hypoplasia in a 5-year-old girl who presented bilaterally with venous stasis dermatitis and ulcers in the lower extremity limb area. Ultrasonography revealed no clear IVC and iliofemoral venous system under the renal venous plane. Magnetic resonance venography subsequently confirmed the same findings. The patient’s ulcers were healed by compression therapy and routine wound care.

CONCLUSIONS

This is a rare case of venous ulcer in a pediatric patient stemming from congenital IVC malformation. With this case, the authors demonstrate the etiology of the appearance of venous ulcers in children.
Determination of Nurses’ Knowledge Levels on Skin Tears: A Cross-sectional Study
Authors: Kaçmaz Hatice Yüceler , Karadağ Ayişe , Çakar Vildan , Ödek Ömer
Published: April 2023

OBJECTIVE

To determine nurses’ knowledge level about skin tears (STs).

METHODS

This cross-sectional study included 346 nurses working in acute care hospitals in Turkey who completed web- or paper-based surveys in September and October 2021. Researchers used the Skin Tear Knowledge Assessment Instrument, which consists of 20 questions across six domains, to assess nurses’ level of ST knowledge.

RESULTS

The mean age of the nurses was 33.67 (SD, 8.88) years, 80.6% were women, and 73.7% had an undergraduate degree. Nurses’ mean number of correct answers on the Skin Tear Knowledge Assessment Instrument was 9.33 (SD, 2.83) of 20 (46.66% [SD, 14.14%]). The mean numbers of correct answers by domain were as follows: etiology, 1.34 (SD, 0.84) of 3; classification and observation, 2.21 (SD, 1.00) of 4; risk assessment, 1.01 (SD, 0.68) of 2; prevention, 2.68 (SD, 1.23) of 6; treatment, 1.66 (SD, 1.05) of 4; and specific patient groups, 0.74 (SD, 0.44) of 1. Significant associations were found among the nurses’ ST knowledge scores and whether they had graduated from a nursing program (P = .005), their working years (P = .002), their working unit (P < .001), and whether they provided care to patients with STs (P = .027).

CONCLUSIONS

Nurses’ level of knowledge of the etiology, classification, risk assessment, prevention, and treatment of STs was low. The authors recommend including more information about STs in basic nursing education, in-service training, and certificate programs to increase nurses’ ST knowledge.
New Combination Asthma Drug
Authors: Aschenbrenner Diane S.
Published: April 2023

A new asthma drug, Airsupra, combines the short-acting β2-adrenergic agonist albuterol with the corticosteroid budesonide to treat acute asthma attacks.

Patients should not stop their asthma maintenance therapy when albuterol–budesonide is prescribed.
The many faces of rural health nurses
Authors: Lockhart Lisa
Published: April 2023

Healthcare in rural parts of the US is extremely important. The rural nurse must be familiar with all facets of rural health, including the benefits of and difficulties in serving communities in these scarcely populated regions.
Autograft Cellular Contribution to Spinal Fusion and Effects of Intraoperative Storage Conditions
Authors: Lombardo Jeremy A. , Russell Nick , He Jiawei , Larson Michael J. , Walsh William R. , Mundis Gregory M. , Vizesi Frank
Published: April 2023

Study Design.

Controlled animal study.

Objective.

To assess the cellular contribution of autograft to spinal fusion and determine the effects of intraoperative storage conditions on fusion.

Summary of Background Data.

Autograft is considered the gold standard graft material in spinal fusion, purportedly due to its osteogenic properties. Autograft consists of adherent and non-adherent cellular components within a cancellous bone scaffold. However, neither the contribution of each component to bone healing is well understood nor are the effects of intraoperative storage of autograft.

Materials and Methods.

Posterolateral spinal fusion was performed in 48 rabbits. Autograft groups evaluated included: (1) Viable, (2) partially devitalized, (3) devitalized, (4) dried, and (5) hydrated iliac crest. Partially devitalized and devitalized grafts were rinsed with saline, removing nonadherent cells. Devitalized graft was, in addition, freeze/thawed, lysing adherent cells. For 90 minutes before implantation, air dried iliac crest was left on the back table whereas the hydrated iliac crest was immersed in saline. At 8 weeks, fusion was assessed through manual palpation, radiography, and microcomputed tomography. In addition, the cellular viability of cancellous bone was assayed over 4 hours.

Results.

Spinal fusion rates by manual palpation were not statistically different between viable (58%) and partially devitalized (86%) autografts (P = 0.19). Both rates were significantly higher than devitalized and dried autograft (both 0%, P < 0.001). In vitro bone cell viability was reduced by 37% after 1 hour and by 63% after 4 hours when the bone was left dry (P < 0.001). Bone cell viability and fusion performance (88%, P < 0.001 vs. dried autograft) were maintained when the graft was stored in saline.

Conclusions.

The cellular component of autograft is important for spinal fusion. Adherent graft cells seem to be the more important cellular component in the rabbit model. Autograft left dry on the back table showed a rapid decline in cell viability and fusion but was maintained with storage in saline.
Preparing the Ocular Surface for a Boston Keratoprosthesis Type 1 Through En Bloc Minor Salivary Gland Transplantation and Mucous Membrane Grafting in End-Stage Stevens–Johnson Syndrome
Authors: Arboleda Alejandro , Phansalkar Ragini , Amescua Guillermo , Lee Wen-Shin , Brandt James D. , Mannis Mark J. , Kossler Andrea L. , Lin Charles C.
Published: April 2023

Purpose:

This case describes the successful visual restoration of a patient with end-stage Stevens–Johnson syndrome (SJS) with a severely keratinized ocular surface.

Methods:

This study is a case report.

Results:

A 67-year-old man with SJS secondary to allopurinol sought visual rehabilitation options. His ocular surface was severely compromised from sequelae of chronic SJS, leaving him with light perception vision bilaterally. The left eye was completely keratinized with severe ankyloblepharon. The right eye had failed penetrating keratoplasty, limbal stem cell deficiency, and a keratinized ocular surface. The patient declined both a Boston type 2 keratoprosthesis and a modified osteo-odonto keratoprosthesis. Therefore, a staged approach was pursued with (1) systemic methotrexate to control ocular surface inflammation, (2) minor salivary gland transplant to increase ocular surface lubrication, (3) lid margin mucous membrane graft to reduce keratinization, and finally, (4) Boston type 1 keratoprosthesis for visual restoration. After minor salivary gland transplant and mucous membrane graft, the Schirmer score improved from 0 mm to 3 mm with improvement in ocular surface keratinization. This approach successfully restored the vision to 20/60, and the patient has retained the keratoprosthesis for over 2 years.

Conclusions:

Sight restoration options are limited in patients with end-stage SJS with a keratinized ocular surface, aqueous and mucin deficiency, corneal opacification, and limbal stem cell deficiency. This case demonstrates successful ocular surface rehabilitation and vision restoration in such a patient through a multifaceted approach that resulted in successful implantation and retention of a Boston type 1 keratoprosthesis.
Long-Term Results of Combined Trabeculotomy Trabeculectomy in Primary Congenital Glaucoma
Authors: Malek Ines , Sayadi Jihene , Choura Racem , Mekni Manel , Rayhane Haythem , Khairallah Moncef , Nacef Leila
Published: April 2023

Précis:

Primary congenital glaucoma (PCG) in Tunisian children seems to be characterized by a high prevalence of inherited and advanced forms of the disease. Primary combined trabeculotomy trabeculectomy (CTT) allowed satisfactory long-term intraocular pressure (IOP) control and reasonable visual outcome.

Purpose:

To report the long-term outcome of CTT as the initial glaucoma surgery in children with PCG.

Methods:

Retrospective analysis of children who underwent primary CTT for PCG between January 2010 and December 2019. The main outcome measures were IOP reduction, corneal clarity, complications, refractive errors, and visual acuity (VA). Success was defined as IOP <16 mm Hg without (complete) or with (qualified) antiglaucoma medication. The WHO criteria of vision loss were used to categorize visual impairment (VI).

Results:

Of 62 patients, 98 eyes were enrolled. At the last follow-up, the mean IOP was reduced from 22.7 ± 4.0 mm Hg to 9.7 ± 3.9 mm Hg (P < 0.0001). The complete success rate was 91.6%, 88.4%, 84.7%, 71.6%, 59.7%, and 54.3%, at the first, second, fourth, sixth, eighth, and tenth year, respectively. Follow-up averaged 42.1 ± 28.4 months. Preoperatively, 72 eyes (73.5%) had significant corneal edema versus 11 eyes (11.2%) at the end of the follow-up (P < 0.0001). Endophthalmitis was encountered in one eye. Myopia was the most common refractive error (80.6%). Data on Snellen VA were available for 53.2% of the patients; 33.3% achieved a VA ≥6/12, 21.2% had mild VI, 9.1% had moderate VI, 21.2% had severe VI, and 15.2% were blind. The failure rate was statistically correlated to the early disease onset (<3 mo) and to preoperative corneal edema (P = 0.022 and P = 0.037, respectively).

Conclusion:

Primary CTT seems to be a good procedure in a population with advanced PCG at presentation, problematic follow-up visits, and limited resources.
Haemodynamic monitoring in the perioperative setting
Authors: Quintão Vinícius Caldeira , Jreige Júnior Armindo , Rizk Stephanie Itala , Hajjar Ludhmila Abrahão
Published: April 2023

Purpose of review

The aim of this study was to review the role of haemodynamic monitoring in the perioperative setting, highlighting who are the patients who most benefit, to describe the type of devices, to analyse the scientific evidence and to suggest algorithms of haemodynamic care in high-risk surgical patients.

Recent findings

In the last 50 years, many advances have contributed to better understand cardiovascular physiology at bedside, and haemodynamic monitoring has moved from invasive methods to minimally invasive and noninvasive devices. Randomized clinical trials have shown benefits of perioperative haemodynamic therapy to improve outcomes in high-risk surgical patients. A multimodal approach is purposed in the perioperative setting to optimize haemodynamic parameters, involving clinical analysis at bedside, the use of dynamic tests for fluid responsiveness and integration of variables, including cardiac output, systolic volume, tissue oxygen markers and echocardiographic measures.

In this review, we summarize the benefits of haemodynamic monitoring, the type of devices with advantages and disadvantages, the scientific evidence supporting perioperative haemodynamic therapy, and we suggest a multimodal approach to improve patients’ care.
Traumatic cardiac arrest
Authors: Lewis Jack , Perkins Gavin D.
Published: April 2023

Purpose of review

This review considers the latest evidence relating to the epidemiology and outcomes, treatment guidelines, diagnostic and therapeutic interventions in traumatic cardiac arrest.

Recent findings

There is variation in the incidence and outcomes of traumatic cardiac arrest which is influenced in part by case definitions. Irrespective of case definitions outcomes from traumatic cardiac arrest are typically worse than those seen from cardiac arrest due to medical causes but not so poor as to consider that treatment is futile. Clinical guidelines focus on the prompt treatment of reversible causes, although evidence that this improves outcomes is limited. Point of care ultrasound to assist with the identification of reversible causes should be limited to experienced operators where there is thought to be a high likelihood of a reversible cause being present. Care should be taken to minimize interruptions in chest compressions during scanning. There is little recent evidence to support specific therapeutic interventions. The role of Resuscitative Endovascular Balloon Occlusion of the Aorta during traumatic cardiac arrest remains to be determined in on-going research.

Conclusion

Trauma related cardiac arrest differs from cardiac arrest due to medical causes. Whilst the core principles of treatment are similar, a higher priority is placed on identifying and treating reversible causes.
Advantages and limitations of noninvasive devices for cardiac output monitoring: a literature review
Authors: Ruste Martin , Jacquet-Lagrèze Matthias , Fellahi Jean-Luc
Published: April 2023

Purpose of review

Individualized hemodynamic optimization often requires cardiac output monitoring, mostly for goal-directed therapy in the operating room and fluid responsiveness assessment in the intensive care unit. Different technologies for noninvasive cardiac output determination have become available over the recent years. It is therefore crucial for care providers to be made aware of the advantages and limitations of those different devices for an appropriate use at the bedside.

Recent findings

Nowadays, different noninvasive technologies exist, each with their advantages and limitations, but none are considered interchangeable with bolus thermodilution. Different clinical studies however, emphasize that the trending ability of such devices allows to guide decisions from care providers, and that their use may be associated with improved prognosis, especially in the operating room. Recent studies have also reported their potential use for hemodynamic optimization in specific populations.

Noninvasive cardiac output monitoring may have a clinical impact on patient outcomes. Further studies are required to evaluate their clinical relevance, notably in the intensive care unit. Noninvasive monitoring opens up the possibility for hemodynamic optimization in specific or low-risk populations, the benefit of which remains to be assessed.
Technique for removing a “cold-welded” interlocking screw from an intramedullary nail in the femur: A case report
Authors: Jian Wang , Jiangwei Fan , Jian Ran
Published: April 2023

Rationale:

Removing a bent or broken intramedullary (IM) nail can be challenging even if the nail is intact. Several methods have been described for removing bent or broken nails. However, few studies have reported the removal of an IM nail when a proximal interlocking screw is cold-welded. We hope to share our successful treatment strategy for future use.

Patient concerns:

A 33-year-old male was admitted to our clinic for IM nail removal. The patient complained of discomfort in his right thigh when the weather changed. He had fallen down the stairs 3 years prior, causing a closed fracture of the right femur, and was treated with an IM nail.

Diagnoses:

Radiography showed an IM nail in the right femur.

Interventions:

Initially, the distal interlocking screw was easily removed using a screwdriver. Attempts to remove the proximal interlocking screw using various methods were futile. Finally, a high-speed cutting burr was used to cut the proximal interlocking screw.

Outcomes:

The IM nail was successfully removed.

Lessons:

A cold-welded proximal interlocking screw was encountered during IM nail removal. The applied technique is an effective alternative when a screw is difficult to remove using conventional tools.