bluuebunny/crossref_metadata_2025 huggingface dataset:
Enhancing Sustainable Development from Oil, Gas, and Mining
Authors: McPhail Kathryn
Published: November 2018

This chapter outlines how sustainable development in resource-rich countries requires an ‘all of government’ approach as well as multi-stakeholder dialogue and partnerships between government, companies, and civil society organizations. Effective management and regulation requires different government agencies to work together and in partnership with stakeholders. The chapter focuses on the need for an agreed set of data and analysis showing the current and potential future contributions of the natural resources sector at the national and local levels. In some countries there is a lack of trust between different stakeholder interests. The chapter probes how collaboration between stakeholders can mitigate the negative impacts of resource development and enhance its potential positive contributions, particularly at the local level and where the governance context is weak. The chapter identifies three important steps toward sustainable development: creating an evidence base to facilitate cross-government coordination; building trust through multi-stakeholder dialogue; and building partnerships for development.
Improving Basic Education—The Governance Challenge
Authors: Levy Brian
Published: November 2018

Building on political settlements analysis, this chapter lays out the multi-level framework used throughout the book to explore how political and institutional context influence the governance of basic education in South Africa at national, provincial, and school levels. It reviews the literature on the influence of politics on bureaucratic performance, and on the potential and limits of school-level participatory, horizontal governance. It details why South Africa’s institutional arrangements for education provide an ideal natural experiment for exploring the influence of divergent contexts on the operation and performance of subnational bureaucracies—and also the potential of horizontal governance as an institutional complement in settings where bureaucracies work well, and as an institutional substitute in settings where educational bureaucracies are dysfunctional.
Explaining the Western Cape Performance Paradox
Authors: Wills Gabrielle , Shepherd Debra , Kotzé Janeli
Published: November 2018

In this chapter we consider how well primary school students perform in the Western Cape when compared with their peers in other provinces and countries across Southern and Eastern Africa. We find that while the Western Cape is a relatively efficient education system within South Africa, particularly in serving the poorest students, a less-resourced country such as Kenya produces higher Grade 6 learning outcomes at every level of student socio-economic status. The system performance differentials are not explained away by differences in resourcing, teacher, school inputs, or indicators of hierarchical governance. The results point to the limits of strong Weberian bureaucratic capabilities for raising learning outcomes.
Context and Capability
Authors: Levy Brian , Cameron Robert , Naidoo Vinothan
Published: November 2018

This chapter explores how context influences bureaucracy. Bureaucratic behaviour and performance are interpreted as endogenous, shaped by decisions of political elites as to whether to direct their efforts towards providing public services or towards more narrowly political or private purposes. The chapter distinguishes among three broad contextual differences between the Western Cape and Eastern Cape—socio-economic, political, and institutional. It identifies the causal mechanisms through which these variables exert their influence, distinguishing between demand-side and supply-side influences. In the Eastern Cape, the consequence of an initially weak context is a low-level equilibrium trap in which incentives transmitted from the political to the bureaucratic levels reinforce factionalized loyalty within multiple patronage networks. By contrast, in the Western Cape, both demand-side and supply-side contextual variables support public service provision; however, weaknesses in ‘soft governance’ limit the positive impact.
Case Studies of School-Level Governance Dynamics in the Western Cape
Authors: Hoadley Ursula , Levy Brian , Shumane Lawule , Wilburn Shelly
Published: November 2018

This chapter details four case studies of school-level management practices in the appointment process of school principals. The school-level processes are used as a lens through which to refract local governance dynamics, and thereby gain insight into the broader multi-stakeholder contexts within which the principal is embedded. The contrasts between the Western Cape and Eastern Cape provinces provide an ideal opportunity to explore a central theme of this book, namely how ‘good fit’ works—how preferred approaches to policy design and implementation might vary according to the contexts in which they are being undertaken. The chapter suggests that rather than viewing the interaction between hierarchical and horizontal governance as zero-sum, the task for practitioners is to find ways to make more effective the ‘both/and’ balance, with an emphasis on impersonal forms of decision-making.
Gregory of Nyssa on the Soul (and the Restoration)
Authors: Ramelli Ilaria L. E.
Published: November 2018

In this chapter, Gregory’s treatment of the soul is examined against the backdrop of philosophical treatises On the Soul and in conversation with Origen’s psychology and On the Resurrection (while Origen never wrote On the Soul, for reasons that are here clarified). Tertullian composed both On the Soul and On the Resurrection; Gregory combined the two discussions in a remake of Plato’s Phaedo on the immortality of the soul—here analysed in many of its philosophical components and their treatment until Plotinus and Proclus, and in light of Gregory’s definition of soul and relation between resurrection and restoration. The chapter examines the role of the soul in Gregory’s ‘theology of freedom’—rooted in Plato’s philosophy—and the influence Gregory exerted on Evagrius’ theories of the threefold resurrection and of the subsumption of body into soul and soul into ‘unified nous’: Eriugena was right to trace the latter theory back to Gregory.
Financial Regulation and Risk Management in Development Banks
Authors: de Castro Lavinia Barros
Published: November 2018

Should development banks (DBs) be regulated? Is Basel regulation a suitable framework for them? With regard to risk management, do DBs entail different characteristics from private banks? What are the main challenges posed by the new Basel regulations for DBs? This chapter explores these largely unexplored questions and the habitual responses to them. The answers are built upon a reconstruction of the theoretical arguments in favour of financial regulation; a historical description of the evolution of the Basel Agreements framework; a few analytical generalizations built upon an exploratory case study; and a review of the literature on risk management practices in DBs as well as interviews with risk management specialists and Brazilian regulatory agencies.
Why Desperate Times (But Only Desperate Times) Call for Consequentialism
Authors: Rosenthal Chelsea
Published: November 2018

People often think there are moral duties that hold irrespective of the consequences, until those consequences exceed some threshold level—that we shouldn’t kill innocent people in order to produce the best consequences, for example, except when those consequences involve saving millions of lives. This view is known as “threshold deontology.” While clearly controversial, threshold deontology has significant appeal. But it has proven quite difficult to provide justifications for it that aren’t ad hoc. This chapter develops a new, non-ad hoc justification, by showing that acting like a threshold deontologist is a good strategy for being moral, given our uncertainty and imperfect moral knowledge. And failing to use good strategies for being moral is, itself, morally bad. The argument of the chapter draws on a broader account of moral uncertainty under which we have a moral responsibility to use good procedures for being moral (“procedural oughts”), alongside ordinary, first-order moral responsibilities (“substantive oughts”).
Decentralization, Provincial Systems, and the Challenge of Equity: High Participation Higher Education in Canada
Authors: Jones Glen A.
Published: November 2018

This chapter provides a detailed and extensive assessment of the Canadian high participation system (HPS) of higher education. It considers the history of Canadian higher education, system development, and the present condition of higher education in the country. System de-centralization is especially remarkable when comparing Canadian higher education to other HPS. Each Canadian province has substantial authority over higher education within its borders, and while the federal-central government plays a role, it is less involved in provision than in most other HPS. The chapter examines Canadian higher education in light of the seventeen HPS propositions. The Canadian case supports most propositions. However, the system is less stratified and produces more equitable outcomes than are suggested by the propositions.
Making Marriages Last
Authors: Thornton Rebecca L. , Kohler Hans-Peter
Published: November 2018

Economists have examined investments under uncertainty in a variety of contexts. Becker et al. applied the idea to marriage and divorce, suggesting that an increased likelihood of separation or divorce reduces the incentive for spouses to invest in marriage-specific assets. This theory has since been tested empirically by measuring changes in investments in marriage-specific capital. In high HIV-prevalence contexts, marriage can lead to significant risks through spousal behaviours. Yet, individuals cannot rely on their spouse to reveal their HIV status. Couples’ HIV testing and counselling can provide spouses with credible information about each other’s HIV status. Using random variation in participation in couples’ testing, this chapter documents that uncertainty about spouses’ HIV status contributes to divorce. Innovations, such as HIV couples’ testing and counselling—and, in the future, possibly rapid self-testing—that reduce this uncertainty can thus have profound impacts on marital behaviours and stability.
Intra-Household Bargaining in Poor Countries
Authors: Baland Jean-Marie , Ziparo Roberta
Published: November 2018

This chapter assesses the relevance of the collective model for the analysis of households in poor countries. As an economic unit, a household creates the possibility of mutual gains for spouses thanks to the possibility of joint consumption of public goods, risk sharing, etc. The collective model assumes that households behave efficiently, in the sense that there is no misallocation or waste of household resources, given the outside options of each spouse. This chapter bridges the theoretical literature describing efficient intra-household behaviour and the development literature that collects empirical regularities pointing toward the existence of strategic decision making among spouses. It examines the key elements of the collective model and discusses its relevance to analysing intra-household behaviour in poor countries. It explores the role that risk and uncertainty, information asymmetries, power imbalances, arranged marriages, strategic investment, gender norms, and extended households play in the attainment of efficiency.
Velvet Revolutions and the Thorny Paths of Transition
Authors: Trencsényi Balázs , Kopeček Michal , Lisjak Gabrijelčič Luka , Falina Maria , Baár Mónika , Janowski Maciej
Published: November 2018

The “velvet” and not so “velvet” revolutions of 1989 triggered fervent discussions on the nature of the postcommunist political system. The paradigm of transitology provided the dominant framework for these debates, while civil society remained a key concept, even though it became increasingly contested by the neoliberals and neoconservatives, as well as by the “new left.” The seemingly dominant, although never uncontested, “liberal consensus” of the early 1990s became challenged by a new wave of conservativism which showed continuities with pre-1945 traditions. In this context, the heritage of communism and Nazism was addressed by different political actors and institutions focusing on memory politics, contributing to the polarization of the ideological field. The churches too gained political importance in the search for sources of authority, but they were also criticized because of their subservience to the state socialist regime before 1989 and for reverting to a conservative nationalist vision after the changes.
The Challenges of Parity: Increasing Women’s Participation in Informal Justice Systems within Sub-Saharan Africa
Authors: Bond Johanna
Published: November 2018

This chapter argues that gender parity should be a priority for both formal governance structures and traditional authorities in sub-Saharan African countries. The path to gender parity within traditional decision-making authorities in the region, however, may be a long one. Efforts to achieve gender parity within traditional institutions are more likely to succeed when they involve local initiatives to facilitate women’s participation in public life and community problem-solving rather than top-down legislative requirements. Efforts to more fully integrate women in positions of public authority and community problem-solving, such as efforts in Tanzania to provide widespread paralegal training for women, may offer more promise in breaking down the public/private divide that continues to characterize much of customary law within the region.
Reclaiming the System
Authors: Herzog Lisa
Published: November 2018

The world of wage labour seems to have become a soulless machine, an engine of social and environmental destruction. Employees seem to be nothing but ‘cogs’ in this system—but is this true? Located at the intersection of political theory, moral philosophy, and business ethics, this book questions the picture of the world of work as a ‘system’. Hierarchical organizations, both in the public and in the private sphere, have specific features of their own. This does not mean, however, that they cannot leave room for moral responsibility, and maybe even human flourishing. Drawing on detailed empirical case studies, Lisa Herzog analyses the nature of organizations from a normative perspective: their rule-bound character, the ways in which they deal with divided knowledge, and organizational cultures and their relation to morality. She asks how individual agency and organizational structures would have to mesh to avoid common moral pitfalls. She develops the notion of ‘transformational agency’, which refers to a critical, creative way of engaging with one’s organizational role while remaining committed to basic moral norms. The last part zooms out to the political and institutional changes that would be required to re-embed organizations into a just society. Whether we submit to ‘the system’ or try to reclaim it, Herzog argues, is a question of eminent political importance in our globalized world.
Priming the Analysis
Authors: Stark Alastair
Published: November 2018

This chapter provides a primer that introduces the reader to the key features of each of the book’s four case studies. Each case is outlined in terms of: the nature of the crisis that created a lesson-learning episode in the first instance; the format and focus of the public inquiry; the inquiry’s most important recommendations; and the nature of the reform agenda that followed. The chapter concludes with a brief reiteration of the book’s theoretical framework and how it will be applied in the analysis that follows in Chapters 5, 6, 7, and 8.
Crafting and Forgetting Policy Lessons
Authors: Stark Alastair
Published: November 2018

This chapter explores the data relating to lesson-learning process. It presents an expanded conceptualization of inquiry learning that covers how lessons are produced, how they are implemented, and their shelf-life once institutionalized. This reconceptualization reveals several new and complex aspects of learning that have not been considered before in public inquiry scholarship. It also draws attention to two specific aspects of lesson-learning process, largely neglected in relation to inquiries, that influence the effectiveness of learning attempts. The first is the issue of policy transfer, which shapes the way in which inquiry lessons are crafted and communicated. The second is the issue of institutional amnesia, which often undermines the lesson-learning gains that inquiries produce.
The Power of the Beaten Path
Authors: Schabas William A.
Published: November 2018

The introductory chapter explains contemporary interest in legal developments a century ago. Discussions and decisions at the Paris Peace Conference in 1919 were the beginning of debates that continue to this day. The chapter looks in some detail at the criminality of starting a war, today known as the crime of aggression, the immunity that can be invoked by a Head of State like the Kaiser, and problems of attributing criminal responsibility to those who are not physically involved in the crime. It also addresses the creation of international criminal tribunals, which began with the International Criminal Tribunal for the former Yugoslavia and the International Criminal Tribunal for Rwanda.
International Law and War Crimes
Authors: Schabas William A.
Published: November 2018

If the Kaiser were to be brought to justice, he had to be charged with war crimes in the strict sense. The Commission on Responsibilities is the first forum in which there is an attempt to define international war crimes. Building upon the Hague Conventions adopted before the outbreak of the war, a list of violations of the laws and customs of war is prepared. When the British and the French insist on adding the phrase ‘the laws of humanity’, the Americans object that this is a matter of morality and not law. The Commission also considers whether to establish an international criminal court where such international crimes might be charged.
Implementing Article 227
Authors: Schabas William A.
Published: November 2018

In late June 1919, as preparations were underway for the signing ceremony of the Treaty of Versailles, rumours reached Paris that the German Crown Prince, who had also found asylum in the Netherlands, was returning home, where he would lead a monarchist revival. The Council of Four sent a message to the Dutch warning them of their concerns and insisting that the Kaiser be safely interned. The Allies were embarrassed when the rumour proved to be false. At the same time, the Council of Four received a strange letter from the former German Chancellor, Theobald van Bethmann-Hollweg, offering to stand in for the Kaiser and take the blame for acts attributed to him. The Council of Four also drafted a letter addressed to the Dutch demanding the Kaiser’s surrender, but agreed to wait before sending it until the Treaty of Versailles entered into force.
Readying the Case for Trial
Authors: Schabas William A.
Published: November 2018

Lloyd George’s offer to host the trial in England was accepted by the Council of Four. But when the Prime Minister told Parliament that it would take place in London, King George V, who was the cousin of Kaiser Wilhelm II, objected strenuously. The Powers did not meet to plan the trial and organise the prosecution, although the British assigned a government lawyer to prepare a brief and to instruct two barristers. Completed in December 1919, the brief was amateurish and incomplete, reflecting either a lack of will to proceed with the trial or else a self-confidence that establishing guilt would be a simple matter. It was almost exclusively based upon published sources in the public domain.
Was He Guilty?
Authors: Schabas William A.
Published: November 2018

The trial might well have taken place were it not for a variety of unforeseen circumstances. For example, the Dutch might have agreed to the Kaiser’s surrender and the Kaiser might even have agreed to the trial. Other options would have been a trial in absentia or a trial in the Netherlands itself. Had a trial been held, the enigmatic charge of an ‘offence against international morality and the sanctity of treaties’ would have required interpretation. Many considered that it would have covered not only violations of the laws of war within the conflict, but also the launching of the aggressive war. This would have necessitated proof that Germany was actually responsible for starting the war, and a possible inquiry into the conduct of the European Powers over several years prior to 1914, something for which the British and the French had little enthusiasm.
Why Culture Matters Most
Authors: Rose David C.
Published: November 2018

A society’s culture can lock in beliefs and practices that inevitably produce persistent poverty and tyranny. But a society’s culture can also provide a foundation for maximizing general prosperity and freedom to produce mass flourishing. This book explains why culture—not genes, geography, institutions, or policies—is therefore what ultimately explains the differential success of societies. In short, when certain kinds of moral beliefs are culturally transmitted, a society can overcome the most fundamental obstacle to societal success: rational self-interest undermining the common good. General prosperity requires large-group cooperation, and the most effective large-group cooperation requires having a high-trust society. This book explains why the larger a society is, the more difficult it is to sustain a high-trust society. At the same time, the larger societies become, the more likely rational self-interest and tribalism will undermine crucial but highly trust-dependent institutions like democratic voting and a free press. This book shows how culture uniquely addresses this problem by aligning individual interests with the common good when specific kinds of moral beliefs are strongly held by most people. Culture also matters instrumentally because childhood instruction, a hallmark of culture, helps overcome the irrationality of adult individuals choosing to have moral beliefs that they know will limit their ability to promote their own welfare at the expense of the common good in the future. The analysis has surprising implications for the family, religion, government, and the stability of Western free market democracies.
Theories of the Soundtrack
Authors: Buhler James
Published: November 2018

This book is concerned with summarizing and critiquing theories of the soundtrack from roughly 1929 until today. A theory of the soundtrack is concerned with what belongs to it, how it is effectively organized, how its status in a multimedia object affects the nature of the object, the tools available for its analysis, and the interpretive regime that the theory mandates for determining the meaning, sense, and structure that sound and music bring to film and other audiovisual media. Beyond that, a theory may also delineate the range of possible uses of sound (and music), classify the types of relations that films have used for image and sound, identify the central problems, and reflect on and describe effective uses of sound in film. This book does not provide an exhaustive historical survey but rather sketches out the range of theoretical approaches that have been applied to the soundtrack over time. For each approach, it presents the basic theoretical framework, considers explicit and implicit claims about the soundtrack, and then works to open the theories to new questions about film sound, often by putting the theories into dialogue with one another. The organization is both chronological and topical: the former in that the chapters move steadily from early film theory through models of the classical system to more recent critical theories; the latter in that the chapters highlight central issues for each generation: the problem of film itself, then of image and sound, then of adequate analytical-descriptive models, and finally of critical-interpretative models.
Strategic Justice
Authors: Vanderschraaf Peter
Published: November 2018

This work presents a new analysis and evaluation, based upon an original game-theoretic analysis of convention, of the thesis that justice consists of systems of distinguished conventions. This thesis has ancient roots but has never been central in philosophy because convention itself has historically been so poorly understood. Given a sufficiently precise and general analysis of convention, the view that justice at bottom consists of conventions provides cogent answers to two perennial questions: (1) What is justice? (2) Why be just? Conventions are analyzed as correlated equilibria of games where the agents involved have available alternative equilibria. This analysis is sufficiently general to summarize social interactions where the interests of the agents diverge, so that a satisfactory resolution incorporates principles of justice. Agents are in circumstances of justice when (i) their underlying game has multiple optimal conventions they can achieve when all contribute to a cooperative surplus and (ii) each contributor risks being let down if this agent contributes and the others fail to contribute. Necessary and sufficient conditions are proposed for a satisfactory analysis of justice as mutual advantage that characterize justice as a special set of Baseline-Consistent conventions of agents in circumstances of justice. The origins of norms of fairness as the product of salience and inductive learning are explored. The state social contract is analyzed as a self-enforcing governing convention. The Reconciliation Project of demonstrating the compatibility of justice and rational prudence is reevaluated in light of the analysis of convention developed here.
Implementation of Ask-Advise-Connect in a safety net healthcare system: quitline treatment engagement and smoking cessation outcomes
Authors: Piñeiro Bárbara , Vidrine Damon J , Wetter David W , Hoover Diana S , Frank-Pearce Summer G , Nguyen Nga , Zbikowski Susan M , Vidrine Jennifer I
Published: November 2018

Ask-Advise-Connect (AAC) was designed to link smokers in primary care settings with evidence-based tobacco treatment delivered via state quitlines. AAC involves training medical staff to Ask about smoking status, Advise smokers to quit, and offer to immediately Connect smokers with quitlines through an automated link within the electronic health record. We evaluated the efficacy of AAC in facilitating treatment engagement and smoking abstinence in a 34 month implementation trial conducted in a large, safety-net health care system. AAC was implemented from April 2013 through February 2016 in 13 community clinics that provided care to low-income, predominantly racial/ethnic minority smokers. Licensed vocational nurses were trained to implement AAC as part of standard care. Outcomes included (a) treatment engagement (i.e., proportion of identified smokers that enrolled in treatment) and (b) self-reported and biochemically confirmed abstinence at 6 months. Smoking status was recorded for 218,915 unique patients, and 40,888 reported current smoking. The proportion of all identified smokers who enrolled in treatment was 11.8%. Self-reported abstinence at 6 months was 16.6%, and biochemically confirmed abstinence was 4.5%. AAC was successfully implemented as part of standard care. Treatment engagement was high compared with rates of engagement for more traditional referral-based approaches reported in the literature. Although self-reported abstinence was in line with other quitline-delivered treatment studies, biochemically confirmed abstinence, which is not routinely captured in quitline studies, was dramatically lower. This discrepancy challenges the adequacy of self-report for large, population-based studies. A more detailed and comprehensive investigation is warranted.
No Illusion of Forever
Authors: Bruno Elizabeth Anne
Published: November 2018

A mother and nurse expertly cares for her dangerously immunocompromised sons while making every day count.
Molecular and immunohistochemical analyses of uveal melanoma patient cohort
Authors: Sarubi Helena C. , Pereira Núbia B. , Gomes Carolina C. , Gomez Ricardo S. , Carmo Ana C.M. , Melo Flavia M. , Bastos-Rodrigues Luciana , Pedrosa Moisés S. , Friedman Eitan , De Marco Luiz
Published: November 2018

Uveal melanoma is a rare form of melanoma and the most frequent primary eye malignancy in adults. The major molecular alterations underlying uveal melanoma pathogenesis affect mainly the GNAQ, GNA11, SF3B1, and BAP1 genes. In this study, we somatically genotyped 31 Brazilian uveal melanomas for BRAF, GNA11, GNAQ, SF3B1, and BAP1 gene mutations and assessed BRCA2 and p53 protein expression. GNAQ and GNA11 mutations were detected in 60%, and SF3B1 mutation rate was 30%. p53 Immunostaining was markedly positive in 5/31, and 3/31 samples showed negative BRCA2 expression. This study supports the importance of these key genes in uveal melanoma tumorigenesis; p53 and BRCA pathways seem to play a role in a subset of patients, possibly heralding unfavorable prognosis.
MiR-135b is a novel oncogenic factor in cutaneous melanoma by targeting LATS2
Authors: Hu Yan , Wang Qi , Zhu Xiao-hong
Published: November 2018

Melanoma develops from pigment-producing melanocytes in the epidermis, and is the most common type of skin cancer. Because of the lack of effective therapies, the median survival of patients developing metastatic melanoma is less the 1 year. In this paper, we studied the oncogenic role of miR-135b in melanoma cells. We compared the miR-135b levels in 20 melanoma tissues in reference to their corresponding nontumor regions. Next, we studied the impact of miR-135b or its inhibitor on cell proliferation, migration, or apoptosis in either primary melanocytes or the melanoma cell line, respectively. Finally, we validated large tumor suppressor kinase 2 (LATS2) as the downstream target of miR-135b in a luciferase reporter assay, western blotting analysis, and knockdown study in primary melanocytes. MiR-135b expression was significantly upregulated in melanoma tissue. Overexpressing miR-135b in primary melanocytes promoted cell proliferation and migration. In contrast, inhibition of miR-135b expression suppressed the growth and metastasis of A-375 cells and enhanced cell apoptosis. LATS2 was confirmed as the target of miR-135b. Knockdown of LATS2 in melanocytes also promoted cell growth, but not cell invasion potential. Our findings showed miR-135b as a novel oncogene in melanoma tumorigenesis. The oncogenic mechanism may involve the downregulation of LATS2.
Giant Nevus Lipomatosus Cutaneous Superficialis on the Buttock
Authors: Takegawa Masayasu , Kakudo Natsuko , Morimoto Naoki , Hihara Masakatsu , Masuoka Hiromu , Kusumoto Kenji
Published: November 2018

Nevus lipomatosus cutaneous superficialis is a benign hamartoma characterized by the presence of mature ectopic adipocytes in the dermis. Here, we report a case of giant nevus lipomatosus cutaneous superficialis, measuring 24 × 14 cm in diameter, on the buttock. The tumor was resected, and the cutaneous defect was closed with a rotation flap under general anesthesia. No complication or recurrence occurred after surgery. Giant nevus lipomatosus cutaneous superficialis is very rare, and repair of the skin defect required plastic and reconstructive surgery.
Pedicled Peroneal Artery Perforator Flap for Knee Defect Reconstruction: Case Presentation and Literature Discussion
Authors: Alshomer Feras , Alhujayri Abdulaziz , Althubaiti Ghazi
Published: November 2018

There have been very limited data on the use of pedicled peroneal artery perforator flaps in knee soft-tissue reconstruction, especially for anterior and medial defects. Here, we present a case of proximally based peroneal artery perforator flap for knee soft-tissue reconstruction in a defect that included lateral, anterior, and medial surfaces of the knee presenting the technical challenges associated with this flap. A 15-year-old girl presented with extruded knee implant after osteosarcoma resection of femur. The defect involved the whole knee with the anterior and mostly the lateral knee surfaces. Her medical condition precluded the use of free tissue transfer. During her previous surgery, gastrocnemius muscles were detached with injured vascular pedicled and posterior tibial artery. Successful single-stage coverage was achieved using a large proximally based pedicled peroneal artery perforator flap. There are only few reports that described the use of peroneal artery flaps for knee soft-tissue coverage. The reach of a proximally based flap can be increased when it is raised on a distal perforator or when peroneal artery has a proximal takeoff. Furthermore, removing the fibula can facilitate the dissection and the reach of the flap till the most medial aspect of the knee. Pedicled peroneal artery perforator flap provides superior soft-tissue coverage with limited morbidity for knee soft-tissue reconstruction; however, flap reach is usually affected by anatomic variation. Preoperative planning can help to determine the reach of the flap and ease the dissection.
Exercise in Persons with Unilateral Lower-Limb Amputation and Contralateral Limb Knee Injury: A Pilot Study
Authors: Caldwell Mary E. , Marshall Benjamin , Semik Patrick , Huang Mark E.
Published: November 2018

Introduction

Exercise habits and return to exercise in individuals with lower-limb amputation (LLA) have been reported in up to 11% to 61% of individuals with amputation, but it is unclear if these individuals meet American College of Sports Medicine (ACSM) exercise guidelines and if there are any negative consequences associated with exercise. This pilot study investigated the exercise habits of individuals with unilateral nonvascular LLA to ascertain adherence to ACSM exercise guidelines and any relationships to contralateral (intact)-limb limb knee injuries.

Methods

A telephone survey was conducted with 25 individuals (n = 7, female) 22 to 90 years of age (M = 47) with nonvascular unilateral LLAs (2 transmetatarsal/Syme [TM], 13 transtibial [TT], 7 transfemoral [TF], 3 hip disarticulation [HD]) from a university hospital population. Weekly reported exercise before and after amputation (including type, frequency, duration and intensity, based on talk test correlating to intensity) as well as any history of intact-limb knee injuries was obtained. Data were analyzed using χ2 and one-way analysis of variance tests.

Results

Sixty-eight percent met the recommended ACSM guidelines for cardiorespiratory (CR) exercise before amputation and 48% of individuals met CR guidelines after amputation, and, of those, 41.7% reported sustaining intact-limb knee injuries (there were no injuries in those not meeting CR guidelines; P = 0.009). Respondents who met CR guidelines were at significantly higher risk of knee injury (P = 0.05). Also, those engaged in greater than moderate intensity CR exercise had significantly higher rates of intact knee injury compared with those exercising at low or moderate intensities (P = 0.01).

Conclusions

This pilot study suggests that engaging in an exercise routine at greater than moderate intensity may significantly increase the risk of intact-limb knee injury in individuals with unilateral LLAs. A larger study involving more subjects would be beneficial in clarifying the risk of knee injury from exercise in patients with amputation.
Dietary fat and risk of type 2 diabetes
Authors: Schlesinger Sabrina , Schwingshackl Lukas , Neuenschwander Manuela
Published: November 2018

Purpose of review

Nutrition recommendations emphasize that not only dietary fat quantity but also fat quality plays a role in the prevention of type 2 diabetes (T2D). The aim of this review is to summarize the evidence for dietary fat and risk of T2D, to highlight recent findings and point out future research directions.

Recent findings

Total fat intake was not associated with risk of T2D, whereas the findings on fatty acids (FAs) and risk of T2D were controversial. Recent findings suggested that FAs from the same classes (e.g. omega-6 FAs) but different sources might be differently associated with the risk of T2D, with indication for an association with lower risk of T2D for plant-based and higher risk/no association for animal-based FAs. In addition, differences between populations from different geographic areas might exist, but no interaction effects for fat intake and genetic predisposition were observed regarding T2D risk. The simultaneous investigation of different fats and dietary patterns can provide important and meaningful insights into these associations.

The evidence for the association between dietary fat intake and risk of T2D is not conclusive yet. To strengthen the evidence, the complexity of the different associations of dietary fats should be considered in well conducted future studies.
Influenza: annual seasonal severity
Authors: Gavigan Patrick , McCullers Jonathan A.
Published: November 2018

Purpose of review

Influenza remains a major cause of morbidity and mortality. The 2017–2018 season was one of the most severe in the past decade. The exact factors determining the severity of a particular influenza season are complex and often poorly understood.

Recent findings

Factors impacting annual influenza severity include characteristics of the specific virus, influenza vaccination, and antiviral use. Although viral virulence factors are important in this context and our knowledge of these is growing, there is a complex interplay between expression of these factors and their impact on a particular patient population. Vaccination has demonstrated efficacy in preventing disease, but vaccination rates remain sub-optimal and vaccine effectiveness can vary significantly between influenza strains and patient populations. Finally, while antiviral treatment is available and has shown benefits, many patients with influenza do not receive treatment.

Strides have been made in recent years towards understanding the many factors that contribute to the severity of any particular influenza season. Obvious areas for improvement include improved vaccination rates and antiviral use. Additionally, a more complete understanding of reasons for poor strain and population-specific vaccine effectiveness may help reduce the severity of future influenza seasons.
Nursing Documentation of Postoperative Pain Management
Authors: Shoqirat Noordeen , Mahasneh Deema , Dardas Latefa , Singh Charleen , Khresheh Reham
Published: November 2018

Background:

Although proper documentation of pain for postoperative patients is essential to promote patient health outcomes, there is limited examination of nurses' documentation of pain management.

Purpose:

The purpose of this study was to qualitatively analyze nursing documentation of pain management among postoperative patients in Jordan.

Method:

A documentary analysis method was used. A purposive sample of 80 medical records were reviewed, and a total of 720 nursing records were analyzed.

Results:

The analysis revealed that nurses' documentation of pain management was limited, vague, incomplete, and largely dependent on their subjective evaluation. Many of the documented goals were broad, not specific, not measurable, and with no time frame.

Conclusions:

Documentation patterns revealed a lack of proactive and systematic approach to pain assessment and management. Furthermore, there was little documented evidence of efforts to evaluate the effectiveness of pain management interventions. Findings have important implications for standardizing documentation of pain assessment, intervention, and evaluation.
Aging: Vitamin K Adequacy
Authors: Berdanier Carolyn D.
Published: November 2018

Aging is often associated with loss in function in a variety of systems. Many of these losses can be managed with the use of a variety of drugs that can affect the need for certain nutrients. Of interest is the possible drug- and age-related change in vitamin K need. This vitamin plays an important role in the postcarboxylation of glutamic acid residues in a small number of proteins that are important to blood coagulation, bone formation, and maintenance and seems to play a role as an anti-inflammatory agent. When an anti–vitamin K drug is used to control clotting, there may be effects on the actions of these other vitamin K–dependent proteins. This then raises the question of whether aging carries with it an increased need for this vitamin.
Eyes and Ears on Patient Safety: Sources of Notifications About the Health, Performance, and Conduct of Health Practitioners
Authors: Bismark Marie , Tibble Holly , Moore Jennifer Schulz , Morris Jennifer Michelle , Paterson Ron , Fletcher Martin , Studdert David
Published: November 2018

Objective

The aim of the study was to describe the sources of notifications of concern (“notifications”) regarding the health, performance, and conduct of health practitioners from 14 registered professions in Australia.

Methods

This retrospective cohort study analyzed 43,256 notifications lodged with the Australian Health Practitioner Regulation Agency and the Health Professional Councils Authority between 2011 and 2016. We used descriptive statistical analysis to describe the characteristics of these notifications, including their source, issue and domain, and subject.

Results

Patients and their relatives lodged more than three-quarters (78%) of notifications regarding clinical performance, including diagnosis, treatment, and communication. Fellow practitioners were a common source of notifications about advertising and titles. Self-reports commonly related to health impairments, such as mental illness or substance use. Other agencies played a role in reporting concerns about prescribing or supply of medicines.

Conclusions

Various actors in the healthcare system play different roles in sketching the picture of healthcare quality and safety that notifications present to regulators. Improved understanding of which sources are most likely to raise which concerns may enhance regulators’ ability to identify and respond to patient safety risks.
Negligible Risk of Acute Renal Failure Among Hospitalized Patients After Contrast-Enhanced Imaging With Iodinated Versus Gadolinium-Based Agents
Authors: Gorelik Yuri , Yaseen Hiba , Heyman Samuel N. , Khamaisi Mogher
Published: November 2018

Introduction

The potential adverse renal outcome among patients undergoing iodine-based contrast-enhanced computerized tomography (CT) has been questioned recently, given the caution undertaken in patients' selection, hydration protocols, and the low radiocontrast volume, used with advanced imaging equipment.

Materials and Methods

This study is a retrospective assessment of renal outcome in 12,580 hospitalized patients undergoing contrast-enhanced CT, compared with 754 patients subjected to gadolinium-based magnetic resonance imaging, with subsequent propensity matching for clinical characteristics and potential risk factors.

Results

The risk of postcontrast acute kidney injury (PC-AKI) was found to be negligible as compared with patients undergoing enhanced magnetic resonance imaging studies, before and after propensity matching (8% vs 7.3% rate of AKI in the nonmatched iodine-based contrast agents [IBCAs] and gadolinium-based contrast agents [GBCAs], respectively, P = 0.3, and 7% in the matched IBCA group, P = 0.9), including comparisons among subgroups with well-defined risk factors such as chronic renal failure, diabetes, older age, and hypertension. However, lower systolic blood pressure before imaging was associated with higher risk to develop PC-AKI after IBCA administration but not with GBCA (for systolic blood pressure lower than 110 mm Hg, odds ratio for AKI after IBCA was 1.49; 95% confidence interval, 1.16–1.88, and after GBCA; odds ratio, 0.12; 95% confidence interval, 0.003–0.73).

Conclusions

With the current precautions undertaken, the real-life risk of PC-AKI among inpatients undergoing CT is insignificant. Possible reasons for the diverse impact of blood pressure on the propensity to develop acute kidney failure after iodine-based but not gadolinium-based enhancement imaging are discussed.
Catecholamine modulation of evidence accumulation during perceptual decision formation; a randomised trial
Authors: Loughnane Gerard M. , Brosnan Méadhbh B. , Barnes Jessica J.M. , Dean Angela , Nandam L. Sanjay , O’Connell Redmond G. , Bellgrove Mark A.
Published: November 2018

Recent behavioural modelling and pupillometry studies suggest that neuromodulatory arousal systems play a role in regulating decision formation but neurophysiological support for these observations is lacking. We employed a randomised, double-blinded, placebo-controlled, crossover design to probe the impact of pharmacological enhancement of catecholamine levels on perceptual decision making. Catecholamine levels were manipulated using the clinically relevant drugs methylphenidate (MPH) and atomoxetine (ATM) and their effects were compared to those of citalopram (CIT), and placebo (PLA). Participants performed a classic EEG oddball paradigm which elicits the P3b, a centro-parietal potential that has been shown to trace evidence accumulation, under each of the four drug conditions. We found that MPH and ATM administration shortened RTs to the oddball targets. The neural basis of this behavioural effect was an earlier P3b peak latency, driven specifically by an increase in its build-up rate without any change in its time of onset or peak amplitude. This study provides neurophysiological evidence for the catecholaminergic enhancement of a discrete aspect of human decision making, i.e. evidence accumulation. Our results also support theoretical accounts suggesting that catecholamines may enhance cognition via increases in neural gain.
Single-cell whole-brain imaging and network analysis provide evidence of the three-stage hypothesis of addiction
Authors: Kimbrough Adam , Lurie Daniel J. , Collazo Andres , Kreifeldt Max , Sidhu Harpreet , D’Esposito Mark , Contet Candice , George Olivier
Published: November 2018

Three main theories of the neurobiology of addiction have been proposed: (1) incentive salience mediated by a brainstem-striatal network, (2) habit mediated by a cortico-striato-thalamic network, and (3) hedonic allostasis mediated by an extended amygdala network. Efforts have been made to reconcile these theories within a three-stage model, but the relevance of each theory remains controversial. We tested the validity of each theory with a single dataset using unbiased single-cell whole-brain imaging and data-driven analyses of neuronal activity in a mouse model of alcohol use disorder. Abstinence in alcohol dependent mice decreased brain modularity and resulted in clustering of brain regions that correspond to each stage of the three-stage theory of addiction. Furthermore, we identified several brain regions whose activity highly predicted addiction-like behaviors and “hub” regions that may drive neural activation during abstinence. These results validate the three-stage theory of addiction and identify potential target regions for future study.