bluuebunny/crossref_metadata_2025 huggingface dataset:
Event-related Potentials as Metrics of Foreign Language Learning and Loss
Authors: Osterhout Lee , Pitkänen Ilona , McLaughin Judith , Zeitlin Margarita
Published: August 2019

We report here a study of adult first language (L1) English speakers who were enrolled in a university course of second language (L2) Finnish instruction. We investigated the acquisition and retention of the phonotactic Finnish Vowel Harmony rule. Event-Related Potentials (ERPs) were recorded while learners read a list of Finnish words and word-like non-words, some of which violated vowel harmony. ERPs were recorded near the beginning, middle, and end of the instructional period, and during a post-instruction language attrition session. The violations elicited an N400 effect during early stages of learning and a P600 effect after additional instruction. Conversely, violations elicited a P600 after short attrition periods and an N400 after longer periods. Our results support a processing-based version of the regression hypothesis: learners gradually transitioned from a lexical processing mode to a grammatical processing mode during the acquisition phase, with the reverse transition occurring once instruction has ended.
Introduction to Heritage Language Development
Authors: Montrul Silvina , Polinsky Maria
Published: August 2019

This chapter presents and analyses main factors that contribute to attrition in heritage languages. It shows that heritage speakers are a highly heterogeneous population from both a psycholinguistic and sociolinguistic point of view. In principle, their language can differ from the language of their input (baseline language, usually that of first-generation immigrants to a new country). The differences can be due to how the heritage language developed under reduced input conditions, interference from the dominant language (transfer) and innovations in the grammar, potential changes incipient in the input, and attrition proper. The latter is particularly apparent when the language of adult heritage speakers is compared with the language of bilingual children; such children outperform heritage speakers on a variety of linguistic properties. The critical factors that affect language change in heritage speakers include the age of onset of bilingualism and quantity/quality of input.
Quantifying Language Experience in Heritage Language Development
Authors: Unsworth Sharon
Published: August 2019

Variation in language experience is a key characteristic of heritage language development. To understand the impact of these varying experiences on children’s heritage language outcomes, researchers typically collate and quantify specific aspects of children’s language input, transforming or reducing them into other more general variables, such as language richness as a measure of input quality and amount of language exposure as a measure of input quantity. This chapter presents an overview of the most frequently used method of operationalizing language experience in bilingual language acquisition research, namely the parental questionnaire. It outlines some conceptual and practical issues surrounding parental questionnaires as a means of quantifying bilingual language experience as well as reviewing a number of questionnaires used in recent studies in more detail.
Intra-Generational Attrition
Authors: Bayram Fatih , Pascual y Cabo Diego , Rothman Jason
Published: August 2019

This chapter contributes to the emerging literature on heritage speaker bilingualism by weighing in on the potential role that intra-generational attrition plays in changing the path of heritage speaker bilingual development. Previous work has generally documented heritage speaker ultimate attainment differences as compared to that of monolingual speakers despite both groups having been native childhood acquirers of the same language. This chapter highlights that fact that some of the ubiquitously noted heritage speaker differences may be ascribed to how the primary linguistic input to which heritage speakers are exposed is qualitatively different or shifting from that which monolingual speakers are exposed to, and in part this is due to a process of trickled down first language attrition in the first generation immigrants.
Language Loss and Language Learning in Internationally Adopted Children
Authors: Pierce Lara J. , Genesee Fred , Klein Denise
Published: August 2019

Internationally adopted (IA) children begin acquiring one language from birth (L1), but typically discontinue it in favour of their adoption language (L2). Language attrition occurs quickly with IA children unable to speak/understand their L1 within months of adoption. However, as adults IA test participants show certain advantages in this language compared to monolingual speakers never exposed to it, suggesting that certain elements of the L1 may be retained. Neuroimaging studies have found that IA participants exhibit brain activation patterns reflecting the retention of L1 representations and their influence on L2 processing. This chapter reviews research on L1 attrition in IA children, discussing whether/how elements of the L1 may be retained. It discusses how L1 attrition versus retention might influence subsequent language processing in the L1 and L2. Implications of language attrition versus retention patterns observed in IA participants for neuroplasticity and language acquisition are also discussed beyond this specific group.
The Interface Hypothesis as a Framework for Studying L1 Attrition
Authors: Chamorro Gloria , Sorace Antonella
Published: August 2019

This chapter focuses on first generation individual attrition from the point of view of the Interface Hypothesis (IH), which proposes that structures at the interface between syntax and other cognitive domains, such as pragmatics, are more likely to undergo attrition than structures that do not involve such an interface, and discusses recent research that provides evidence of the selectivity and reversibility of individual first language (L1) attrition. This research provides supporting evidence for the IH as it reveals that attrition affects structures at the syntax-pragmatics interface but not structures requiring the satisfaction of semantic conditions. This chapter also reviews research that supports Sorace’s (2011, 2016) proposal that individual L1 attrition affects only the ability to process interface structures but not knowledge representations, as it reveals that attrition only affects online sensitivity with structures at the syntax-pragmatics interface rather than causing a permanent change in speakers’ L1 knowledge representations.
A Complex Dynamic Systems Perspective on Personal Background Variables in L1 Attrition
Authors: Opitz Conny
Published: August 2019

This chapter discusses the methodological challenges associated with studying personal background variables in first language (L1) attrition from the perspective of Complex Dynamic Systems Theory (CDST). It starts with a review of extant research which, despite concerted efforts to design rigorous, comparable studies, to date has not turned up strong, unambiguous predictors for L1 attrition. I argue that this failure lies in the nature of language as a complex dynamic system, and consequently in the properties of variables, their interaction, and varying contribution to the process and outcome of L1 attrition, and indeed to L1 and L2 (second language) acquisition in the larger context of multilingual development. CDST provides a challenge not just for common empirical and analytical approaches to attrition, but for the very notion of ‘predictor’. The chapter concludes by discussing some ways in which the current stalemate may be overcome.
Introduction to Psycholinguistic and Neurolinguistic Approaches to Language Attrition
Authors: Köpke Barbara , Keijzer Merel
Published: August 2019

It is now widely accepted that language attrition is inextricably linked to processes and mechanisms that have their origin in the human mind/brain. However, the field of attrition has built on linguistic, sociolinguistic, and applied linguistic perspectives, and psycholinguistic or neurolinguistics approaches did not have a place in this tradition until relatively recently. In this introductory chapter, we first of all sketch how psycholinguistic and neurolinguistic insights have very quickly become a pillar of attrition research. To do this, this introduction explores language attrition as a processing, memory, and brain mechanism before turning to an outline of the contributions in this section. As part of this tripartite introduction, models and theories that are introduced include activation and inhibition, declarative vs. procedural memory, retrieval induced forgetting, the savings account, and neural multifunctionality and plasticity.
Christian Contemplative Thought and Practice in the Contemporary World
Authors: Christie Douglas E.
Published: August 2019

“Christian Contemplative Thought and Practice in the Contemporary World” describes the growth and development of contemplative and meditative practices within contemporary Christianity, focusing especially on the retrieval of ancient contemplative practices in the contemporary period by Thomas Merton, John Main, and Thomas Keating. It also attends to the varied expressions of Christian contemplative thought among contemporary thinkers and practitioners and movements, such as the new monasticism, to ask how and why it continues to thrive and develop in the contemporary period. Noteworthy here are the distinctive contributions made by emerging writers such as Martin Laird, Richard Rohr, Cynthia Bourgeault, Kathleen Norris, Barbara Holmes, Sarah Coakley, Adam Bucko, Bernadette Flanagan, and Jean-Yves Leloup in extending and deepening the understanding of Christian contemplative practice in light of contemporary experience. Also significant are contributions by Latin American, African American, and feminist writers, such as Gustavo Gutiérrez, Maria Clara Bingemer, and Howard Thurman, in illuminating the role of Christian contemplative practice in responding to social injustice.
The Neurobiology of Sensory Valuation
Authors: Skov Martin
Published: August 2019

This chapter introduces the reader to the basic features of the neurobiological system involved in forming a hedonic liking response for sensory objects. In this way it aims to provide nonneuroscientists working in empirical aesthetics with a first primer on the neurobiological mechanisms and computational principles that underlie aesthetic appreciation. It describes how hedonic valuation is primarily computed by neural processes in the mesocorticolimbic reward circuit, and reviews some of the intrinsic and extrinsic factors that modulate these processes, thereby influencing how likable or dislikable a stimulus is experienced to be. It is argued that the neuroscientific evidence presented here suggests that the computational principles driving aesthetic appreciation can only be understood if seen as fundamentally rooted in functional mechanisms that evolved to help regulate adaptive behavior.
The Evolution of Aesthetics and Beauty
Authors: Zaidel Dahlia W.
Published: August 2019

For over two millennia philosophical discussions tied aesthetics mainly to art and led to meager insights, if any, into why humans experience aesthetic reactions. Current scientific discussions on the issue, on the other hand, have turned to biology, evolution, and neuroscience. They link aesthetics with beauty in art, faces, scenery, and a variety of other sources. The biology of beauty is now viewed as having roots that extend far into the human ancestry, specifically to animal mate selection strategies. This chapter traces and explains the biological role in the human beauty response and its usefulness in various domains of human interactions.
Revisiting Fechner’s Methods
Authors: Westphal-Fitch Gesche
Published: August 2019

Gustav Fechner, the founding father of empirical aesthetics, was the first to suggest that multiple methods should be used when approaching any aesthetic phenomenon empirically. He introduced the methods of production, use, and choice and laid out why they should typically be used in combination. While the method of choice is widely used today, the other two remain somewhat neglected, to the detriment of the field, as is argued here. Fechner’s other key contribution to empirical aesthetics is the distinction between “aesthetics from above” (which is purely theoretical) and “aesthetics from below” (which is guided by empirical research). One example of the application of aesthetics from below is research on the golden section, which is discussed here in connection with Fechner’s three proposed methods. The relevance of Fechner’s methods for research today is discussed.
Louis Spohr’s Tragic Faust
Authors: McClelland Clive
Published: August 2019

Louis Spohr’s Faust is the first operatic setting of the legend by a major composer. Unlike most of the Faust settings of later years, Spohr’s used a libretto based on Faustian characters and ideas, but not the main events associated with the legend. A subplot presents a second female love interest for Faust, and he is ultimately punished for his misdeeds with eternal damnation. The opera displays many of the features associated with German Romantic opera, including sophisticated characterization and motivic development. In particular, Spohr’s handling of the supernatural elements develops the disruptive procedures associated with two eighteenth-century musical styles, ombra and tempesta, the one slow and menacing, the other fast and furious, both of which lie at the root of Romantic expressivity.
The Serial Concept in Pousseur’s Votre Faust
Authors: Brégégère André
Published: August 2019

The product of an eight-year collaboration between Belgian composer Henri Pousseur and French writer Michel Butor, Votre Faust (Your Faust) (1969) engages in a critical dialogue with the operatic genre and the Western tradition through a multifaceted exploration of the Faust theme. This chapter analyzes the opera’s intricate design, highlighting the extensive influence of the serial concept in Pousseur’s compositional approach. It discusses the opera’s origins, setup, and plot elements; Pousseur’s innovative harmonic techniques; the dense web of musical and literary quotations concentrated in the central locale, the fair; and the work’s complex mobile structure, a unique blend of aleatoric performance mechanics and elements of audience participation.
Reflections of the Contemporary Schizophrenia in Josef Berg’s Two Versions of Johanes doktor Faust
Authors: Flašar Martin
Published: August 2019

Czech music has a lengthy tradition of Faustian settings extending back to the nineteenth century. Two important Faust compositions from the mid-twentieth century were created by the composer, writer, and poet Josef Berg. Berg’s position in post–World War II music resembled the story of Doctor Faustus in that he was faced with the choice of an official existence provided by the Czechoslovak Composers' Union or a life in isolated opposition. After starting his career as an optimistic supporter of communism, Berg shifted to a critical mode involving irony and parody. In the 1960s, Berg worked on two different adaptations of the Faust theme entitled Johanes doktor Faustus (Johanes Doctor Faustus). The first was created as a chamber opera for three persons and a small ensemble, while the second was conceived as a grand opera inspired by the poetics of folk puppet theater.
Pascal Dusapin’s New Lyrical Style in Faustus, the Last Night
Authors: Amblard Jacques
Published: August 2019

Pascal Dusapin, an acclaimed French composer, created the opera Faustus, the Last Night in 2005–6. In this dark work, the myth of Faust from the perspective of Marlowe’s tragedy, Doctor Faustus, is revisited through the prism of different contemporary topics and a general atmosphere of tragicomedy, perhaps typical of postmodern times. The composer called on his well-known prosodic style (a translation in music of the intonation of speech). But he also experimented with a new style, more typical of the early 2000s and their relative aesthetic return (or stagnation), which is more “Romantic,” dedicated to the strings. This new Romanticism seems well adapted to the archaic Faust theme and its association with pain, fate, and damnation.
Berlioz, Faust, and the Gothic
Authors: Rushton Julian
Published: August 2019

On reading Gérard de Nerval’s translation of Goethe’s Faust, Hector Berlioz set nine lyrics, grouped into eight miscellaneous pieces, which he immediately published (April 1829) as Huit scènes de Faust (Eight Scenes from Faust). This, his opus 1, was well received by fellow musicians, but he withdrew it, subsequently reworking the material in a full-scale dramatic work, La damnation de Faust (The Damnation of Faust) (1846), the title of which separates it from Goethe’s larger scheme in which, as Berlioz remarked, “Faust is saved.” Although Berlioz’s Faust suffers from ennui, suicide is prevented by the Easter Hymn and a nostalgic vision of childhood piety. Méphistophélès intervenes directly at this point, and controls the remaining action, in which Berlioz contrasts the purity of Marguerite (Gretchen) with demonic manifestations; in these Berlioz subverts musical expectations, notably turning a minuet of “follets” into one of music’s most fascinating evocations of the romantic grotesque.
The Paradoxical Faust Cantatas of Adrian Leverkühn and Alfred Schnittke
Authors: McKnight Charles
Published: August 2019

The Russian composer Alfred Schnittke’s Faust cantata, Seid nüchtern und wachet (Be sober and watch), remarkably parallels the fictional work of the hero of Thomas Mann’s 1947 novel Doktor Faustus (Doctor Faustus). Mann’s novel is a retelling of the sixteenth-century Faust story in the light of the history of German music of the late nineteenth and early twentieth centuries. The central character, the composer Adrian Leverkühn, navigates the currents of social and artistic unrest. The fictional composer’s last work was the cantata D. Fausti Weheklag (The Lamentation of Doctor Faustus) with a text drawn from the 1587 Spies Faust Book. One of the first readers of Mann’s novel, Schnittke patterned much of his own life on his fictional counterpart. The main characteristic of both Schnittke’s and Leverkühn’s cantatas is a pervasive sense of paradox.
Faust Goes Dancing
Authors: Rygg Kristin
Published: August 2019

This chapter discusses four ballets, all based on Goethe’s Faust, created over the period 1832–48 by four leading choreographers: August Bournonville in Copenhagen, André-Jean-Jacques Deshayes in London, Salvatore Taglioni in Naples, and Jules Perrot in Milan. Each was significantly influenced by the early French Romantic ballet and the great Parisian Faust vogue of the 1820s and 1830s. Of the musical scores, only those from Copenhagen and London are extant, the former being largely a compilation. The London version, by Adolphe Adam, is an original composition treated here in some detail. The power of Adam’s music to evoke something of the variety and profundity of Goethe’s Faust as conceived by Deshayes is explored.
The American Musical and the Faustian Bargain
Authors: Knapp Raymond
Published: August 2019

The history of the American musical is framed by spectacular successes driven by Faustian elements: The Black Crook (1866, running for decades, based loosely on Weber’s Der Freischütz [The Freeshooter]) and The Phantom of the Opera (1988; still running as of 2019). Yet, straightforwardly Faust-based musicals are rare, with Damn Yankees (1955) being the single obvious example. A discussion of Damn Yankees relates it to other treatments in popular culture, including the film version of The Devil and Daniel Webster (1941), as a basis for a wider discussion of Faustian elements deployed in American musical theater, including magic, striving, earning, idealism, temptation, and sexuality, leading to a consideration of the Faustian bargain of the genre itself, which uses the magic of music, dance, sex, and spectacle to seduce audiences and achieve commercial success, but at the apparent price of its artistic soul.
Gounodian Fausts by Pablo de Sarasate, Joan Baptista Pujol, and Felip Pedrell i Sabaté
Authors: Bäcker Rolf
Published: August 2019

This chapter addresses the reception of the Faust myth in Spanish musical culture, focusing on three nineteenth-century composers: Pablo de Sarasate, Joan Baptista Pujol, and Felip Pedrell i Sabaté. The theme found its way into Spanish music by means of Charles Gounod’s opera, Faust (Barcelona premiere, 1864), upon which the Faust works of these composers are based. Analysis of their adaptations reveals their dependence upon certain genres and styles (especially virtuoso piano/violin fantasies) more than a creative engagement with the myth itself and its translation into musical language.Among these works, Sarasate’s Nouvelle fantaisie sur Faust (Fantasy on Gounod’s “Faust” for Violin and Orchestra or [Piano]) [1874] may be the most well-known Spanish musical interpretation of the Faust theme.
Schumann’s Struggle with Goethe’s Faust
Authors: Tunbridge Laura
Published: August 2019

Robert Schumann had a long and complicated relationship with Goethe’s Faust, as is reflected in the compositional history of his Scenen aus Goethe’s Faust (Scenes from Goethe’s Faust), begun in 1844 and completed in 1853, but not published in his lifetime. Schumann was unusual among composers in using Goethe’s words rather than a paraphrase and in selecting scenes from both parts of the drama. He began with the closing “Chorus mysticus,” working his way backward through aspects of the Gretchen tragedy, and finally providing an overture. Unusually, Schumann decided to treat Faust as an oratorio rather than as an opera, but as in his other choral dramatic works of the time there is crossover, musically, with more theatrical approaches. The chapter examines musico-dramatic features of the work to reconsider its reception, which has been made problematic by critics viewing the Faustszenen as a barometer of Schumann’s late style.
Mefistofele Triumphant—From the Ideal to the Real
Authors: Girardi Michele
Published: August 2019

Arrigo Boito sought to escape the limiting conventions of contemporary melodrama in order to revolutionize Italian opera. However, the most radical expression of that effort, his adaptation of Goethe’s Faust, Mefistofele (Mephistopheles), which premiered at La Scala in 1868, did not attain the desired result. In reworking the score, the composer took practical concerns into account, making the opera more pleasing to the mainstream audiences who demanded melodious vocal lines and a tighter dramatic pace. The revised version staged in Bologna in 1875 and the subsequent revivals marked an important turning point: what had been an avant-garde work now entered into the repertoire of all the major theaters. This chapter retraces Boito’s journey from the setback of the premiere to the success for which he strove so diligently, highlighting the creative process that forged a new relationship between poetry and music, which Giuseppe Verdi later exploited in his collaboration with the poet.
Faust Rocks the Stage (Not)
Authors: Wollman Elizabeth L.
Published: August 2019

This chapter considers commercial rock musicals with Faustian themes that have been staged or workshopped in New York City between the mid-1960s and mid-1990s. Emphasis is placed on the ways in which rock music’s evolving relationship with philosophical notions of authenticity—often involving Faustian theme—stends to complicate such projects. Variations on the authenticity myth in rock music are examined and applied to several musicals: Tom Sankey’s The Golden Screw, which ran Off-Off-Broadway at Theatre Genesis in 1966; Joseph M. Kookoolis and Scott Fagan’s Soon, which premiered on Broadway at the Ritz (now Kerr) in 1971; and Randy Newman’s Faust, which was workshopped in New York and produced at the La Jolla in California and the Goodman in Chicago with the aim of a Broadway run that was ultimately deemed unwise.
Extending the Reach of Ferruccio Busoni’s Doktor Faust
Authors: Roberge Marc-André
Published: August 2019

This chapter documents the history and impact of the opera Doktor Faust (Doctor Faust), left incomplete by the Italian composer Ferruccio Busoni at his death in 1924, by surveying the completion proposed for the first performance (Dresden, 1925) by Busoni’s disciple Philipp Jarnach and, more recently, those offered by the musicologist Antony Beaumont and the composer Larry Sitsky, as well as the work’s translations, performances, and recordings. It examines works by Ronald Stevenson, Alistair Hinton, and Michael Finnissy, three composers from the United Kingdom on whom Busoni’s artistic figure has left a deep imprint and who have drawn on material from his masterpiece in a spirit of homage, thus drawing attention to its significance.
The Faustian and Mephistophelean Worlds in Stravinsky’s The Rake’s Progress
Authors: Carr Maureen A.
Published: August 2019

Created by Igor Stravinsky, in collaboration with W. H. Auden and Chester Kallman, the Faustian opera The Rake’s Progress (1947–51) was inspired by a series of engravings by William Hogarth. The collaboration between Stravinsky and Auden is a fascinating study, not only because of the way in which these luminaries interacted to produce this masterwork, but also because it provides insights into Stravinsky’s compositional process for his first dramatic work that involved the setting of a text in English. This chapter provides a glimpse into the process for specific musical passages in The Rake’s Progress and considers certain parallels between the storyline of Auden’s text and that of Goethe’s Faust.
Havergal Brian’s Gothic Opera Faust
Authors: Schaarwächter Jürgen
Published: August 2019

English composer Havergal Brian’s setting of Goethe’s Faust was the third of his large-scale German-language operatic projects. Goethe’s Faust had interested Brian for at least forty years when he started composing his Faust opera. Brian was fascinated by the Gothic, and the Goethean Faust represented Gothic Germany as he imagined it. In his opera Faust (1955–56), Brian sought to recreate the German Gothic, filtered through Goethe’s words, which he left unaltered. The opera is full of invention and new perspectives on Goethe’s play. The composer has avoided any superficial picturesqueness, creating a density and intensity typical of his later large-scale operatic works.
Public health and climate change: How are local authorities preparing for the health impacts of our changing climate?
Authors: Woodhall Sarah C , Landeg Owen , Kovats Sari
Published: August 2019

Background

Local authorities have a crucial role in preparing for the impacts of climate change. However, the extent to which health impacts are being prioritized and acted on is not well understood.

Methods

We investigated the role of public health in adapting to climate change through: (i) a content analysis of local authority climate change adaptation strategies in South West England and (ii) semi-structured telephone interviews with local authority public health consultants and sustainability officers and a regional Public Health England representative (n = 11).

Results

Adaptation strategies/plans varied in existence and scope. Public health consultants did not have an explicit remit for climate change adaptation, although related action often aligned with public health’s emergency planning functions. Key barriers to health-related adaptation were financial constraints, lack of leadership and limited public and professional awareness about health impacts.

Conclusions

Local authorities in South West England have differing approaches to tackling health impacts of climate change, and the prominence of public health arguments for adaptation varies. Improved public health intelligence, concise communications, targeted support, visible local and national leadership and clarity on economic costs and benefits of adaptation would be useful for local authorities in preparing for the health impacts of climate change.
Approaches to feedback in the mathematical sciences: just what do students really think?
Authors: Grove Michael J , Good Chris
Published: August 2019

Assessment and feedback is an area where mathematical sciences departments have invested significant effort in recent times. Particular challenges have been identified relating to timely and detailed feedback, both of which are important given the widespread use of formative, and typically weekly, problem sheet assessments to aid and structure the mathematical development of learners. Here, we report on a first cycle of action research, linked to the implementation of a revised curriculum in a large UK research-intensive mathematical sciences department, which was designed to enhance the feedback received by students and their subsequent engagement with it. Whilst we draw upon the results of a survey of 74 undergraduate students, we also describe the pilot of a method for providing video-based marking and feedback. Our results show the importance that students within the mathematical sciences place upon feedback as part of their learning experience, but also that amongst those undergraduates surveyed, there was no clear consensus as to whether they had received sufficient feedback upon their work. The findings reinforce the need for students themselves to engage with their mathematical feedback in a meaningful way, and significantly they indicate that the feedback perceived as most valuable involves opportunities to engage in dialogue about their work with either their peers, postgraduate teaching assistants or academic members of staff. As such, the emphasis that departments place upon providing ‘detailed written comments’ on formative work appears not to be valid, and instead more ‘dialogical’ or ‘interactive’ mechanisms for providing feedback in mathematics may have the potential to yield more effective results.
AMPK promotes induction of the tumor suppressor FLCN through activation of TFEB independently of mTOR
Authors: Collodet Caterina , Foretz Marc , Deak Maria , Bultot Laurent , Metairon Sylviane , Viollet Benoit , Lefebvre Gregory , Raymond Frederic , Parisi Alice , Civiletto Gabriele , Gut Philipp , Descombes Patrick , Sakamoto Kei
Published: August 2019

AMPK is a central regulator of energy homeostasis. AMPK not only elicits acute metabolic responses but also promotes metabolic reprogramming and adaptations in the long‐term through regulation of specific transcription factors and coactivators. We performed a whole‐genome transcriptome profiling in wild‐type (WT) and AMPK‐deficient mouse embryonic fibroblasts (MEFs) and primary hepatocytes that had been treated with 2 distinct classes of small‐molecule AMPK activators. We identified unique compound‐dependent gene expression signatures and several AMPK‐regulated genes, including folliculin (Flcn), which encodes the tumor suppressor FLCN. Bioinformatics analysis highlighted the lysosomal pathway and the associated transcription factor EB (TFEB) as a key transcriptional mediator responsible for AMPK responses. AMPK‐induced Flcn expression was abolished in MEFs lacking TFEB and transcription factor E3, 2 transcription factors with partially redundant function; additionally, the promoter activity of Flcn was profoundly reduced when its putative TFEB‐binding site was mutated. The AMPK‐TFEB‐FLCN axis is conserved across species; swimming exercise in WT zebrafish induced Flcn expression in muscle, which was significantly reduced in AMPK‐deficient zebrafish. Mechanistically, we have found that AMPK promotes dephosphorylation and nuclear localization of TFEB independently of mammalian target of rapamycin activity. Collectively, we identified the novel AMPK‐TFEB‐FLCN axis, which may function as a key cascade for cellular and metabolic adaptations.—Collodet, C., Foretz, M., Deak, M., Bultot, L., Metairon, S., Viollet, B., Lefebvre, G., Raymond, F., Parisi, A., Civiletto, G., Gut, P., Descombes, P., Sakamoto, K. AMPK promotes induction of the tumor suppressor FLCN through activation of TFEB independently of mTOR. FASEB J. 33, 12374–12391 (2019). www.fasebj.org
Impact of a Perioperative Protocol on Length of ICU and Hospital Stay in Complex Spine Surgery
Authors: Ayrian Eugenia , Sugeir Shihab H. , Arakelyan Anush , Arnaudov Dimiter , Hsieh Patrick C. , Laney Jeremy V. , Roffey Peter , Tran Thang D. , Varner Chelsia L. , Vu Kevin , Zelman Vladimir , Liu John C.
Published: August 2019

Background:

In an attempt to improve patient care, a perioperative complex spine surgery management protocol was developed through collaboration between spine surgeons and neuroanesthesiologists. The aim of this study was to investigate whether implementation of the protocol in 2015 decreased total hospital and intensive care unit (ICU) length of stay (LOS) and complication rates after elective complex spine surgery.

Materials and Methods:

A retrospective cohort study was conducted by review of the medical charts of patients who underwent elective complex spine surgery at an academic medical center between 2012 and 2017. Patients were divided into 2 groups based on the date of their spine surgery in relation to implementation of the spine surgery protocol; before-protocol (January 2012 to March 2015) and protocol (April 2015 to March 2017) groups. Outcomes in the 2 groups were compared, focusing on hospital and ICU LOS, and complication rates.

Results:

A total of 201 patients were included in the study; 107 and 94 in the before-protocol and protocol groups, respectively. Mean (SD) hospital LOS was 14.8±10.8 days in the before-protocol group compared with 10±10.7 days in the protocol group (P<0.001). The spine surgery protocol was the primary factor decreasing hospital LOS; incidence rate ratio 0.78 (P<0.001). Similarly, mean ICU LOS was lower in the protocol compared with before-protocol group (4.2±6.3 vs. 6.3±7.3 d, respectively; P=0.011). There were no significant differences in the rate of postoperative complications between the 2 groups (P=0.231).

Conclusion:

Implementation of a spine protocol reduced ICU and total hospital LOS stay in high-risk spine surgery patients.
Setting Yourself Up for Success: Locked Plating for Vancouver B1 Fractures
Authors: Collinge Cory A.
Published: August 2019

This chapter discusses principles and controversies surrounding the treatment of periprosthetic fractures around a hip replacement, specifically the Vancouver B1 injury. Evaluation and treatment decisions, as well as surgical tips and tricks, are discussed.
Improved Clinical and Functional Outcomes in Crouch Gait Following Minimally Invasive Hamstring Lengthening and Serial Casting in Children With Cerebral Palsy
Authors: Long Jason T. , Cobb Leah , Garcia Micah C. , McCarthy James J.
Published: August 2019

Background:

Serial extension casting represents a novel solution for addressing residual knee flexion contractures following hamstring lengthening in children with cerebral palsy. The purpose of this study was to investigate postoperative changes in patients following hamstring lengthening with a serial casting protocol.

Methods:

Measures from preoperative and postoperative gait analyses were reviewed retrospectively for 19 patients with cerebral palsy who underwent hamstring lengthening followed by serial extension casting. Postoperative changes in clinical, functional, and kinematic parameters were assessed using paired parametric methods.

Results:

Improvements were measured in popliteal angle, knee contracture, peak stance phase knee extension, sagittal plane range of motion of the knee during walking, Gait Deviation Index, and pediatric outcomes data collection instrument Global score. Nearly 80% of the cohort (15/19 patients) demonstrated a significant or moderate response to the intervention, whereas 20% demonstrated no improvement. Of note, significantly increased anterior pelvic tilt was also observed.

Conclusions:

Hamstring lengthening combined with a serial casting protocol was associated with significant postoperative improvements in a range of clinical (eg, knee contracture), functional (eg, pediatric outcomes data collection instrument Global), and kinematic (eg, knee extension in stance) parameters. Improvements following this minimally invasive surgery were comparable to outcomes from procedures with higher complication rates.

Level of Evidence:

This is a Level III Therapeutic Study (retrospective study investigating the results of a treatment).
Five-year Results of a Randomized Controlled Trial for Lumbar Artificial Discs in Single-level Degenerative Disc Disease
Authors: Yue James J. , Garcia Rolando , Blumenthal Scott , Coric Dom , Patel Vikas V. , Dinh Dzung H. , Buttermann Glenn R. , Deutsch Harel , Miller Larry E. , Persaud Elizabeth J. , Ferko Nicole C.
Published: August 2019

Study Design.

A prospective, multicenter, randomized, controlled, investigational device exemption (IDE) noninferiority trial.

Objective.

The aim of this study was to compare the 5-year safety and effectiveness of the activL Artificial Disc with Control Total Disc Replacement (TDR) systems (ProDisc-L or Charité) in the treatment of patients with symptomatic single-level lumbar degenerative disc disease (DDD).

Summary of Background Data.

The activL Artificial Disc received Food and Drug Administration approval in 2015 based on 2-year follow-up data.

Methods.

Eligible patients presented with symptomatic, single-level, lumbar DDD who failed ≥6 months of nonsurgical management. At entry, 324 patients were randomly allocated (2 : 1) to treatment with activL (n = 218) or Control (n = 106, including n = 65 ProDisc-L and n = 41 Charité) TDR. At 5-year follow up, a total of 261 patients (176 activL patients and 85 Control patients) were available for analysis.

Results.

The primary composite endpoint at 5 years for activL patients was noninferior to Control TDR. Relative to baseline, reductions in back pain severity and improvements in Oswestry Disability Index (ODI) were maintained for both the activL and Control TDR groups through 5 years. The activL group showed significantly better range of motion for flexion-extension rotation, flexion-extension translation, and disc angle, compared with Control TDR. Freedom from a serious adverse event through 5 years was 64% in activL patients, 47% in Control patients (log-rank P = 0.0068). Freedom from index-level and adjacent-level reoperation was high for TDR patients, ranging between 94% and 99%, respectively.

Conclusion.

Long-term evidence supports lumbar total disc replacement as safe. The next-generation activL Artificial Disc is more effective at preserving range of motion than first-generation lumbar TDRs (ProDisc-L and Charité) and offers a higher safety profile. Other primary and secondary outcomes are similar between disc designs.

Level of Evidence: 2
Families in Context
Authors: Brewer Mackenzie , Kimbro Rachel Tolbert , Denney Justin T.
Published: August 2019

Using restricted, geo-coded Early Childhood Longitudinal Study, Kindergarten Class of 2010-2011 data (N = 2700) linked with 3 sources of contextual data, we examine whether a comprehensive set of individual, household, and county-level characteristics explains disparities in household food insecurity between Hispanic children of foreign- and US-born parents. Adjusting for individual, household, and county-level characteristics does not eliminate the higher odds of household food insecurity among Hispanic children in immigrant families, especially of Mexican origin. Moreover, growth in the noncitizen population at the county level is associated with food insecurity among Hispanic families, though the impact differs by parental nativity.
VITREOUS AND PRERETINAL SEEDING AFTER TRANSVITREAL FINE NEEDLE ASPIRATION BIOPSY OF CHOROIDAL MELANOMA
Authors: Mashayekhi Arman , Shields Carol L. , Eagle Ralph C. , Shields Jerry A.
Published: August 2019

Background/Purpose:

To report vitreous and epiretinal seeding of choroidal melanoma after transvitreal fine-needle aspiration biopsy (FNAB).

Methods:

A 74-year-old Caucasian man with a medium-sized, dome-shaped choroidal melanoma without Bruch membrane rupture, retinal invasion, or vitreous seeding. Transvitreal FNAB was performed for cytopathologic evaluation using a long 27-gauge needle attached to a 10-mL syringe by connector tubing. After passing through the pars plana, vitreous cavity, neurosensory retina, and Bruch membrane, the needle was inserted into the tumor and aspiration was performed.

Results:

Cytopathologic evaluation revealed spindle B melanoma cells, and the tumor was subsequently treated with an 18-mm round Iodine-125 radioactive plaque delivering a tumor apex radiation dose of 7,000 cGy. Transscleral FNAB for cytogenetic evaluation performed at the time of plaque application disclosed chromosome three monosomy and chromosome six and eight disomy. Vitreous pigmented cells were first noted 14 months after brachytherapy. Funduscopy and optical coherence tomography at 24 months after plaque radiotherapy showed extensive vitreous and preretinal pigmented seeding that completely covered the optic disk. Fine-needle aspiration biopsy of the vitreous confirmed the presence of malignant melanoma cells, and the right eye was enucleated. Histopathologic evaluation showed a totally necrotic choroidal melanoma and an extensive malignant epiretinal membrane that covered and extended into the substance of the optic nerve head and focally invaded the neurosensory retina. The patient developed liver metastasis 3 years after the initial presentation and died 10 months later.

Conclusion:

This case demonstrates the rare development of extensive vitreous and preretinal seeding with retinal and optic nerve invasion after transvitreal FNAB of choroidal melanoma.
Evaluation and Management of Premalignant Conditions of the Esophagus
Authors: Ramai Daryl , Lai Jonathan K. , Ofori Emmanuel , Linn Sandar , Reddy Madhavi
Published: August 2019

Esophageal cancer represents one of the most lethal forms of malignancy. The growing incidence of esophageal adenocarcinoma represents an emerging public health concern. This review article summarizes current diagnostic, management, and therapeutic practices of premalignant conditions of the esophagus including Barrett’s esophagus, tylosis, granular cell tumors, achalasia, and the ingestion of caustic substances. Our report provides clinicians and academics with a global clinical perspective regarding presentation, surveillance guidelines, and therapeutic management of these esophageal conditions.
Preventing Aspiration Complications
Authors: Wangen Tina , Hatlevig Janelle , Pifer Gina , Vitale Kirsten
Published: August 2019

Aims:

The aim of this study was to decrease the number of patients with acquired aspiration mortality.

Design:

This was an evaluation research study. Data were collected on acutely ill hospitalized patients from January 2013 to December 2017.

Methods:

In 2016, a 1100-bed Midwestern quaternary care facility found an increasing trend in mortality rates of patients with acquired aspiration from 2013 to 2015. A need for improved detection of patients at risk of aspiration was identified. A multidisciplinary team analyzed this need and developed a screening process found on the American College of Chest Physicians practice guidelines and the Massey Bedside Swallowing Screen to reduce these rates. Nurses implemented the aspiration risk screening process on all hospitalized patients. Data were collected through nursing responses and chart reviews.

Results:

Initial implementation of the aspiration risk screening process yielded procedural concerns that were ameliorated through increased education and refinement of the screen. After refinement and reimplementation, mortality data from 2016 to 2017 revealed a decrease to zero aspiration-related events.

Conclusion:

Our findings suggest implementation of a nursing-led aspiration risk screening process with acutely ill patients is a factor in decreasing patient mortality from acquired aspiration. These clinical practice changes of identifying patients at risk of aspirating and involving dysphagia therapists prior to oral intake increase patient safety while decreasing acquired aspiration mortality.

Impact:

This study addressed upward trends in patient mortality with acquired aspiration. Mortality rates declined after implementation of the aspiration risk screening process on hospitalized patients. These findings have potential to impact healthcare personnel and all acutely ill hospitalized patients.
Papillary Lesions of the Male Breast
Authors: Zhong Elaine , Cheng Esther , Goldfischer Michael , Hoda Syed A.
Published: August 2019

Papillary lesions of the male breast (PLMB) are uncommon. To date, PLMB have been reported as individual case reports and in relatively small series. We reviewed cases of PLMB diagnosed at our medical center over a 19-year (2000-2019) period. A total of 117 cases were identified, with an age range of 7 months to 88 years. These cases included 3 of papillary ductal hyperplasia, 5 intraductal papillomas, 1 adenomyoepithelioma, 5 atypical papillomas (ie, papillomas with atypia), 51 papillary ductal carcinoma in situ, 14 encapsulated papillary carcinomas, 38 solid papillary carcinomas, and 8 invasive papillary carcinomas. Malignant papillary neoplasms, including invasive and noninvasive ones, had a mean size of 1.3 cm (range: 0.3 to 4.4 cm), and all were ER+ and HER2−. Fifty-four percent (19/35) of carcinomas were treated with excision alone, 46% (16/35) underwent mastectomy, and 63% (22/35) had axillary lymph node sampling. Only one case had metastatic involvement of axillary lymph nodes. Of the cases with follow-up, no (0/8) invasive carcinoma showed distant metastasis or proved fatal, and no (0/23) noninvasive papillary carcinoma recurred. Two notable cases of PLMB were encountered: one of a 7-month-old boy with NF1 mutation and florid papillary hyperplasia, and another of a 57-year-old man with Klippel-Feil syndrome and bilateral solid papillary carcinoma, invasive and oligometastatic on one side and noninvasive on the other. On the basis of this study of PLMB cases, the largest to date, and review of literature, we conclude that PLMB span a broad clinicopathologic spectrum, and that both invasive and noninvasive papillary carcinomas have relatively good prognosis.
Postsurgical Opioid Prescriptions and Risk of Long-term Use
Authors: Young Jessica C. , Dasgupta Nabarun , Chidgey Brooke A. , Jonsson Funk Michele
Published: August 2019

Objective:

The aim of this study was to evaluate differences in risk of long-term opioid therapy after surgery among an opioid-naive population using varying cutoffs based on days supplied (DS), total morphine milligram equivalents (MME) dispensed, and quantity of pills (QTY) dispensed.

Background:

In response to the US opioid crisis, opioid prescription (Rx) limits have been implemented on a state-by-state basis beginning in 2016. However, there is limited evidence informing appropriate prescribing limits, and the effect of these policies on long-term opioid therapy.

Methods:

Using the MarketScan claims databases, we identified all opioid-naive patients undergoing outpatient surgery between July 1, 2006 and June 30, 2015. We identified the initial postsurgical opioid prescribed, examining the DS, total MME, and QTY dispensed. We used Poisson to estimate adjusted risk differences and risk ratios of long-term opioid use comparing those receiving larger versus smaller volume of opioids.

Results:

We identified 5,148,485 opioid-naive surgical patients. Overall, 55.5% received an opioid for postoperative pain, with median days supply = 5 and median total MME = 240. The proportion of patients receiving prescriptions above 7 DS increased from 11% in 2006 to 19% in 2015. Among those receiving postoperative opioids, 8% had long-term opioid use, and risk of long-term use was 1.16 times [95% confidence interval (CI), 1.10–1.25] higher among those receiving >7 days compared with those receiving ≤7 days. Those receiving >400 total MME (15% of patients) were at 1.17 times (95% CI, 1.10–1.25) the risk of long-term use compared with those receiving ≤400 MME.

Conclusions:

Between 2005 and 2015, the amounts of opioids prescribed for postoperative pain increased dramatically, and receipt of larger volume of opioids was associated with increased risk of long-term opioid therapy.