bluuebunny/crossref_metadata_2025 huggingface dataset:
Political Parties and Political Representation
Authors: Esaiasson Peter , Wängnerud Lena
Published: July 2016

Although Sweden is characterized by a stable formal framework for political representation, major changes during recent decades have affected the conditions in which political representation is exercised. A once orderly five-party system has evolved into an unwieldy eight-party system, and turnover in the Riksdag has increased. Parties are challenged from the inside by an increased presence of previously excluded groups, such as women and foreign-born representatives. Analyzing a unique series of mail surveys to Swedish MPs from 1985–2010, the chapter reports congruence on left–right issues versus profile issues for newcomer parties, gender gaps in policy priorities and policy standpoints, and trends in citizens’ trust in representative institutions. The long-term perspective demonstrates that Swedish political parties are successful survivors. There is stability in policy agreement on left–right issues, and the increased number of parties and women MPs has meant stronger agreement between certain segments of MPs and voters.
Swedish Foreign Policy
Authors: Bjereld Ulf , Möller Ulrika
Published: July 2016

This chapter examines the modern history of Sweden’s foreign policy and external relations through the lens of neutrality. Sweden’s commitment to neutrality has not meant that the country is passive in international arenas. To the contrary, neutrality has for decades dovetailed with “international activism” and the articulation of international law and collective action. The chapter describes the emergence of the Swedish policy of neutrality during the Cold War and the post-neutrality policy that has evolved since the collapse of the bipolar world order. It details the primary components of and main reasons for the somewhat overlapping yet otherwise different versions of Swedish foreign policy between the two periods.
Pre-Romantic French Thought
Authors: Warman Caroline
Published: July 2016

This chapter explores what is at stake for supposedly ‘pre-romantic’ thinkers in France, and try to understand what ‘pre-romanticism’ is. It argues that many of the most resonant themes associated with Romanticism, already compellingly and unflinchingly explored by Diderot, It requires us to abandon the familiar models of straightforward transmission and influence which we can fruitfully use in the case of Rousseau, because with Diderot we simply don’t have all the evidence about who said what to whom, or who read what when. Instead, we have sudden manifestations of interest, such as Goethe’s 1805 translation of theNeveu de Rameau, its first publication in any language. We also have to abandon the idea of a literary history in which Classicism dominated then faded to make way for the Enlightenment, which dominated and then faded to make way for Romanticism. This model is too simplistic, although its very convenience explains its existence.
Freedom, Reason, and Art in Idealist and Romantic Philosophy
Authors: Bowie Andrew
Published: July 2016

Concentrating on ‘The Oldest System-Programme of German Idealism’, this chapter argues that the significance of aesthetics for modern philosophy is adumbrated in Idealist and Romantic philosophical texts in ways which have often not been adequately appreciated. It is notoriously difficult to characterize Romanticism conclusively, but it undoubtedly has to do with tensions in the way the modern world is understood in the differing spheres of modern science, modern law and the state, and modern art. The difference between broadly construed German Idealist and early German Romantic philosophy is that the former seeks a philosophical account of how unity can be articulated through division, whereas the latter (exemplified by Novalis and Friedrich Schlegel) sees such unity as only accessible at all in our sense of failure when we strive to achieve definitive unity.
Heidelberg, Dresden, Berlin, Vienna
Authors: Mahoney Dennis F.
Published: July 2016

In the various permutations of German Romanticism from its beginnings in the 1790s, two factors remain constant: a penchant for collaborative, transdisciplinary work, and the formation of small circles—often in university towns—whose particular character often depended upon and contributed to the prevailing intellectual discourse of that locale. For the four cities highlighted in the chapter heading, one further factor needs to be considered: the impact of the Napoleonic reorganization of central Europe. The breakup and dispersal of the Jena Romantics coincided with the collapse of the moribund Holy Roman Empire, which officially ended in 1806 but whose final dissolution began with the Treaty of Lunéville in 1801. This chapter looks at the interplay between history and creative collaboration, literary innovation and political aspiration or restraint, as the main energies of German Romanticism relocate themselves in these different cities at different times.
Leopardi as a Writer of Prose
Authors: D’Intino Franco
Published: July 2016

Nietzsche claimed that Leopardi was the greatest prose writer of his century. It is to Leopardi that we owe the creation of modern Italian prose outside the world of novel writing. This important distinction presents us with a problem. Among the different genres of prose writing practised by Leopardi, novel writing is absent, nor is it an absence which can be easily passed over. Let us not forget that Leopardi, almost exactly contemporary with Balzac and only slightly younger than Stendhal, is as capable of observing and describing social phenomena and individual psychology. This chapter evaluates Leopardi’s prose by answering the crucial question: what are the implications of the fact that, in contrast to what happens in every other European country, the greatest prose writer of the century in Italy does not write novels?
Scandinavian Romanticism
Authors: Müller-Wille Klaus
Published: July 2016

According to more traditional accounts in literary history, the exact date when Romanticism first reaches Scandinavia can be identified. In 1802, the geologist and philosopher of nature, Henrik Steffens, returns to Copenhagen after spending seven years studying and researching in Jena. Back in Denmark, he holds a controversial and widely noted series of lectures that familiarize the Danish audience with the ideas of German Romanticism. The literary impact ascribed to Steffens’s lectures is at least equally as relevant as its philosophical content, as the young poet Adam Oehlenschläger was a member of the audience. According to an anecdote in his autobiography, the creation of the first programmatic poem of Scandinavian Romanticism was inspired by a sixteen-hour-long discussion with Steffens. The anecdote of the poem’s origin alone shows how Oehlenschläger contributes to the self-referential staging and mythical aggrandisement of the epochal break into Romanticism which this chapter examines.
The Romantic Construction of Greece
Authors: Beaton Roderick
Published: July 2016

Greece as a modern nation-state is itself a product of European Romanticism. Once revolution broke out in 1821, the conflict was successfully internationalized by mobilizing European ‘romantic’ ideas about ancient Greece, in the service of ‘reviving’ a long-suppressed but latent nation—ideas espoused in different ways by the leading English Romantic poets of the time, P. B. Shelley and Lord Byron. Romanticism as a literary and aesthetic movement first makes its appearance in Greek in the 1820s. Its impact is observed in poetry, fiction, public architecture, and language reform. In the mid-nineteenth century historicism arrives in Greece. The projection of thecontemporaryGreek nation back through three thousand years of history is an essentially Romantic endeavour. In literature, the effects of Romanticism are slow to fade. In the poetry of Kostis Palamas (1859–1943) the uneasy synthesis of the different phases of the Greek past with the present reaches its fullest exploration.
Pragmatics and Grammar
Authors: Ariel Mira
Published: July 2016

This paper argues that the grammar/pragmatics division of labour should be drawn along a code versus inference distinction. On this view, grammar specifies a set of codes, while pragmatics provides a set of context-dependent inferences. However, despite this very clear grammar/pragmatics distinction, it is not necessarily trivial to determine which aspects of the interpretation are encoded and which are inferred. Such decisions must be based on empirical examinations of each case. Thus, interpretations commonly analysed as part of grammar may be reanalysed as pragmatics, and vice versa, aspects of use and interpretation previously analysed as pragmatic may turn out to be grammatical after all.
Social Inhibition
Authors: McCarty Megan , Karau Steven
Published: July 2016

Social inhibition is the tendency for behaviors that are exhibited when one is alone to be minimized in the presence of others. Despite the long tradition of research investigating the effects of social presence on behavior, research on social inhibition does not constitute a cohesive literature. This chapter integrates social inhibition research from different traditions, focusing on helping behaviors, emotional expression, and behaviors that elicit social disapproval. We discuss moderators and processes that explain when and why social inhibition occurs: arousal, ambiguity, pluralistic ignorance, diffusion of responsibility, feelings of capability, evaluation apprehension, and confusion of responsibility. Key distinctions between social inhibition and related concepts are presented, helping to establish social inhibition as a central social influence concept. We conclude with an analysis of why social inhibition research has not formed a cohesive literature, and we hope that our review of social inhibition facilitates the integration of future research on the topic.
Implicature
Authors: Davis Wayne A.
Published: July 2016

Implicature for speakers is meaning one thing by saying something else. Semantic implicatures are part of sentence meaning, whereas conversational implicatures depend on the utterance context. Conventional forms of conversational implicature include figures and modes of speech like irony and relevance implicature. A sentence has an implicature when speakers conventionally use sentences of that form with the corresponding implicature. Speakers implicate things for many reasons. Some apply to saying (communication, self-expression, record creation), others do not (verbal efficiency, misleading without lying, veiling, good social relations, style, and entertainment). A sentence has an implicature today because that use became self-perpetuating. The dependence of implicature on intention and convention, and the variety of conflicting goals implicature serves, show that implicatures cannot be derived from conversational principles. Interpreting implicatures is largely the automatic exercise of a competence acquired with one’s native language rather than calculation.
Bantu Lexical Reconstruction
Authors: Bostoen Koen , Bastin Yvonne
Published: July 2016

Lexical reconstruction has been an important enterprise in Bantu historical linguistics since the earliest days of the discipline. In this chapter a historical overview is provided of the principal scholarly contributions to that field of study. It is also explained how the Comparative Method has been and can be applied to reconstruct ancestral Bantu vocabulary via the intermediate step of phonological reconstruction and how the study of sound change needs to be completed with diachronic semantics in order to correctly reconstruct both the form and the meaning of etymons. Finally, some issues complicating this type of historical linguistic research, such as “osculance” due to prehistoric language contact, are addressed, as well as the relationship between reconstruction and classification.
The Future of Legal Families
Authors: Husa Jaakko
Published: July 2016

The aim of this article is to give an account of legal families as a comparative law approach and as a classification of legal systems. The text discusses especially the future of legal families. The article begins with a short review of macro-comparative law’s basic approaches and concepts. It then considers the past and present of the basic notions of macro-comparative law, focusing on the classification of legal families and the recent critique of them. Finally, this article examines the new roles of legal families and, in particular, it addresses the possible future utility of legal family as a basic notion and as an approach in macro-comparative law.
Long-Term Consequences of Childhood Abuse
Authors: Wright Emily M.
Published: July 2016

This essay reviews the evidence regarding the impact of childhood abuse (e.g., physical, sexual, psychological, maltreatment, and neglect) on long-term outcomes, such as violence, criminality, abuse, mental health problems, and physical health problems, in adolescence and adulthood. Overall, childhood abuse is highly detrimental to these outcomes, with evidence suggesting that “more is worse” when it comes to its lasting effects. This essay also briefly reviews the theoretical bases upon which the research regarding childhood abuse and later outcomes is founded and discusses the evidence regarding moderating variables, such as age, gender, and race/ethnicity. Finally, it concludes with a discussion of the theoretical and methodological limitations in the research and suggests avenues for future endeavors to consider.
Youth Justice in Hungary During the 20th and 21st Centuries
Authors: Lévay Miklós
Published: July 2016

Juvenile justice systems are not static constructions but are highly dependent on the cultural, historical, and political environment. Therefore, analyses cannot provide a complete picture of them without explaining the effects of these to the development of the system. To encourage precise understanding on the main issues and institutions of the contemporary Hungarian juvenile justice system, this essay uses developmental and cultural perspectives, focusing on the introduction of formal law and legal practice. In this framework the author explains special characteristics of the Hungarian system, such as the traditional two-tiered justice system, the types and practice of deprivation of liberty of juveniles, the development of the consideration of culpability and maturity of delinquent children, and the limited overlap with child welfare. Beyond historical explanations, the author provides a contemporary evaluation of this development and points out the weakest areas with respect to international children’s rights.
Greek Philosophy in the Twenty-first Century
Authors: Brill Sara
Published: July 2016

This article addresses contemporary efforts to understand how the earliest practitioners of philosophy conceived of the philosophic life. It argues that, for Plato, the concept of bios was a central, animating, and structuring object of philosophic inquiry. Concentration on the imagery Plato employed to draw bios into the purview of philosophic contemplation and choice points to interpretative avenues that further the aim of treating the dialogues as complex, integrated wholes, and offers a new approach to the question of the status of image-making in them. The article concludes with thoughts on how an exploration of bios might extend beyond Plato to Aristotle, via an examination of his treatment of the range of human and animal bioi, suggesting that such an examination clarifies the relationship between his analysis of the polis-dwelling animal and his broader investigation of living beings as such.
Bronze Age Central Asia
Authors: Dupuy Paula Doumani
Published: July 2016

This article focuses on the principal characteristics and features of the Bronze Age of the steppes, deserts, mountain foothills, and oases of Central Asia. It outlines the history of research on the region’s mobile pastoral and settled agricultural societies during the third and second millennium BC. The article examines how approaches to the social history and economy have changed from one of macro-studies of regional assemblages toward more targeted investigations of the dynamic and variable nature of this period. Finally, an overview of pottery, metal, and textile assemblages and analyses is used to form a discussion on craft production practices, consumption, and regional exchange across Central Asia.
A Picture of Prehistoric Sudan
Authors: Usai Donatella
Published: July 2016

The physiographic setting of the Nile valley, in Sudan as well as in Egypt, provides a nearly homogenizing factor in the cultural and socioeconomic development of Mesolithic and Neolithic prehistoric populations. Unfortunately, a dearth of prehistoric research has hindered the recognition of regional differences and our comprehension of the complexity of such development. Furthermore the past fifty years of archaeological investigations in prehistoric Sudan have not, paradoxically, pushed forward our understanding beyond A. J. Arkell excavations at the Khartoum Hospital site (1949) and Shaheinab (1953), the first prehistoric sites excavated in this region. This premise is necessary in order to advise of the volatility of the picture that can be drawn with the currently available data. The Mesolithic populations of the Sudanese Nile valley are characterised by their pottery production and associated with a hunter-gatherer-fishers economy. The Neolithization of the region is rooted in these groups, but the contribution of foreign influences cannot be ruled out.
The Origins and Early Development of Writing in Egypt
Authors: Regulski Ilona
Published: July 2016

The Egyptian writing system represents one of the oldest recorded languages known to humankind, along with Sumerian. But the system took centuries to adapt to what we now regard as its primary function: the encoding of continuous speech. Major changes in the historical and social-linguistic environment of late Predynastic and Early Dynastic Egypt (ca. 3250–2700 BC) left traces in the written communication and steered significant developments in the early writing system. After a brief introduction of the earliest evidence of writing in Egypt, this chapter will focus on the long and complex process of creating, extending, and standardizing the early hieroglyphic sign corpus. It will propose possible explanations for the dramatic decrease in the number of signs in the beginning of the third millennium BC.
Measuring and Explaining Inmate Misconduct
Authors: Steiner Benjamin
Published: July 2016

This essay explores definitions of inmate misconduct (e.g., the distinction between crimes versus “other” rule infractions, violent versus property versus drug crimes in prison, and the incidence versus the prevalence of institutional misconduct). The current applicability of importation, deprivation, and administrative control theories to understanding inmate deviance is assessed. Other potentially applicable criminological theories (e.g., social control theories, Agnew’s general strain theory) are also discussed. General theories of crime and deviance may offer a comprehensive explanation of misconduct and permit consideration of incarceration as a stage (or stages) in an offender’s life course that may encourage desistance from offending or induce further criminality. The literature on best practices for predicting (and preventing) institutional misconduct is also reviewed, as well as research on a possible link between engaging in misconduct during confinement and postrelease recidivism.
Models of Bilateral Trade in Networks
Authors: Manea Mihai
Published: July 2016

This chapter reviews the research on bilateral trade in markets with a network structure. The survey focuses on the following questions: how do local prices depend on global network architecture? When does the law of one price hold? How do competitive forces in different segments of the market influence the bargaining power of each position in the network? Is trade efficient? How does the network evolve as traders reach agreements and exit the market? If forming links is costly for the traders, what networks will emerge? How does the underlying market mechanism affect payoffs and allocations?
Attention in Organizations
Authors: Dessein Wouter , Prat Andrea
Published: July 2016

By bringing together multiple workers, organizations can perform tasks that are outside the reach of any individual. In order to be productive, however, workers must coordinate their actions. Often this requires communicating information that is dispersed throughout the organization, but communication is time-consuming and costly. As Arrow (1974) noted, given the importance of communication both as an opportunity and as a cost, organizations will strive to optimize information flows between workers. As a result, communication patterns within an organization will not be random but will be shaped by the goals of the organization. An attention network describes how communication flows and, as a result, how decisions are made within the organization. This chapter reviews optimal and equilibrium attention networks.
Targeting and Pricing in Social Networks
Authors: Bloch Francis
Published: July 2016

This chapter analyzes the optimal use of social networks by firms that wish to diffuse new products, rely on word-of-mouth communication for advertising, or exploit consumption externalities among consumers. It focuses on two topics: the targeting of individuals to diffuse information or opinions in a social network, and the pricing at different nodes of the social network when agents experience consumption externalities. In both cases, firms take the network of social interaction as given and consider how to optimally leverage social effects to introduce new products or maximize profits .
Neural Structure and Organization of Mood Pathology
Authors: Disabato Brianne , Bauer Isabelle E. , Soares Jair C. , Sheline Yvette
Published: July 2016

Unipolar major depressive disorder (MDD) and bipolar disorder (BD) are among the world’s leading causes of disability. This chapter highlights the importance of neuroimaging in understanding their neural mechanisms. Depression affects limbic-corticostriatopallidothalamic regions. Structurally, depressed subjects showed increased volume of lesions in white matter (WMH) and decreased gray matter in prefrontal-striatum, orbitofrontal, anterior cingulate cortices, and hippocampus. Functionally, depressed subjects showed abnormal activation in amygdala and medial prefrontal cortex and dsyconnectivity in executive and emotional networks. BD was associated with frontocingulate, limbic-striatal, and hippocampus abnormalities. Specifically, BD subjects showed increased WMH in frontocortical and subcortical areas and altered microstructure in limbic-striatal, cingulate, thalamus, corpus callosum, and prefrontal regions. Functionally, abnormal activations in dorsolateral prefrontal and ventrolimbic regions, hypoconnectivity in the cinguloinsularopercular, mesoparalimbic, and cerebellar networks, and hyperconnectivity in affective and executive networks were also observed. These studies show congruence. Full integration of them would allow better understanding of mood disorders.
Kinesthetic Empathy
Authors: Wood Karen
Published: July 2016

The aim of this chapter is to use the concept of kinesthetic empathy as a framework to investigate the production and reception of dance made for the screen, focusing on the audience’s kinesthetic experience of screendance versus (or synergistically related to) live dance performances. The study employs kinesthetic empathy as a focus through which to analyze choreographers’ intentions in making, and audience responses to watching, screendance across a range of formats and styles, and whether there are common contributors to the viewing experience. Qualitative methods and interviews were employed to gather information from filmmakers and focus groups of viewers (pseudonyms were used when referring to conversations with the audience members) to investigate the creative process of making screendance and to explore the experience of the spectator. The findings revealed that viewers bring different experiences and histories with them to a viewing experience; however, there are shared conditions when experiencing kinesthetic empathy.
A Pilot Study of the Efficacy of Active Leptospermum Honey for the Treatment of Partial-Thickness Facial Burns
Authors: Duncan Christina L. , Enlow Paul T. , Szabo Margo M. , Tolchin Eric , Kelly Robert W. , Castanon Lourdes , Aballay Ariel M.
Published: July 2016

OBJECTIVE:

Research suggests that active Leptospermum honey (ALH) improves outcomes in patients with partial-thickness burns by enhancing healing and reepithelialization rates, as well as by protecting against antibiotic-resistant microorganisms. This study assessed the effectiveness of ALH gel on healing time, bacterial growth, patient satisfaction, and cost of treatment.

DESIGN:

Single-arm, prospective case series.

SETTING AND PATIENTS:

Seven patients (aged 7–64 years) with partial-thickness facial burns were recruited from a northeastern US burn center.

INTERVENTION:

All patients cleansed their wounds daily with soap and water, after which they applied ALH gel.

MAIN OUTCOME MEASURES:

Three physicians independently rated healing using wound photography and daily tests for the presence of exudate. Wound cultures on days 1 and 7 (±2 days) assessed bacterial growth. Patients completed a satisfaction survey at the end of treatment, and cost of treatment was calculated.

MAIN RESULTS:

Healing time ranged from 3 to 14 days (mean, 8.1 days). Wound cultures revealed normal bacterial growth on days 1 and 7 for all patients. Patients rated ALH gel favorably, with the most common complaint of stickiness in 5 patients. One patient experienced transient burning on application that did not interrupt treatment. Average hospital-based cost of treatment was $26.15 per patient.

CONCLUSIONS:

Healing time was congruent with or better than what would have been expected with standard treatment. Furthermore, despite no antibiotic treatment, wound culture results yielded no abnormal bacterial growth. Finally, patients overall reported satisfaction with treatment. The findings of this study suggest that ALH is a clinically and economically valuable treatment for partial-thickness facial burns.
Environmental exposures and the development of systemic lupus erythematosus
Authors: Barbhaiya Medha , Costenbader Karen H.
Published: July 2016

Purpose of review

This review examines evidence relating environmental factors to the development of systemic lupus erythematosus (SLE).

Recent findings

The strongest epidemiologic evidence exists for the associations of silica, cigarette smoking, oral contraceptives, postmenopausal hormone therapy and endometriosis, with SLE incidence. Recent studies have also provided robust evidence of the association between alcohol consumption and decreased SLE risk. There are preliminary, conflicting or unsubstantiated data that other factors, including air pollution, ultraviolet light, infections, vaccinations, solvents, pesticides and heavy metals such as mercury, are related to SLE risk. Biologic mechanisms linking environmental exposures and SLE risk include increased oxidative stress, systemic inflammation and inflammatory cytokine upregulation, and hormonal triggers, as well as epigenetic modifications resulting from exposure that could lead to SLE.

Identifying the environmental risk factors related to risk of SLE is essential as it will lead to increased understanding of pathogenesis of this complex disease and will also make risk factor modification possible for those at increased risk.
Plasma Concentrations of Soluble Suppression of Tumorigenicity-2 and Interleukin-6 Are Predictive of Successful Liberation From Mechanical Ventilation in Patients With the Acute Respiratory Distress Syndrome*
Authors: Alladina Jehan W. , Levy Sean D. , Hibbert Kathryn A. , Januzzi James L. , Harris R. Scott , Matthay Michael A. , Thompson B. Taylor , Bajwa Ednan K.
Published: July 2016

Objectives:

Soluble suppression of tumorigenicity-2 and interleukin-6 concentrations have been associated with the inflammatory cascade of acute respiratory distress syndrome. We determined whether soluble suppression of tumorigenicity-2 and interleukin-6 levels can be used as prognostic biomarkers to guide weaning from mechanical ventilation and predict the need for reintubation.

Design, Setting, and Patients:

We assayed plasma soluble suppression of tumorigenicity-2 (n = 826) concentrations and interleukin-6 (n = 755) concentrations in the Fluid and Catheter Treatment Trial, a multicenter randomized controlled trial of conservative fluid management in acute respiratory distress syndrome. We tested whether soluble suppression of tumorigenicity-2 and interleukin-6 levels were associated with duration of mechanical ventilation, the probability of passing a weaning assessment, and the need for reintubation.

Measurements and Main Results:

In models adjusted for Acute Physiology and Chronic Health Evaluation score and other relevant variables, patients with higher day 0 and day 3 median soluble suppression of tumorigenicity-2 and interleukin-6 concentrations had decreased probability of extubation over time (day 0 soluble suppression of tumorigenicity-2: hazard ratio, 0.85; 95% CI, 0.72–1.00; p = 0.05; day 0 interleukin-6: hazard ratio, 0.64; 95% CI, 0.54–0.75; p < 0.0001; day 3 soluble suppression of tumorigenicity-2: hazard ratio, 0.64; 95% CI, 0.54–0.75; p < 0.0001; and day 3 interleukin-6: hazard ratio, 0.73; 95% CI, 0.62–0.85; p = 0.0001). Higher biomarker concentrations were also predictive of decreased odds of passing day 3 weaning assessments (soluble suppression of tumorigenicity-2: odds ratio, 0.62: 95% CI, 0.44–0.87; p = 0.006 and interleukin-6: odds ratio, 0.61; 95% CI, 0.43–0.85; p = 0.004) and decreased odds of passing a spontaneous breathing trial (soluble suppression of tumorigenicity-2: odds ratio, 0.45; 95% CI, 0.28–0.71; p = 0.0007 and interleukin-6 univariate analysis only: odds ratio, 0.55; 95% CI, 0.36–0.83; p = 0.005). Finally, higher biomarker levels were significant predictors of the need for reintubation for soluble suppression of tumorigenicity-2 (odds ratio, 3.23; 95% CI, 1.04–10.07; p = 0.04) and for interleukin-6 (odds ratio, 2.58; 95% CI, 1.14–5.84; p = 0.02).

Conclusions:

Higher soluble suppression of tumorigenicity-2 and interleukin-6 concentrations are each associated with worse outcomes during weaning of mechanical ventilation and increased need for reintubation in patients with acute respiratory distress syndrome. Biomarker-directed ventilator management may lead to improved outcomes in weaning of mechanical ventilation in patients with acute respiratory distress syndrome.
Early Angiosarcoma of the Scalp: A Clinicopathological Pitfall
Authors: Paolino Giovanni , Lora Viviana , Cota Carlo , Panetta Chiara , Muscardin Luca Maria , Donati Pietro
Published: July 2016

Angiosarcoma (AS) is a rare malignant vascular tumor, which affects mainly elderly patients. After the diagnosis, the mean overall survival of patients is 30 months. The variable presentation of the malignancy, the benign appearance of the cutaneous lesions, and the minimal histological changes in early lesions can sometimes delay the correct diagnosis. The authors report a case of an 80-year-old white male patient, with a painless and ecchymotic lesion of the scalp, which histologically showed minimal pathological atypia, conclusive for a diagnosis of AS with minimal histological changes. The authors discuss the main and most emblematic cases of AS initially misdiagnosed for other cutaneous diseases reported in the literature, noting that in some cases, also the histology can be treacherous and a trap for the dermatopathologist. The recent findings on MYC, FLT4 and KDR amplification, and the relative therapeutic perspectives are also discussed. Finally, the authors draw up some pathological cornerstones, which could improve the diagnosis, above all in early lesions with minimal atypia.
Improvement of the Rotation Arch of the Posterior Interosseous Pedicle Flap Preserving Both Reverse Posterior and Anterior Interosseous Vascular Sources
Authors: Tiengo Cesare , Dalla Venezia Erica , Lombardi Matteo , Bassetto Franco
Published: July 2016

Purpose:

The reverse posterior interosseous artery flap has several advantages, not sacrificing any major blood vessel, but its relatively short pedicle limits the use to cover defects up to the metacarpophalangeal joint. Our purpose is to demonstrate that the ligature of the anterior interosseous artery (AIA), proximal to the communicating branch with the posterior interosseous artery, leads to an improved flap rotation arch, preserving both vascular sources.

Methods:

Sixteen fresh cadavers with latex perfusion were analyzed before and after our technique of elongation, and the so-obtained measures were standardized in “percentage of elongation of the pedicle.” Eight patient with the loss of substance at the dorsal aspect of the hand have been treated with this technique, and results were evaluated in terms of flap survival and complication rates.

Results:

The medium length of the pedicle in the normal flap was 10.8 cm, and after the section of the AIA, the medium length of the pedicle was 13.6 cm with a medium increase of 2.8 cm. It means a medium increase of 24% of the length of the pedicle. In all patients treated, full coverage of the defect was obtained, and we did not experience major complications.

Conclusions:

This anatomical study supported by our clinical experience demonstrates that the use of the variant described above permits to reach more distal part of the hand without being afraid to stretch the pedicle because of the connection with the anastomotic arcades of the AIA at the wrist reducing the risk of ischemia of the flap.
Practical Work-up and Management of Recurrent Pregnancy Loss for the Front-Line Clinician
Authors: BRANCH D. WARE , SILVER ROBERT M.
Published: July 2016

Only a few so-called etiologies of recurrent pregnancy loss recurrent pregnancy loss in otherwise healthy women are adequately supported by well-designed investigations of association. The majority of proposed “treatments” have not been subjected to rigorous trials. The American Board of Internal Medicine Choosing Wisely initiative urges providers and patients to have constructive dialog aimed at choosing health care that is supported by evidence, not duplicative of other tests or procedures already received, free from harm, and truly necessary. We support the refreshing, objective frankness promoted by this campaign. A version of the Choosing Wisely “Do” and “Don’t” format for recurrent pregnancy loss is presented.
Corneal Sublayers Thickness in Patients With Mitral Valve Prolapse
Authors: Duru Necati , Haşhaş Oğuz Erman , Göktaş Emre , Duru Zeynep , Arifoğlu Hasan Basri , Ulusoy Döndü Melek , Karatepe Haşhaş Arzu Seyhan , Ataş Mustafa
Published: July 2016

Objectives:

The aim of this study was to compare the thickness of each corneal sublayer in patients with mitral valve prolapse (MVP) and healthy individuals.

Methods:

A total of 38 eyes from 38 patients with MVP and 34 eyes from 34 age- and sex-matched healthy individuals were included in this study. The thickness of the corneal epithelium, Bowman layer, stroma, and Descemet membrane—endothelium complex were measured on the central cornea (i.e., corneal apex) and both the inferior and superior halves of the cornea with anterior segment module of spectral domain optical coherence tomography.

Results:

No statistically significant differences emerged between the study and control groups in terms of Bowman layer thickness in the central cornea and the cornea's superior half (P=0.092 and P=0.128, respectively). However, in the inferior half of the cornea, Bowman layer thickness among patients with MVP was 11.95±2.34 μm (range 7–16 μm) and in the control group was 13.03±1.62 μm (range 10–16 μm), which made for a statistically significant difference (P=0.025).

Conclusions:

Our study revealed thinning of Bowman layer in the inferior half of the cornea in patients with MVP.
Partial Orbicularis Resection for the Augmentation of Traditional Internal Brow Pexy: The “Tuck and Rise”
Authors: Armstrong Blair K. , Sobti Deepak , Mancini Ronald
Published: July 2016

Purpose:

Brow ptosis commonly occurs with aging. Minimally invasive techniques are varied and include neurotoxin paralysis of eyebrow depressors and internal brow pexy. The authors present a modification of the traditional brow-pexy surgery which incorporates weakening of the lateral eyebrow depressor, the orbicularis oculi muscle, to synergistically influence brow position.

Methods:

This retrospective review includes 44 brows in 22 patients treated over a 14-month period. All patients underwent surgery by a single surgeon (RM) at UT Southwestern Medical Center. The surgical technique includes partial orbicularis resection to augment the traditional internal brow pexy. Preoperative and postoperative photographs were analyzed using ImageJ software.

Results:

This procedure has been successfully performed on 44 brows in 22 patients with no complications and a high satisfaction rate. ImageJ analysis demonstrates an average elevation of 2.42 mm of the lateral tail of the brow with improved brow contour, volume, and symmetry.

Conclusions:

The “Tuck and Rise” has proven a simple, minimally invasive, and effective technique to volumize and elevate the lateral tail of the eyebrow.
Disproportionate longer-term opioid use among U.S. adults with mood disorders
Authors: Halbert Brian T. , Davis Roger B. , Wee Christina C.
Published: July 2016

Adults with mood disorders frequently use prescription opioids. The factors associated with this increased use remain unclear. We used the Medical Expenditure Panel Surveys from 2005 to 2011 to measure the association of mood disorders with new opioid use and the transition to longer-term opioid use for a variety of pain conditions before and after controlling for patient characteristics and clinical disability. We analyzed 33,450 adults with likely acute or potentially chronic pain conditions who were not using opioids at baseline. Among respondents with likely acute pain conditions, those with mood disorders initiated opioids more frequently for that pain condition compared with those without mood disorders (19.3%, vs 17.2%, P = 0.01). After initiation, they also transitioned to longer-term opioid therapy more frequently (11.7% vs 5.3%, P < 0.01). Among respondents with potentially chronic pain conditions, adults with mood disorders initiated opioid therapy more frequently for their chronic pain condition (11.5% vs 9.2%, P < 0.01) and transitioned to longer-term therapy more frequently (36.8% vs 19.9%, P < 0.01). After adjusting for sociodemographics and clinical disability, there was no association between mood disorders and new opioid use for likely acute (adjusted odds ratio [aOR] 1.05 [0.92-1.20]) or potentially chronic pain (aOR 0.91 [0.80-1.03]). However, there remained a strong association between mood disorders and the transition to longer-term opioid use for likely acute (aOR 1.77 [1.15-2.72]) and potentially chronic pain (aOR 1.95 [1.42-2.68]). Targeting the transition to longer-term opioid use may help clinicians reduce potentially inappropriate opioid prescriptions in this high-risk population.
Advanced Practice Nursing Committee on Process Improvement in Trauma: An Innovative Application of the Strong Model
Authors: West Sarah Katherine
Published: July 2016

This article aims to summarize the successes and future implications for a nurse practitioner–driven committee on process improvement in trauma. The trauma nurse practitioner is uniquely positioned to recognize the need for clinical process improvement and enact change within the clinical setting. Application of the Strong Model of Advanced Practice proves to actively engage the trauma nurse practitioner in process improvement initiatives. Through enhancing nurse practitioner professional engagement, the committee aims to improve health care delivery to the traumatically injured patient. A retrospective review of the committee's first year reveals trauma nurse practitioner success in the domains of direct comprehensive care, support of systems, education, and leadership. The need for increased trauma nurse practitioner involvement has been identified for the domains of research and publication.
Reconstruction of nasal defects: contemporary approaches
Authors: Austin Grace K. , Shockley William W.
Published: July 2016

Purpose of review

There are many well-established principles and surgical techniques for nasal reconstruction. The purpose of this study is to describe contemporary reconstruction of nasal defects. The unique anatomic features of the nose make this a challenging task. Although obtaining an optimal esthetic result is always the goal of reconstruction, maintenance and restoration of nasal function are of equal importance.

Recent findings

The first step of nasal reconstruction is a thoughtful analysis of the defect. The best surgical option will provide the patient with an excellent esthetic result and nasal function. Depending upon the extent of the defect as well as the anatomic site, a local flap, full-thickness skin graft, composite graft, or interpolated flap will provide the optimal result. The decision will depend on the surgeon's experience and expertise, as well as expectations and desires of the patient. Many cutaneous defects will require not only reconstruction of the defect, but also cartilage grafts to provide nasal contour and support. Most large or complex defects will require a paramedian forehead flap for reconstruction along with cartilaginous and/or bony support, as well as a lining flap.

This study highlights recent advances in nasal reconstruction and novel modifications of well-accepted traditional techniques.
The Impact of SMS-Based Interventions on VMMC Uptake in Lusaka Province, Zambia: A Randomized Controlled Trial
Authors: Leiby Kevin , Connor Alison , Tsague Landry , Sapele Crispin , Kaonga Albert , Kakaire Joshua , Wang Paul
Published: July 2016

Introduction:

Zambia has high HIV prevalence and low voluntary medical male circumcision (VMMC) rates, heightening the need for effective VMMC demand generation strategies for HIV prevention.

Methods:

A 3-arm randomized controlled trial measured the impact of 2 short message service (SMS) campaigns on self-reported and verified VMMC uptake over 6 months in Lusaka Province. The study enrolled 2312 uncircumcised males aged 15–30 previously subscribed on Zambia U-Report, an existing SMS platform providing confidential, free counseling services relevant to HIV and other sexually transmitted infections. Participants in the “Conventional” campaign group received a standard package of messages promoting VMMC. Messages sent to the “Tailored” campaign group were targeted at participants' intention level to get circumcised. The control group had routine counselor access through SMS. Data were collected using SMS surveys, and verification of self-reported VMMC uptake used health facility client data.

Results:

Six-month self-reported VMMC uptake was 11.6%, 12.6%, and 10.4% in the Conventional, Tailored, and control arms, respectively; verified uptake was 1.8%, 1.1%, and 1.5%. Using multivariate logistic regression, the adjusted odds ratio of self-reported VMMC uptake was 1.17 (95% CI: 0.80 to 1.72) in the Conventional campaign arm compared with the control arm and 1.24 (95% CI: 0.84 to 1.81) in the Tailored campaign arm. The adjusted odds ratios of verified VMMC uptake in the Conventional and Tailored campaign arms were 1.34 (95% CI: 0.45 to 4.02) and 0.67 (95% CI: 0.20 to 2.23), respectively.

Conclusions:

Neither SMS campaign had statistically significant impact on VMMC uptake compared with routine SMS counseling. Future research is necessary to fully understand the potential of SMS-based tools for VMMC demand creation.
A Sport-Based Intervention to Increase Uptake of Voluntary Medical Male Circumcision Among Adolescent Male Students: Results From the MCUTS 2 Cluster-Randomized Trial in Bulawayo, Zimbabwe
Authors: Kaufman Zachary A. , DeCelles Jeff , Bhauti Kenneth , Hershow Rebecca B. , Weiss Helen A. , Chaibva Cynthia , Moyo Netsai , Mantula Fennie , Hatzold Karin , Ross David A.
Published: July 2016

Background:

Mathematical models suggest that 570,000 HIV infections could be averted between 2011 and 2025 in Zimbabwe if the country reaches 80% voluntary medical male circumcision (VMMC) coverage among 15- to 49-year-old male subjects. Yet national coverage remains well below this target, and there is a need to evaluate interventions to increase the uptake.

Methods:

A cluster-randomized trial was conducted to assess the effectiveness of Make-The-Cut-Plus (MTC+), a single, 60-minute, sport-based intervention to increase VMMC uptake targeting secondary school boys (14–20 years). Twenty-six schools in Bulawayo, Zimbabwe, were randomized to either receive MTC+ at the start (intervention) or end (control) of a 4-month period (March to June 2014). VMMC uptake over these 4 months was measured via probabilistic matching of participants in the trial database (n = 1226 male participants; age, 14–20 years; median age, 16.2 years) and the registers in Bulawayo's 2 free VMMC clinics (n = 5713), using 8 identifying variables.

Results:

There was strong evidence that the MTC+ intervention increased the odds of VMMC uptake by approximately 2.5 fold (odds ratio = 2.53; 95% confidence interval, 1.21 to 5.30). Restricting to participants who did not report being already circumcised at baseline, MTC+ increased VMMC uptake by 7.6% (12.2% vs 4.6%, odds ratio = 2.65; 95% confidence interval, 1.19 to 5.86). Sensitivity analyses related to the probabilistic matching did not change these findings substantively. The number of participants who would need to be exposed to the demand creation intervention to yield one additional VMMC client was 22.7 (or 13.2 reporting not already being circumcised). This translated to approximately US dollar 49 per additional VMMC client.

Conclusions:

The MTC+ intervention was an effective and cost-effective strategy for increasing VMMC uptake among school-going adolescent male subjects in Bulawayo.
Design Issues in Transgender Studies
Authors: Hughes James P. , Emel Lynda , Hanscom Brett , Zangeneh Sahar
Published: July 2016

Transgender individuals constitute an important focus for HIV prevention, but studies in this population present some unique methodologic and operational challenges. We consider issues related to sampling, sample size, number of sites, and trial cost. We discuss relevant design issues for evaluating interventions in both HIV-negative and HIV-infected transgender populations, as well as a method for assessing the impact of an intervention on population HIV incidence. We find that HIV-endpoint studies of transgender individuals will likely require fewer participants but more sites and have higher operational costs than HIV prevention trials in other populations. Because any intervention targeted to transgender individuals will likely include antiretroviral drugs, small scale studies looking at potential interactions between antiretroviral therapy and hormone therapy are recommended. Finally, assessing the impact of an intervention targeted to transgender individuals will require better information on the contribution of such individuals to the population HIV incidence.