bluuebunny/crossref_metadata_2025 huggingface dataset:
Game localization research and translation studies
Authors: O'Hagan Minako , Chandler Heather
Published: August 2016

Game localization has been largely ignored in game studies and constitutes a
relatively new area of research in translation studies. It is a specialized translation
practice requiring technical, cultural and business considerations specific
to games with multiple stakeholders involved. Addressing a general lack of
dialog between these parties, the chapter brings together perspectives of a game
producer and a translation scholar under the key theme of “loss and gain” with
the third voice of a game localization practitioner enriching the final synthesis.
Our tri-party views confirm that games as interactive entertainment designed
to maximally engage the player call for deeper and more trustful partnership
between the stakeholders in game localization than is the case today.
Further changes in the dynamic game industry are evident in the application of
crowdfunding and crowdsourcing of translation. In such a climate this chapter
demonstrates the value of combined perspectives in further advancing game
localization as practices that must be built on mutual understanding of parties
serving different roles in delivering compelling gameplay experience across
languages and cultures.
Datives in Basque bivalent unergatives
Authors: de Urbina Jon Ortiz , Fernández Beatriz
Published: August 2016

Bivalent predicates which mark their sole object dative rather than absolutive/accusative are unexpected under the assumption that dative is associated with a ‘second complement’. Apparently first complements of morphologically transitive verbs are also found in Basque, in the main semantic classes already identified by Blume (1998). Morphologically, this sole object is indistinguishable from the indirect object of trivalent predicates of the give-type: both of them share dative case and trigger identical agreement marking on a ditransitive-like auxiliary form. In this chapter, we will focus on the syntactic behavior of these datives and, following McFadden (2004), we will show that similarities with indirect objects extends also to syntax, as attested in: (i) secondary predication, (ii) impersonal/passive clauses, (iii) adnominals, and (iv) causativization and relativization. These dative objects, then, differ from DOM dative complements in Basque (Fernández and Rezac, this volume) both in syntactic behavior and in distribution.
Nominals in Basque and their existential interpretation
Authors: Etxeberria Urtzi
Published: August 2016

Assuming that Souletin, the Basque dialect from Zuberoa, is a previous stage compared to Standard Basque (cf. Michelena 1964, Camino 2015; cf. also Manterola 2012, 2015), this paper tries to explain how Basque historically moves from a situation where bare nouns are allowed (Souletin dialect) to a situation where bare nouns are not allowed in argument position (Standard Basque). The reason we move from system A to system B is argued to be due to a semantic weakening and loss of the null D: (i) in Souletin BNs are full DPs with an empty head occupied by a phonetically null D (with indefinite reference and unspecified for number); (ii) this null D loses its semantic features and since it is null it cannot be reanalyzed and gets lost; (iii) in Standard Basque, due to the fact that null D is no longer available, the definite article [-a] -a semantically flexible element, cf. Etxeberria 2005 et seq- takes its place, as is phonologically a weak element, i.e. a suffix, and so the closest phonological alternative to the null D.
Strategies of verb and verb phrase focus across Basque dialects
Authors: Elordieta Arantzazu , Haddican Bill
Published: August 2016

In this chapter we study four different strategies available in Basque dialects to focalize the verb and the verb phrase: (i) verb doubling, (ii) ba-insertion, (iii) V1 strategy, and (iv) expletive egin insertion. We argue that the four constructions reflect different ways of complying with morphophonological requirements of foci, including the requirement that foci be capable of bearing sentence stress. In particular, we argue that these strategies reflect selective deletion of material (PF repair operations) that would otherwise violate these constraints (Bošković and Nunes 2007). In so doing, the discussion provides a partially unified analysis of these four constructions.
Interrogative Strategies
Authors: Luo Tianhua
Published: August 2016

This book deals with how to ask questions in the languages of China. The syntactic, morphological, and lexical forms for distinguishing interrogatives take centre stage; intonation is also dealt with, but more peripherally than question particles, disjunctive and negative constructions, and word order. 140 languages spoken in China are covered coming from four major families: Sino-Tibetan, Altaic, Austronesian and Austro-Asiatic, accompanied by a few mixed languages. The approach is areal-typological, i.e. these focal languages are compared to the languages of the world as represented in typological samples, and within China areal patterns of the structural variables are examined.
The book will be an indispensable reference for future work on interrogatives in a typological context and for areal studies of the language situation in China and more generally East Asia.
Nonlethal Batch Identification of Atlantic Salmon Using Coded Wire Tags
Authors: Goulette Graham S. , Lipsky Christine A.
Published: August 2016

Hatchery fish are a valuable asset to and often an essential component of endangered species recovery programs. The recovery program for Atlantic Salmon Salmo salar in the Penobscot River, Maine, uses multiple life stages of hatchery fish. Correct identification of returning adults is vital to assess the contribution of each stocked life stage to overall Atlantic Salmon returns. We investigated the use of coded wire tags (CWTs) implanted into various body locations of salmon parr to determine whether the tags could be used as a nonlethal batch identifier after recapture. We tagged 200 (four groups of ~50) Atlantic Salmon parr with CWTs in four different anatomical locations (right and left dorsal and right and left adipose areas) using a Northwest Marine Technology (NMT) handheld multishot injector. We used an additional 51 nontagged parr as a control. We examined fish for CWTs using a NMT blue handheld wand and kept track of individuals using PIT tags. We monitored CWT recovery, correct identification of CWT location, growth rates for all tagged groups, and growth rates for the control group. Tag recovery was 94.7% at 28 months posttagging. Correct identification of CWT location improved with each sampling event to 88.3% at 28 months. Tag location did not affect growth rates, but we found a significant difference between tag location and tag recovery. The left dorsal and left adipose areas had the highest recovery rates. Tagging fish in different anatomical locations with CWTs can provide a minimally invasive batch mark when benign recovery is desired.

Received June 16, 2015; accepted May 25, 2016 Published online August 30, 2016
A high-quality factor hybrid plasmonic nanocavity based on distributed Bragg reflectors*
Authors: Tu Linlin , Zhang Chi , Huang Zhong , Yau Jason , Zhan Peng , Wang Zhenlin
Published: August 2016

Herein, we propose a high-quality (Q) factor hybrid plasmonic nanocavity based on distributed Bragg reflectors (DBRs) with low propagation loss and extremely strong mode confinement. This hybrid plasmonic nanocavity is composed of a high-index cylindrical nanowire separated from a metal surface possessing shallow DBRs gratings by a sufficiently thin low-index dielectric layer. The hybrid plasmonic nanocavity possesses advantages such as a high Purcell factor (F
p) of up to nearly 20000 and a gain threshold approaching 266 cm−1 at 1550 nm, promising a greater potential in deep sub-wavelength lasing applications.
Climate Policy and Border Measures: The Case of the U.S. Aluminum Industry
Authors: Sheldon Ian , McCorriston Steve
Published: August 2016

This article analyzes the impact of border measures for climate policy on carbon leakage and the competitiveness of U.S. aluminum producers. An appropriate border measure is shown to depend on competition in aluminum production, as well as the basis for assessing trade neutrality of a border measure. If neutrality is based on market volume, carbon leakage is prevented, but competitiveness cannot be maintained. If neutrality is based on market share, competitiveness can be maintained and there is negative carbon leakage. In either case, users of aluminum incur deadweight losses from the combination of climate policy and border measures. The key policy implication of the analysis is that appropriately designed border measures for climate policy may break the link between competitiveness and carbon leakage, but their design is important in ensuring that they are not protectionist.
The Case for Low Blood Pressure Targets
Authors: Flack John M. , Nolasco Carlos , Levy Phillip
Published: August 2016

The “totality” of hypertension clinical trial endpoint data has shown that the absolute benefit of pharmacological blood pressure (BP) lowering is directly related to the BP level and baseline cardiovascular risk, albeit with attenuation of the relative risk reduction per unit of BP lowering in patients with diabetes and chronic kidney disease. Absolute risk reductions with pharmacological treatment are greater with advancing age. Cardiovascular risk and mortality reductions attributable to pharmacological BP lowering have been demonstrated for progressively lower BP levels extending well below the conventional BP threshold (140/90mm Hg) for hypertension. Hypertension endpoint trials have shifted from determining the relative clinical benefits of various antihypertensive drugs to exploring whether lower than conventional BP targets in persons with BP levels spanning the prehypertensive to much higher BP strata confer clinical benefit. The more recent of these trials were “relatively” agnostic to the drugs used for BP lowering although several trials provided, but did not mandate the use of, specific agents. Pharmacological treatment benefit has been demonstrated at pretreatment BP levels even lower than the intensive SPRINT BP target (<120mm Hg) and a growing body of evidence suggests that substantial risk reduction can be achieved by maintaining a normal BP over time (rather than waiting for BP to exceed 140/90mm Hg before treating). Thus there is a compelling rationale to lower the BP threshold not just for a therapeutic goal but also for the initiation of pharmacological intervention.
Barriers to comparing the usability of electronic health records
Authors: Ratwani Raj M , Hettinger A Zachary , Fairbanks Rollin J
Published: August 2016

Despite the widespread adoption of electronic health records (EHRs), usability of many EHRs continues to be suboptimal, with some vendors failing to meet usability standards, resulting in clinician frustration and patient safety hazards. In an effort to increase EHR vendor competition on usability, recommendations have been made and legislation drafted to develop comparison tools that would allow purchasers to better understand the usability of EHR products prior to purchase. Usability comparison can be based on EHR vendor design and development processes, vendor usability testing as part of the Office of the National Coordinator for Health Information Technology certification program, and usability of implemented products. Barriers exist within the current certified health technology program that prevent effective comparison of usability during each of these stages. We describe the importance of providing purchasers with improved information about EHR usability, barriers to making usability comparisons, and solutions to overcome these barriers.
Essential role of conserved DUF177A protein in plastid 23S rRNA accumulation and plant embryogenesis
Authors: Yang Jiani , Suzuki Masaharu , McCarty Donald R.
Published: August 2016

DUF177 proteins are nearly universally conserved in bacteria and plants except the Chlorophyceae algae. Thus far, duf177 mutants in bacteria have not established a function. In contrast, duf177a mutants have embryo lethal phenotypes in maize and Arabidopsis. In maize inbred W22, duf177a mutant embryos arrest at an early transition stage, whereas the block is suppressed in the B73 inbred background, conditioning an albino seedling phenotype. Background-dependent embryo lethal phenotypes are characteristic of maize plastid gene expression mutants. Consistent with the plastid gene expression hypothesis, quantitative real-time PCR revealed a significant reduction of 23S rRNA in an Escherichia coli duf177 knockout. Plastid 23S rRNA contents of duf177a mutant tissues were also markedly reduced compared with the wild-type, whereas plastid 16S, 5S, and 4.5S rRNA contents were less affected, indicating that DUF177 is specifically required for accumulation of prokaryote-type 23S rRNA. An AtDUF177A–green fluorescent protein (GFP) transgene controlled by the native AtDUF177A promoter fully complemented the Arabidopsis atduf177a mutant. Transient expression of AtDUF177A–GFP in Nicotiana benthamiana leaves showed that the protein was localized in chloroplasts. The essential role of DUF177A in chloroplast–ribosome formation is reminiscent of IOJAP, another highly conserved ribosome-associated protein, suggesting that key mechanisms controlling ribosome formation in plastids evolved from non-essential pathways for regulation of the prokaryotic ribosome.
Early Modern Philosophy, 1600-1750
Authors: LoLordo Antonia
Published: August 2016

In 21st century academic philosophy, “early modern philosophy” refers to the study of texts written in a specific time and place, and understood as works of philosophy in that context. The time is, roughly, the 17th century and the first half of the 18th century. This article is limited to philosophers who published or wrote most of their major works between 1600 and 1750, thus including Hume and Condillac but omitting near-contemporaries like Rousseau. The place is often described as Western Europe, but this is a bit misleading: with very few exceptions, the philosophers discussed here were from France, Holland, or what is now the United Kingdom. The traditional canon of Early Modern philosophers was very small: Locke, Berkeley, and Hume on one side of the English Channel; Descartes, Leibniz, and Spinoza on the other. In the last decades of the 20th century and first decades of the 21st century, the canon was expanded significantly. Two main factors drove the expansion of the canon. One was increased attention to works of what was then called natural philosophy, like Newton’s Philosophiae Naturalis Principia Mathematica. The other was increased attention to the work of women. This bibliography aims to capture some of this expansion, but still, hundreds of other works could have been included—and more will be as time goes on.
Restoration of Physical Integrity of Rivers
Authors: Polvi Lina E. , Baker Daniel W.
Published: August 2016

Physical integrity for rivers refers to a set of active fluvial processes and landforms wherein the channel, floodplain, sediment, and overall spatial configuration maintain a dynamic equilibrium, according to Graf 2001 (cited under Components of Physical Integrity). Physical integrity is achieved when river processes and forms maintain active connections with each other in the present hydrologic regime. The term “physical integrity” was first used in an important piece of legislation in the United States of America, the Clean Water Act of 1977, in which it is stipulated that the nation must restore and maintain the chemical, physical, and biological integrity of the nation’s water. Within the Environmental Protection Agency, the governmental agency charged with carrying out and enforcing the Clean Water Act, and the scientific literature, much of the focus has been on the chemical and biological integrity, with less direct focus on how to restore physical integrity. However, in the late 20th and early 21st centuries, there has been a greater scientific focus on restoration of physical forms and processes in rivers. Restoration of physical integrity encompasses several aspects: reducing fragmentation, ensuring functional physical processes and equilibrium, allowing dynamic processes, and matching restoration to geographic large-scale controls. In practice, restoration of physical integrity can be divided into two main categories—those focused on restoring form by increasing physical heterogeneity or creating a specific planform (e.g., meandering) or bedform (e.g., pool-riffles), and those focused on restoring processes, including sediment transport, flow retention, and flooding in order to maintain forms. Form-based restoration is usually rooted in the assumption that a reference condition can elucidate the forms that best match the processes under similar hydrologic and sediment regimes. Reference conditions can either be historical (i.e., where there is sufficient data on previous channel conditions before the degradation occurred) or geographical—where there is an undisturbed stream reach within the same region with similar climatic, hydrological, geological, and land-use conditions and the reference and degraded reaches have similar drainage areas and valley characteristics (in terms of valley slope and with and hillslope conditions). In addition, process-based restoration goals based on ecosystem functioning or channel classification schemes can be used in designing channel restoration. In areas where the flow regime is heavily altered, by for example dams, flow diversions or land-use conditions, environmental or functional flows have been used to determine which flows (e.g., five-year flood) are necessary to maintain certain physical processes or forms.
Global University Rankings
Authors: Hazelkorn Ellen
Published: August 2016

Global university rankings have become a significant feature of international higher education and are commonly interpreted as an indicator of success in the global economy. They came to prominence in 2003 with the publication of the Shanghai Jiao Tong Academic Rankings of World Universities (ARWU). Today, there are ten global rankings of varying degrees of popularity, reliability, and trustworthiness. National rankings have existed since the early 19th century, primarily in the United States, but they now exist in many countries around the world. It is the ability of global rankings to provide a simple, easily understood method by which to compare higher education internationally that has made them a phenomenon. Thus, rankings are viewed as a measure of “world-class excellence.” The performance and quality of higher education is a vital sign of a country’s capacity to participate successfully in the global economy. This follows from studies that continue to highlight strong correlations between investment in education and research and economic growth. While this has highlighted the importance of higher education in creating competitive advantage, it has also brought increased public scrutiny to how higher education is governed and managed, and about value-for-money. This is now the subject of policy debate and public discourse at both the national and the supranational levels. Rankings are also a response to growing pressure from students and parents for more consumer information. As students look for the “best” universities and colleges, rankings appear to provide information about educational quality and, correspondingly, about career prospects. Because rankings are seen as independent of the higher education sector and individual institutions, they are perceived as a more reliable source of information for employers, policymakers, and the public. But rankings are also controversial. Studies raise many questions about their methodology and choice of indicators, which are widely seen as promoting a narrow definition of excellence, and thus as favoring a small subset of the world’s 18,000 higher education institutions. Nonetheless, international research shows that the influence of global rankings on the choices and decisions taken by governments, higher education institutions, students, employers, and others continues to grow. Today’s debates have moved beyond discussing the advantages and disadvantages of global rankings to examining their impact and influence, alternative accountability and transparency instruments, and what global rankings are telling us about the changing shape or the geopolitics of higher education internationally. For further information on a related topic, see the separate Oxford Bibliographies in Education article “Value of Higher Education for Students and Other Stakeholders.”
Linguistic Areas
Authors: van Gijn Rik , Muysken Pieter
Published: August 2016

“Linguistic areas” are defined as social spaces (regions, countries, (sub-)continents) in which languages from different families have influenced each other significantly, leading to striking or remarkable structural resemblances across genealogical boundaries. Since the early work of Trubetskoj and his contemporaries, work on other parts of the world, for example the Indian subcontinent, has unveiled a number of other regions where contact between languages has led to convergence, and thus the general field of areal linguistics has developed. This article surveys the different proposals for linguistic areas roughly continent by continent, and then lists a number of general overviews and contributions in textbooks and handbooks. As the notion of “linguistic area” was further developed, a number of definitional and theoretical issues came up. During most of the past century, linguistic areas were thought of as something special, out of the ordinary. In addition, the view arose that there were regions which qualified as linguistic areas and others which did not. At the beginning of the 1990s awareness grew that many linguistic patterns and features, both typological and historical, could and should be studied in an areal perspective. This areal turn led to a reconceptualization of many of the issues involved in areal linguistic studies, many of them involving problems of scale and operationalization. Even though the notion of “linguistic area” has been much criticized in the strict sense, the areal perspective keeps gaining ground in the study of the distribution of linguistic features. A final section of this survey will be devoted to psycholinguistic and sociolinguistic mechanisms and scenarios leading to linguistic areas. While earlier approaches had been mostly structural and historical, recent work in areal linguistics tries to bridge the gap with meso-level language contact studies: how do languages actually converge and what are the mechanisms promoting or blocking this type of convergence? Languages do not converge by themselves; rather, it is the agency or unconscious behavior of speakers that has this effect.
Unequal Treaties in International Law
Authors: Conde Pérez Elena , Yaneva Zhaklin Valerieva
Published: August 2016

The “unequal treaties” (known also by the terms “unjust,” “coercive,” “predatory,” “enslaving,” “leonine”) refers fundamentally, but not exclusively, to a historical category of bilateral treaties concluded in the late 19th and early 20th century between European states, the United States of America (USA) or Latin American countries (states that fulfilled the standards of “civilization”), and Asian or African states (perceived as “uncivilized”). Therefore, most of these treaties were signed after military defeat or as a consequence of such a threat and often provoked dissatisfaction, as they were establishing a system of benefits for the “civilized” powers, while restricting the sovereignty of the “uncivilized” and subordinate states. Hence, the “uncivilized” was being put in an unequal position while negotiating, as the “civilized” imposed—because of its economic and military superiority—harsh restrictions and inequitable terms and extorted for special privileges through concession of territorial and sovereign rights, division of spheres of influence, opening of ports, enforcement of extraterritorial jurisdiction, acquisition of railways, mining, etc. That said, the first unequal treaty is the peace treaty between the Qing Empire (China) and the United Kingdom signed in 1842, known as the Treaty of Nanking. It was followed by similar agreements between the United States and Japan (Convention of Kanagawa, 1854), or between Korea and Japan (Treaty of Kanghwa/Ganghwa, 1876). After World War II, all states suffering from unequal treaties tried to revoke the established system but met with varying success. Nevertheless and despite being seen as a historical category, the idea of unequal treaties is believed to have its prolongation to the present. Thus, the idea that lies behind the concept of “unequal treaties” is often related to imbalance between the parties, whether formal or substantive; nonreciprocal rights; and obligations and/or a coercive form of conclusion regardless of it being a military, political, or economic form of coercion. Accordingly, a question arises as to whether any of these forms of inequality affects a treaty qualified as unequal: whether it is valid or null, whether there are grounds for its revision or amendment or causes to declare its termination or suspension. However, applying the current international law—both its conventional (Vienna Convention on the Law of Treaties) and customary sources—there are not enough foundations to affirm the existence of an autonomous category of “unequal treaties” and, above all, that they could possibly have some legal consequences.
Habeas Corpus
Authors: Clark David
Published: August 2016

This article considers habeas corpus in common law jurisdictions (including mixed jurisdictions such as Cameroon and in international law. Habeas corpus also exists in Latin America, Spain, the Philippines, and east Asian states such as Japan, Taiwan, and Korea, as well as in Lusophone countries. The remedy is rooted in the municipal law of the states that may award it, and this article concentrates on that body of law. But domestic law does not operate in isolation, and there are instances where the remedy has been sought in and criticized by international tribunals. The subject has experienced a resurgence in the twenty-first century as the result of three stimuli: the detentions in aftermath of the attacks on the United States in 2001; the entry into force of the United Kingdom’s Human Rights Act of 1998 in 2000, which brought European law to bear on the subject; and the rise of refugee and immigration cases worldwide. The efficacy of the writ of habeas corpus presents a paradox. In those states with a developed legal order, where the executive generally adheres to the rule of law, there are likely to be fewer illegal detentions. These are also the legal systems in which the writ is most often obeyed. In contrast, legal systems that are poorly developed and riven by internal disorder, where the executive government acts with impunity, and where nonstate actors control parts of the state—think of the abduction and disappearance of 276 schoolgirls by Boko Haram in Nigeria in April 2014 or the takeover of Ukrainian territory in 2014 and 2022 by Russia—are less able to employ the remedy in an effective manner. The pen and the law book are not always mightier than the kalashnikov or the tank. Yet it is in such places that illegal detentions are more common and where the need for an effective remedy is greatest. These are not matters that would normally trouble a lawyer in Sydney, New York, Madrid, or London, but it means that effective protection of personal liberty is not merely dependent upon a procedure such as habeas corpus but on wider features of the legal and political order. Even where the remedy appears to be the same in comparable jurisdictions it should not be assumed that this is the case. Comparative studies have shown that the operation of the remedy is linked to features of the wider legal system, in particular in most states where the remedy enjoys constitutional status, the courts have widened the remedy far beyond its original or contemporary English characteristics.
Archaeology: The Rabbinic Period
Authors: Burns Joshua Ezra
Published: August 2016

This article comprises a bibliographical guide to the archaeology of Jewish life during the times of the rabbinic sages whose intellectual traditions fill the Mishnah, the Tosefta, the Palestinian and Babylonian Talmuds, and the classical Midrash. When considering the history of what is commonly known as Judaism’s rabbinic period, one must bear in mind several points about their relationship with the aforementioned texts. Firstly, the rabbinic sages did not dictate the prevailing modes of Jewish thought and practice of their days. Originating in Judea following the collapse of the second Jewish commonwealth in 70 ce, the rabbinic movement migrated north into the Galilee region of Palestine following the Bar Kokhba rebellion of 132–135 ce. There it gradually took root amid the local Jewish population, concurrently expanding east into Babylonia, or central Mesopotamia, over the centuries to follow. In the meantime, the rabbinic sages spoke not for all Jews, but for the relatively few who counted themselves as their disciples. As such, the target audiences of the rabbis were adult Jewish men (as opposed to women) who possessed the time, the financial freedom, and the ideological temperament to commit to the halakhah, the devout “way” of life embodied in their teachings. The sages therefore tended to speak solipsistically, as though to a reality governed by their own ritual and ethical concerns. Conversely, theirs was a reality not entirely representative of the experiences of all the Jews in whose midst they operated. They had even less to say about Jewish life outside of Palestine and Babylonia. The critical reader of the archaeological record of ancient Judaism record must therefore proceed with caution when relating it to a literary record not oblivious to the common Jewish experience but conditioned by the uncommon sensibilities, pedagogical priorities, and rhetorical biases of its authors. In view of these caveats, the entries in this article focus not only on the namesakes of the so-called rabbinic period, but also on topics in archaeological research pertaining to the lives of all Jews of their age. Consequently, this article does not attempt to describe specific sites of Jewish habitation except where said sites furnish evidence that exemplifies aspects of the common Jewish experience. Reference to excavation reports, regional surveys, and other such technical literature will be limited. Readers seeking scholarship of that variety are referred to the volumes cited under Reference Works.
The mindful nurse leader
Authors: Pipe Teri , FitzPatrick Kate , Doucette Jeffrey N. , Cotton Amy , Arnow Debra
Published: August 2016

In this first installment of a three-part series on mindfulness, we describe a dynamic project aimed at elevating the importance of mindfulness, compassion, and presence as key competencies for professional nurses across the career span in all healthcare settings.
A Transformative Approach to Academic Medicine: The Partnership Between the University of Arizona and Banner Health
Authors: Cairns Charles B. , Bollinger Kathy , Garcia Joe G.N.
Published: August 2016

The University of Arizona Health Network (UAHN) was a modestly successful health care delivery organization with a vibrant academic portfolio and stable finances. By 2013, however, market forces, health care financing changes, and the burden of technology and informatics upgrades led to a compromised financial position at UAHN, a situation experienced by many academic medical centers. Concurrently, Banner Health had been interested in forming an academic partnership to enhance innovation, including the incorporation of new approaches into health care delivery, and to recruit high-quality providers to the organization. In 2015, the University of Arizona (UA) and Banner Health entered into a unique partnership known as Banner – University Medicine. The objective was to create a statewide system that provides reliable, compassionate, high-quality health care across all of its providers and facilities and to make a 30-year commitment to UA’s College of Medicine in Tucson and the College of Medicine in Phoenix to support the State of Arizona’s position as a first-tier research and training destination with world-class physicians. The goal of the Banner – University Medicine partnership is to create a nationally leading organization that transforms health care by delivering better care, enhanced service, and lower costs through new approaches focused on wellness. Key elements of this partnership are highlighted in this Commentary, including the unique governance structure of the Academic Management Council, the creation of the Academic Enhancement Fund to support the UA Colleges of Medicine in Tucson and Phoenix, and novel approaches to medical education, research, innovation, and care.
Working Definitions of the Roles and an Organizational Structure in Health Professions Education Scholarship: Initiating an International Conversation
Authors: Varpio Lara , Gruppen Larry , Hu Wendy , O’Brien Bridget , ten Cate Olle , Humphrey-Murto Susan , Irby David M. , van der Vleuten Cees , Hamstra Stanley J. , Durning Steven J.
Published: August 2016

Problem

Health professions education scholarship (HPES) is an important and growing field of inquiry. Problematically, consistent use of terminology regarding the individual roles and organizational structures that are active in this field are lacking. This inconsistency impedes the transferability of current and future findings related to the roles and organizational structures of HPES.

Approach

Based on data collected during interviews with HPES leaders in Canada, Australia, New Zealand, the United States, and the Netherlands, the authors constructed working definitions for some of the professional roles and an organizational structure that support HPES. All authors reviewed the definitions to ensure relevance across multiple countries.

Outcomes

The authors define and offer illustrative examples of three professional roles in HPES (clinician educator, HPES research scientist, and HPES administrative leader) and an organizational structure that can support HPES participation (HPES unit). These working definitions are foundational and not all-encompassing and, thus, are offered as stimulus for international dialogue and understanding.

Next Steps

With these working definitions, scholars and administrative leaders can examine HPES roles and organizational structures across and between national contexts to decide how lessons learned in other contexts can be applied to their local contexts. Although rigorously constructed, these definitions need to be vetted by the international HPES community. The authors argue that these definitions are sufficiently transferable to support such scholarly investigation and debate.
Heme Oxygenase-1/Carbon Monoxide-regulated Mitochondrial Dynamic Equilibrium Contributes to the Attenuation of Endotoxin-induced Acute Lung Injury in Rats and in Lipopolysaccharide-activated Macrophages
Authors: Yu Jianbo , Shi Jia , Wang Dan , Dong Shuan , Zhang Yuan , Wang Man , Gong Lirong , Fu Qiang , Liu Daquan
Published: August 2016

Background

Sepsis-associated acute lung injury remains the major cause of mortality in critically ill patients and is characterized by marked oxidative stress and mitochondrial dysfunction. Mitochondrial dynamics are indispensable for functional integrity. Additionally, heme oxygenase (HO)-1/carbon monoxide conferred cytoprotection against end-organ damage during endotoxic shock. Herein, we tested the hypothesis that HO-1/carbon monoxide played a critical role in maintaining the dynamic process of mitochondrial fusion/fission to mitigate lung injury in Sprague-Dawley rats or RAW 264.7 macrophages exposed to endotoxin.

Methods

The production of reactive oxygen species, the respiratory control ratio (RCR), and the expressions of HO-1 and mitochondrial dynamic markers were determined in macrophages. Concurrently, alterations in the pathology of lung tissue, lipid peroxidation, and the expressions of the crucial dynamic proteins were detected in rats.

Results

Endotoxin caused a 31% increase in reactive oxygen species and a 41% decrease in RCR levels (n = 5 per group). In parallel, the increased expression of HO-1 was observed in lipopolysaccharide-stimulated macrophages, concomitantly with excessive mitochondrial fission. Furthermore, carbon monoxide-releasing molecule-2 or hemin normalized mitochondrial dynamics, which were abrogated by zinc protoporphyrin IX. Additionally, impaired mitochondrial dynamic balance was shown in Sprague-Dawley rats that received lipopolysaccharide, accompanied by pathologic injury, elevated malondialdehyde contents, decreased manganese superoxide dismutase activities, and lowered RCR levels in rat lung mitochondria. However, the above parameters were augmented by zinc protoporphyrin IX and were in turn reversed by hemin.

Conclusions

The HO-1/carbon monoxide system modulated the imbalance of the dynamic mitochondrial fusion/fission process evoked by lipopolysaccharide and efficiently ameliorated endotoxin-induced lung injury in vivo and in vitro.
Rotator Cuff-Sparing Approach for Antegrade Humeral Nailing With Biceps Tenodesis: A Technical Trick With Clinical Implications
Authors: Christ Alexander B. , Gausden Elizabeth B. , Warner Stephen J. , Nellestein Andrew M. , Thacher Ryan R. , Lorich Dean G.
Published: August 2016

Antegrade intramedullary nails are an established, effective method of fixation for humeral shaft fractures. One significant limitation of this technique is chronic postoperative shoulder pain, which is likely related to the standard approach that involves splitting the rotator cuff to gain access to the nail starting point. Furthermore, mounting evidence suggests that both the intra-articular portion of the biceps tendon and the extra-articular portion in the bicipital groove can scar down after trauma, causing pain and limiting shoulder range of motion. We describe an approach through the rotator interval with tenodesis of the biceps tendon and resection of the intra-articular portion. Using a rotator cuff interval instead of a rotator cuff insertion approach allows access to the optimal humeral nail starting point while avoiding damage to intra-articular structures of the shoulder, potentially decreasing sources of postoperative shoulder pain.
Nursing Student Experiences Regarding Safe Use of Electronic Health Records
Authors: Whitt Karen J. , Eden Lacey , Merrill Katreena Collette , Hughes Mckenna
Published: August 2016

Previous research has linked improper electronic health record configuration and use with adverse patient events. In response to this problem, the US Office of the National Coordinator for Health Information Technology developed the Safety and Assurance Factors for EHR Resilience guides to evaluate electronic health records for optimal use and safety features. During the course of their education, nursing students are exposed to a variety of clinical practice settings and electronic health records. This descriptive study evaluated 108 undergraduate and 51 graduate nursing students' ratings of electronic health record features and safe practices, as well as what they learned from utilizing the computerized provider order entry and clinician communication Safety and Assurance Factors for EHR Resilience guide checklists. More than 80% of the undergraduate and 70% of the graduate students reported that they experienced user problems with electronic health records in the past. More than 50% of the students felt that electronic health records contribute to adverse patient outcomes. Students reported that many of the features assessed were not fully implemented in their electronic health record. These findings highlight areas where electronic health records can be improved to optimize patient safety. The majority of students reported that utilizing the Safety and Assurance Factors for EHR Resilience guides increased their understanding of electronic health record features.
Physical and Visual Accessibilities in Intensive Care Units
Authors: Rashid Mahbub , Khan Nayma , Jones Belinda
Published: August 2016

This study compared physical and visual accessibilities and their associations with staff perception and interaction behaviors in 2 intensive care units (ICUs) with open-plan and racetrack layouts. For the study, physical and visual accessibilities were measured using the spatial analysis techniques of Space Syntax. Data on staff perception were collected from 81 clinicians using a questionnaire survey. The locations of 2233 interactions, and the location and length of another 339 interactions in these units were collected using systematic field observation techniques. According to the study, physical and visual accessibilities were different in the 2 ICUs, and clinicians' primary workspaces were physically and visually more accessible in the open-plan ICU. Physical and visual accessibilities affected how well clinicians' knew their peers and where their peers were located in these units. Physical and visual accessibilities also affected clinicians' perception of interaction and communication and of teamwork and collaboration in these units. Additionally, physical and visual accessibilities showed significant positive associations with interaction behaviors in these units, with the open-plan ICU showing stronger associations. However, physical accessibilities were less important than visual accessibilities in relation to interaction behaviors in these ICUs. The implications of these findings for ICU design are discussed.
Point-of-Care Testing of Troponin Levels Compared With Automated Laboratory Evaluation
Authors: Sardi Adacilis Ramirez , Lamoureux Julie A. , Cohn Tanya M. , Phillip-Samuel Shirley G.
Published: August 2016

Traditionally, troponin levels are measured in the blood using an automated laboratory protocol, but the use of a faster technology, the point-of-care (POC) testing of troponin levels, has shown promise in the effective differential diagnosis of cardiac injury. The purpose of this study was to compare the 2 methods. A total of 1567 patients were seen in the emergency department who were tested with both the POC iSTAT troponin and laboratory troponin from a secondary analysis of retrospective data collected between June 2012 and December 2012. The values for laboratory troponin varied between 0 and 30 with a mean and standard deviation of 0.060 ± 0.842 and the values for POC testing varied between 0 and 17.2 with a mean and standard deviation of 0.042 ± 0.492. The Bland-Altman analysis showed a systematic negative bias for the POC values compared with the laboratory troponin values. Lowering the POC cut-off value for troponin to 0.035 yielded 3 out of 4 better validity coefficients compared with those with the suggested manufacturer's cut-off value of 0.08 when predicting the gold standard. The POC troponin can be used to measure troponin level and similar diagnosis if the cut-off value for the POC troponin is lowered to 0.035 instead of the 0.08 suggested manufacturer's cut-off.
Implementation of a Pediatric Early Warning Scoring System at an Academic Medical Center
Authors: Douglas Kimberly , Collado Jerry Christopher , Keller Sheila
Published: August 2016

Despite the addition of family-activated rapid response to the rapid response team algorithm, a children's hospital did not see an increase in utilization of the pediatric rapid response team. A Pediatric Early Warning Score in non-ICU pediatric inpatient units was implemented to increase the number of rapid response team activations. A retrospective review of the 130-bed facility, over a 12-month period, revealed an increase in pediatric rapid response calls, with a subsequent decrease in code team activations. The authors outline implementation strategies and discuss barriers encountered throughout the process, along with implications for nurse leaders.
Gastric Residual Volume
Authors: Emami Zeydi Amir , Sharafkhani Mohammad , Armat Mohammad Reza
Published: August 2016

There are many challenges related to enteral feedings of the mechanically ventilated patient. Among the most often debated issues is the threshold for gastric residual volume before further feeding. This brief article considers the factors to be considered and reviews current thinking on the topic.
Predictors of Reoperations in Deep Inferior Epigastric Perforator Flap Breast Reconstruction
Authors: Unukovych Dmytro , Gallego Camilo Hernandez , Aineskog Helena , Rodriguez-Lorenzo Andres , Mani Maria
Published: August 2016

Background:

The deep inferior epigastric perforator (DIEP) procedure is regarded a safe option for autologous breast reconstruction. Reoperations, however, may occur, and there is no consensus in the literature regarding the risk factors. The aim of this study was to identify factors associated with reoperations in DIEP procedure.

Patients and Methods:

A retrospective study of consecutive patients undergoing DIEP breast reconstruction 2007 to 2014 was performed and included a review of 433 medical charts. Surgical outcome was defined as any unanticipated reoperation requiring return to the operating room. Multivariate regression analysis was utilized to identify predictors of reoperation. The following factors were considered: age, body mass index, comorbidity, childbearing history, previous abdominal surgery, adjuvant therapy, reconstruction laterality and timing, flap and perforator characteristics, and number and size of veins.

Results:

In total, 503 free flaps were performed in 433 patients, 363 (83.8%) unilateral and 70 (16.2%) bilateral procedures. Mean age was 51 years; 15.0% were obese; 13.4% had hypertension; 2.3% had diabetes; 42.6% received tamoxifen; 58.8% had preoperative radiotherapy; 45.6% had abdominal scars. Reoperation rate was 15.9% (80/503) and included flap failure, 2.0%; partial flap loss, 1.2%; arterial thrombosis, 2.0%; venous thrombosis, 0.8%; venous congestion, 1.2%; vein kinking, 0.6%. Other complications included bleeding, 2.2%; hematoma, 3.0%; fat necrosis, 2.8%, and infection, 0.2%. Factors negatively associated with reoperation were childbearing history (odds ratio [OR]: 3.18, P = 0.001) and dual venous drainage (OR: 1.91, P = 0.016); however, only childbearing remained significant in the multivariate analyses (OR: 4.56, P = 0.023).

Conclusions:

The history of childbearing was found to be protective against reoperation. Number of venous anastomoses may also affect reoperation incidence, and dual venous drainage could be beneficial in nulliparous patients.
OCCULT MACULAR DYSTROPHY WITH MUTATIONS IN THE RP1L1 AND KCNV2 GENES
Authors: Agange Negin , Sarraf David
Published: August 2016

Purpose:

To report a case of occult macular dystrophy associated with mutations in the RP1L1 and KCNV2 genes.

Methods:

Case report. Multimodal retinal imaging and the results of genetic testing are described.

Results:

A 27-year-old Chinese man presented with complaints of decreased central vision and normal retinal examination. Color fundus photography and fundus autofluorescence were unremarkable. Spectral-domain optical coherence tomography did reveal central ellipsoid loss in each eye. Genetic testing confirmed mutations in the RP1L1 and KCNV2 genes.

Conclusion:

The presence of central ellipsoid loss with spectral-domain optical coherence tomography should be evaluated for genetic disorders such as RP1L1 and KCNV2 mutations.