bluuebunny/crossref_metadata_2025 huggingface dataset:
Medieval York
Authors: Merlo Perring Stefania
Published: May 2019

The medieval period in York spans from the end of the Roman rule in Britain in 410 ce to the early 16th century, when the Reformation had a dramatic impact on religious and secular institutions and urban space. The Roman fortress of Eboracum was founded in c. 71 ce in a strategic location at the confluence of two rivers. The annexed civil settlement in the late 2nd century became a provincial capital. Roman emperors resided in Eboracum to control the northern border; Constantine was proclaimed emperor there in 313 ce and Christianity was established by 314 ce. After the Roman period, archaeological sources suggest that there was human activity on the site; however, there is no clear evidence for continuity of urban life. From 627 ce written sources indicate that a wooden church dedicated to Saint Peter was founded within the walls of the Roman fortress by bishop Paulinus, a Gregorian missionary sent to convert the local pagan population. Archaeological evidence shows, however, that the Anglian settlement of Eoforvic was located by the rivers outside of the Roman walls. By 866 ce, at the time of the Viking conquest, York must have been a prosperous town, with commercial and cultural exchanges with the Carolingian world. Under Viking and Anglian rulers, the Anglo-Scandinavian town of Jorvik flourished. Churches, cemeteries, and possibly centers of secular power were located within the Roman walls, while densely populated residential and commercial areas were developed along the rivers. Trade and cultural exchange were established with Northern Europe and the wider Viking network. In 1066 the Norman Conquest had a great impact on York’s urban environment and institutions. Changes that occurred in the 11th century shaped the form and life of the city and influenced its development for centuries to come. The cathedral, the Minster, was re-founded and rebuilt; two castles were built in Norman style to control the rivers; Roman gates and defenses were enhanced; and parish churches, monasteries, royal mansions, houses, and bridges were built in stone within the city walls. By the 13th century York had grown in economic importance; in 1212 the city communality obtained a royal charter and a civic government was developed. In the 14th century York was a center of wool trade and the wealthiest city in Northern England; private and public buildings were extensively rebuilt and a rich civic culture was flourishing. Despite the 15th century economic crisis, York remained the regional capital of Northern England until the end of the medieval period.
Women and Work: Fourteenth to Seventeenth Centuries
Authors: Lanza Janine
Published: May 2019

In Europe in the Early Modern period, women worked an enormous range of jobs and professions. From farmwives who helped plant and harvest crops to fishmongers who sold their wares in markets to guildswomen who engaged in skilled labor, as well as artists, scholars, midwives, doctors, prostitutes, and servants, women participated in every corner of the economy. This wide participation was evident in all of Europe, east as well as west, despite many local and regional differences in how women labored. But notwithstanding the presence of women in all sectors of the economy, women’s work was not understood or valued in the same way as men’s work. In contrast to male workers, female workers saw their ability to practice certain trades curtailed and their capabilities were often seen as inferior to those of men. Women were paid less than men and their work was often more contingent, despite that fact that many families relied on the income or work of all their members. Nonetheless, despite the patriarchal ideology that sought to limit or undervalue their working contributions, women forged ahead working in all sectors of the economy. They did so in order to not only support themselves and their families, but also as part of their self-conception as productive and contributing members of their communities. This article provides sources to support this understanding of the vast range of female economic activity in Europe in the Early Modern period. While women participated broadly in the labor market, it cannot be denied that the pay, professions, and status they enjoyed from those activities were shaped by the assumptions of patriarchy. In her 2008 work Women and Gender in Early Modern Europe, Merry Wiesner notes that “the gender of the worker, not the work itself or its location, marked the difference between what were considered domestic tasks and what was considered production” (p. 104); we can add, the conditions of work and pay hinged upon gendered definitions. For example, one of the most prestigious and lucrative sectors of the economy were skilled trades, often controlled by guilds, especially in France, Germany, the Low Countries, and Italy; English guilds had little real influence by the Early Modern period, but the trades they had controlled remained high-status ones that tried to admit few women. Nonetheless, women found ways to work in skilled trades, regardless of how they were organized. Likewise, other professions marked by high levels of education, pay, and status, such as the law, medicine, academia, and the fine arts, created bars to women joining their ranks, despite the presence of a handful of path-breaking female practitioners. Globally, women were found in greater numbers in less skilled and less lucrative jobs.
Gender and Professions
Authors: Irvine Leslie , Vermilya Jenny R.
Published: May 2019

The term “professions” generally refers to occupations that require expertise obtainable only through specialized training and credentialed by advanced degrees or licenses. Examples include academia, medicine, law, engineering, the clergy, and accountancy. The professions generally provide greater social prestige relative to other occupations. Moreover, professionals determine the scope of their work, the requisite level of expertise, and the terms of inclusion. Much of the research on gender and professions highlights the structural barriers to entry and advancement by women. Because the professions developed from endeavors long considered “gentlemanly vocations,” they were historically dominated by men. Most universities prohibited women from matriculating until the mid-1800s, allowing few to obtain the advanced education required for the professions. By excluding women from highly rewarded roles, the professions have long produced and maintained gender inequalities, particularly the Wage Gap. Over recent decades, women have entered the professions in growing numbers. In some cases, such as veterinary medicine, women have even overtaken men numerically, resulting in the feminization of the field. Salaries in feminized professions, or sectors of a profession, are generally lower than are those in fields with fewer women. The explanations offered for this wage gap involve devaluation or queuing. The devaluation view argues that the sex composition of a profession affects the salary offered. Because of gender bias, employers devalue work done by women. Consequently, they lower the rewards in occupations numerically dominated by women. This is particularly the case for professions involving emotional labor and care work. In the queuing view, the salary levels of a profession affect its gender composition. Although both men and women prefer to work in higher paid professions, employers prefer to hire men for high-reward positions. This suggests a gendered labor queue consisting of men, leaving women clustered in professions offering lower pay. In research on other topics, different definitions of “gender” lead to varying perspectives on its implications for the professions. When understood as a set of attributes associated with biological sex, research emphasizes the sex-typing of skills and sex-based differences within professions. When understood as a relation that influences interactions and identities, research investigates how gender informs the daily functioning of the workplace in various ways, producing professional cultures that create formal or informal barriers and advantages.
Music in Afghanistan
Authors: Slobin Mark
Published: May 2019

The literature on the musics of the peoples of Afghanistan is recent and small. Due to the cross-regional setting, Afghanistan’s music cultures and literature overlap with three neighboring zones: the Iranian, the Central Asian, and the South Asian. The citations in this article are only for modern Afghanistan proper. European travelers described Kabul’s 19th-century court music and offered stray, casual accounts of folk musics. But the kingdom was not open to Western researchers until the 1950s. Only a few scholars were able to complete fieldwork before the tragic cycle of invasions and wars began in 1979. Massive dislocation and destruction eroded social customs and networks, cultural monuments, and sources. For music, the worst period was under the rule of the Taliban (1996–2001), who actively suppressed music, which survived mainly in clandestine domestic performance and public religious/propaganda formats. The post-2001 situation saw revival of traditions, but no new literature on music, with the notable exception of the historical survey Sarmast 2009 (cited under General Overviews). As a result of this turbulent history, nearly all the writing on the topic comes from the pens of only five scholars: John Baily, Veronica Doubleday, Hiromi Lorraine Sakata, Felix Hoerburger, and Mark Slobin. Sakata, Baily, Doubleday, and Sarmast assisted with the preparation of this article.
Venezuelan Literature
Authors: Troconis Irina
Published: May 2019

This article presents an overview of some of the most representative and influential writers and works from Venezuela in the genre of novel, poetry, short story, and essay, from the 19th to the 21st century. Although Venezuela has a rich literary culture and critically acclaimed authors—such as Rómulo Gallegos, Arturo Uslar Pietri, and Miguel Otero Silva—whose works have become Latin American classics, the country’s literature has remained for the most part underread and understudied outside its frontiers. The reasons for this relative invisibility have been the focus of many debates among intellectuals both inside and outside Venezuela, who have pointed—not without criticism—to the writers’ almost exclusive reliance on national publishing houses, the impossibility of a recognizable literary identity, and the lack of noteworthy innovation as some of the reasons behind it. Nevertheless, since the mid-1990s, a renewed interest in Venezuelan literature has become palpable; international publishing houses have awarded prestigious awards to works by Venezuelan authors (Alberto Barrera Tyszka’s novel Patria o muerte was the winner of the XI Premio Tusquets Editores de Novela, and Rafael Cadenas’s extensive poetic work won him in 2016 the Premio Internacional de Poesía Federico García Lorca, to mention but a few), several new anthologies have been published, and symposiums and conferences drawing scholars from all over the world have been organized on the topic by prestigious international universities and organizations. This has partly been due to the political events that have taken place in the country since the arrival to power of Hugo Chávez, which have made Venezuela—and thus the literature written there—a “hot topic” among academic circles, both national and international. Furthermore, recent waves of emigration have brought Venezuelan authors to many universities abroad, where they have given the country’s literature more exposure, in many cases with the help of social media and other online platforms. In light of these events, this article offers a chronology of Venezuelan literature as a whole rather than constructing a separate chronology for each genre, and thus serves as an introduction to the authors and works that critics consider fundamental in the evolution of the country’s literary history. While theater has been excluded from this selection, two references have been included that give an overview of Venezuela’s abundant theatrical production and the important role it has played in shaping the country’s cultural and political identity.
Walter Van Tilburg Clark
Authors: Chisum Jeffrey
Published: May 2019

Walter Van Tilburg Clark (b. 1909–d. 1971) was born in Maine, but spent his formative years growing up in Reno, Nevada, where his father served as president of the University of Nevada. Clark’s body of work (notably The Ox-Bow Incident) established him as one of the preeminent writers of the American West during the middle of the 20th century (he was friends with Wallace Stegner, the “Dean of Western Writers”), and in 1988, he was one of the first writers inducted into the Nevada Writers Hall of Fame. Clark’s fiction blends elements of the genre western with a careful eye for the local landscape and a spiritual ambivalence toward nature. The Ox-Box Incident (1940), about a lynch mob that erroneously executes a trio of innocent men, is his best-known work (it was made into an Academy Award–nominated film in 1943), though it’s perhaps the least characteristic of his artistic concerns. Clark’s second novel, The City of Trembling Leaves (1945), is a Künstlerroman that details the growth and maturation of a young, budding composer named Tim Hazard. The novel is a powerfully evocative depiction of early-20th-century Reno, and the scene-setting, characterizations, and development of central themes are all expressive of Clark’s prowess as a fiction writer. His final two creative works—The Track of the Cat (1949) and The Watchful Gods and Other Stories (1950)—are arguably his best. The Track of the Cat is a tense, tightly wound novel about a marauding mountain lion which has been preying on the cattle of the isolated Bridger family, and which begins to prey upon the humans as well. The Watchful Gods, meanwhile, shows Clark’s range as a storyteller, with the title story being perhaps the purest and most focused narrative expression of his main thematic concerns (especially the spiritual connection between humans and the natural environment). Clark did not publish any fiction after The Watchful Gods. This dry spell, from one of the most promising writers of the American West, remains one of the great enigmas of Clark’s career. The secondary literature on Clark ranges from scholarly analysis to exploration of the narrative themes in his work to biographical and archival work. Generally speaking, Clark’s fiction is interpreted through the lens of western American literary criticism and history, with many scholars treating it as both an exemplar of and deviation from western generic conventions.
Indian Removal
Authors: Calcaterra Angela
Published: May 2019

“Indian Removal” refers to the forced migration of Indigenous communities from their homelands in what is currently the United States. It is often connected to a particular era (the 1820s and 1830s), federal policy (the Indian Removal Act), or event (the singular Trail of Tears). Yet dispossession from ancestral lands has been persistent and pervasive and is an ongoing, lived reality for many Indigenous people. From the first moments of their arrival in what they would call the Americas, Europeans expelled Native Americans and confiscated their lands for themselves. Natives lost not only land but also familial bonds, historical information, sites of religious significance, and ecological knowledge. Beginning with the Louisiana Purchase of 1803, in which the United States acquired a vast territory west of the Mississippi, federal efforts to compel Indians to exchange land holdings in the east for lands west of the Mississippi intensified. This practice developed into a political program of ethnic cleansing during the 1820s and 1830s, particularly under the presidency of Andrew Jackson. The Indian Removal Act of 1830 targeted the large southeastern nations (Cherokees, Chickasaws, Choctaws, Creeks, and Seminoles), but since those nations were forced into western territories its effects spread immediately across the Mississippi to tribes such as the Osages. Removal of western tribes onto reservations continued into the 20th century. Many lesser-known communities in the north, such as the Delawares, experienced multiple removals over centuries. The Delaware Tribe currently resides within the Cherokee Nation in Oklahoma, a forced positioning that has made it difficult for the Delawares to gain federal recognition. Today, the erasure of Indigenous presences and histories from the United States’ national consciousness contributes to public sentiment supporting ongoing forms of removal. Racist sports mascots, stereotypes in film and television, and societal ignorance of specific Native histories and cultures perpetuate the political and cultural marginalization of Indigenous people. It is thus important to recognize the “removal period” as one of immense suffering for the more well-known tribal nations, while also acknowledging removal’s deeper history and ongoing effects. Equally important, Indigenous communities and individuals have always protested and countered the many forms of removal with their own writings, media, cultural practices, and legal and political actions. As it documents scholarship and creative work on Indian Removal, this bibliography also attends to what Anishinaabe author Gerald Vizenor has termed “Native survivance . . . an active sense of presence over absence, deracination, oblivion.” It highlights the voices and presences of Indigenous authors, scholars, and activists who work to reclaim the past and reimagine the future.
Harvesting Alternative Water Resources (US West)
Authors: Randle Sayd
Published: May 2019

Since the mid-20th century, the western half of the United States has been known worldwide as a landscape marked by extraordinary water infrastructure. The semi-arid region’s enormous network of dams, reservoirs, and pipelines distributes its freshwater resources among an ever-growing population of residential, industrial, and agricultural users. Since the 1970s, however, growing environmental stresses and water demands have led many of the region’s water managers to look beyond the region’s rivers, lakes, and aquifers to expand the available supply. Wastewater and stormwater, substances previously approached as wastes or hazards in the region’s dominant management paradigms, are now increasingly understood as potential water resources. And saltwater, particularly the Pacific Ocean, is frequently cited as a potential solution to water supply stresses, particularly in densely populated coastal Southern California. The reassessment and exploitation of these waters entail regulatory, governance, political, infrastructural, and cultural challenges, as water managers and residents must rework the laws, institutions, and norms around these substances. Resistance to the new water sources has also arisen within the region, due to concerns about the safety, environmental impacts, and cost of their capture, cleaning, and distribution. This article draws on documents from a wide range of disciplines to explore the complicated (and at times, contentious) process of introducing these new supplies to the US West’s networks of water provision.
Education
Authors: Stambach Amy
Published: May 2019

Education in Africa refers to a number of social institutions and teaching practices, including government-run systems of schooling, religious instruction, and childhood socialization. Government-run systems of schooling follow a standardized timetable, curriculum, and examination system. European colonizers established schools to instruct and “civilize” Africans and, later, to educate a cadre of civil service personnel who would staff colonial offices. After independence, which occurred for most countries between 1956 and 1964, secondary school graduates and university-educated Africans often became government leaders of their countries. Religious instruction, as well as the many forms of child socialization and inculcation in Africa, pre-date government systems of schooling but increasingly have come to run parallel to them. Today, religious forms of schooling generally follow a timetable and include secular subjects. Literacy rates have improved, as has gender parity in primary schools, in that the number of girls and boys enrolled and able to read and write is roughly equal. Higher education is expanding rapidly in Africa, and student politics and student activism on campuses remain powerful forces, as they were in colonial times, for questioning political authority and foreign influences. As in all parts of the world, adults in Africa socialize children and youth into norms and practices, both through explicit instruction and through learning-by-doing everyday activities. The cultural forms these lessons take often derive from age-old rituals and stories that vary considerably across the continent. On the other hand, children and young people socialize themselves into new communities, often using social media to do so.
Capital accumulation when consumers are tempted by others’ consumption experience
Authors: Alonso-Carrera Jaime , Bouché Stéphane
Published: May 2019

We analyse how the influence of peer effects on self-control affects capital accumulation. We consider an overlapping generations model where individuals are tempted to take the economy-wide average consumption as an aspiration. Consumers exhibit a preference for self-control. They face a self-control problem, and observing each other’s consumption determines the individual’s capacity to deal with this problem. We show that temptation and self-control may either increase or decrease the accumulation of capital. The crucial point would be whether or not consumers take the consumption of the individuals belonging to the other living generations as a reference in forming their aspirations. This point also crucially determines the stability properties of the equilibrium paths.
Antibiotic Impregnated Catheter Coating Technique for Deep Brain Stimulation Hardware Infection: An Effective Method to Avoid Intracranial Lead Removal
Authors: Levi Vincenzo , Messina Giuseppe , Franzini Andrea , Laurenzio Nicola Ernesto Di , Franzini Angelo , Tringali Giovanni , Rizzi Michele
Published: May 2019

BACKGROUND

Few studies have proposed alternative salvage methods of deep brain stimulation (DBS) intracranial lead once the infection has already occurred.

OBJECTIVE

To assess the effectiveness of antibiotic impregnated catheter coverage of DBS leads in case of hardware infection.

METHODS

Patients with a hardware infection and consequent partial removal of extension and internal pulse generator (IPG) were reviewed. To diagnose an infection, criteria provided by the Guideline for Prevention of Surgical Site Infection were used. We compared the intracranial lead salvage rate between the group that underwent antibiotic catheter lead protection (group A) and the group that did not (group B).

RESULTS

A total of 231 DBS surgeries and 339 IPG replacements were performed from January 2012 to January 2017. Twenty-three hardware-related infections (4%) were identified. Nineteen patients (82.6%) underwent partial hardware removal with an attempt to spare intracranial lead. Of these, 8 patients (42.1%) had antibiotic catheter lead coverage (group A) while 11 patients (57.9%) did not receive any antibiotic protection (group B). At 6-mo follow-up, 6 patients had the extension and IPG successfully re-implanted in group A, whereas only 1 patient was successfully re-implanted in group B (75 vs 9.1%; P < .001)

CONCLUSION

The antibiotic impregnated catheter coating technique seems to be effective in avoiding intracranial lead removal in case of IPG or DBS extension-lead junction infection. This method does not require any surgical learning curve, it is safe and relatively inexpensive. Randomized, prospective, larger studies are needed to validate our results.
EXTERNAL DOSE RATE MONITORING IN FINLAND: HISTORY, EXPERIENCES AND A GLIMPSE AT THE FUTURE
Authors: Lahtinen J , Koivukoski J
Published: May 2019

Finland has a long history in monitoring external radiation. Regular monitoring began in the early 1960s when the first networks measuring exposure rates were established. Today the nation-wide network is fully automatic and consists of about 260 stations with Geiger-Műller (GM) tubes. Some 25 stations also have a LaBr3 spectrometer. In this article the authors describe the history, experiences and major development stages of the Finnish dose rate monitoring arrangements and also have a brief look at the possible future.
The Giving Up of Weekly Rest-Days by Migrant Domestic Workers in Singapore: When Submission Is Both Resistance and Victimhood
Authors: Schumann Margaret Fenerty , Paul Anju Mary
Published: May 2019

Why do so few live-in migrant domestic workers (MDWs) in Singapore utilize their weekly rest-day entitlement? Using data drawn from 3,886 online profiles of prospective MDWs and 40 interview sessions with MDWs, employers, and manpower agencies, we demonstrate how the industry encourages a “logic of submission” around rest-days. Through processual analysis, we unearth multiple, repeated moments of capitulation at key moments in a MDW’s work-life: (1) their interactions with a recruitment agency while still in their home country; (2) their matching with an overseas employer; (3) the duration of their two-year contract; and (4) the time of contract renewal. Submission to less frequent rest-days can secure their employability and financial mobility but also further individuates the MDW within the employer’s household and may lead to the engraining of a habitus of submissiveness towards their employers that can open the door to workers’ exploitation. We demonstrate how nationality and work experience further inflect this logic of submission to motivate non-Filipina and inexperienced MDWs to request even fewer rest-days than their counterparts. By combining feminist migration scholarship on Asian MDWs, with a sociology of law analysis, we offer up an example of how the same act of submission can simultaneously embody both resistance and victimhood depending upon the temporal and spatial scale used, and varying interpretations of the rest-day benefit as a much-needed respite, a monetizable benefit, or a signaling mechanism.
The Runaround: Punishment, Welfare, and Poverty Survival after Prison
Authors: Halushka John M
Published: May 2019

Based on 17 months of ethnographic fieldwork and 45 in-depth interviews with formerly-incarcerated men, this article explores how former prisoners navigate criminal justice and welfare bureaucracies in their daily lives. Formerly-incarcerated men must repeatedly engage with parole, public assistance agencies, transitional housing facilities, and community-based service providers to maintain freedom and access food, shelter, and rehabilitative services. Accessing resources requires the men simultaneously to manage multiple, overlapping entanglements across a fragmented network of bureaucracies. This runaround exacerbates the stress of poverty, breeds distrust of state authorities, and, in some cases, precipitates recidivism. Former prisoners learned how to cope with the runaround by treating systems navigation as a full-time occupation, but these skills did not translate into long-term economic security. Most study participants recurrently cycled between low-wage jobs, transitional housing facilities, and public assistance programs for years after release. This article illustrates the need to theorize prisoner reentry as a process that unfolds across a network of criminal justice and welfare bureaucracies and demonstrates how formerly-incarcerated men experience citizenship not only through coercive encounters with the criminal justice system but also through their simultaneous entanglements with safety-net bureaucracies.
Monophyly, Taxon Sampling, and the Nature of Ranks in the Classification of Orb-Weaving Spiders (Araneae: Araneoidea)
Authors: Kallal Robert J , Dimitrov Dimitar , Arnedo Miquel A , Giribet Gonzalo , Hormiga Gustavo
Published: May 2019

We address some of the taxonomic and classification changes proposed by Kuntner et al. (2019) in a comparative study on the evolution of sexual size dimorphism in nephiline spiders. Their proposal to recircumscribe araneids and to rank the subfamily Nephilinae as a family is fundamentally flawed as it renders the family Araneidae paraphyletic. We discuss the importance of monophyly, outgroup selection, and taxon sampling, the subjectivity of ranks, and the implications of the age of origin criterion to assign categorical ranks in biological classifications. We explore the outcome of applying the approach of Kuntner et al. (2019) to the classification of spiders with emphasis on the ecribellate orb-weavers (Araneoidea) using a recently published dated phylogeny. We discuss the implications of including the putative sister group of Nephilinae (the sexually dimorphic genus Paraplectanoides) and the putative sister group of Araneidae (the miniature, monomorphic family Theridiosomatidae). We propose continuation of the phylogenetic classification put forth by Dimitrov et al. (2017), and we formally rank Nephilinae and Phonognathinae as subfamilies of Araneidae. Our classification better reflects the understanding of the phylogenetic placement and evolutionary history of nephilines and phonognathines while maintaining the diagnosability of Nephilinae. It also fulfills the fundamental requirement that taxa must be monophyletic, and thus avoids the paraphyly of Araneidae implied by Kuntner et al. (2019).
Drug hypersensitivity in HIV infection
Authors: Peter Jonny , Choshi Phuti , Lehloenya Rannakoe J.
Published: May 2019

Purpose of review

Immune-mediated adverse drug reactions (IM-ADRs) are many times more common in HIV-infected patients. Usual offending drugs include antiretroviral and antiinfectives, but the burden of specific drug IM-ADRs is population-specific; changing as new and fixed dose combinations enter the market, and drug-resistance patterns demand. This review considers recent literature on epidemiology, mechanisms, clinical management and prevention of IM-ADRs amongst persons living with HIV/AIDS.

Recent findings

Epidemiological studies continue to describe high rates of delayed hypersensitivity to known offenders, as well as similar reactions in preexposure prophylaxis. IM-ADRs to oral and injectable integrase strand transfer inhibitors are reported with expanding use. The clinical spectrum and management of IM-ADRs occurring in HIV-infected populations is similar to uninfected; with exceptions such as a recently described severe delayed efavirenz DILI with high mortality. Furthermore, the context can be unique, such as the lower than expected mortality in a Stevens–Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) cohort from a HIV/TB high burden setting. Programmatic data showing the near complete elimination of Abacavir drug hypersensitivity syndrome following implementation of HLA-B57:01 screening is a stellar example of how prevention is possible with mechanistic insight.

IM-ADRs remain a challenge in persons living with HIV. The complexities posed by polypharmacy, overlapping drug toxicities, drug interactions, overlap of IM-ADRs with other diseases, limited alternative drugs, and vulnerable patients with advanced immunosuppression with high mortality, necessitate increased use of drug provocation testing, treat-through and desensitization strategies. There is an urgent need for improved diagnostics and predictive biomarkers for prevention, or to guide treat-through, rechallenge and desensitization approaches.
Dupilumab after the 2017 approval for the treatment of atopic dermatitis: what's new and what's next?
Authors: van der Schaft Jorien , Thijs Judith L. , de Bruin-Weller Marjolein S. , Balak Deepak M.W.
Published: May 2019

Purpose of review

The IL-4/13 antagonist dupilumab was approved in 2017 as the first biologic for atopic dermatitis. Here, we comprehensively review compelling new data regarding dupilumab published following the approval.

Recent findings

Daily clinical practice reports of dupilumab in atopic dermatitis are favorable and in line with the registration trials. Dupilumab does not appear to negatively affect pharmacokinetics of CYP450-metabolized drugs nor vaccination responses. Type 2 inflammation biomarkers in skin and serum are reduced following dupilumab treatment. Dupilumab increases the risk for conjunctivitis, especially with higher baseline atopic dermatitis severity and a history of conjunctivitis, but the underlying mechanisms are unknown. Favorable effects of dupilumab have been reported in treatment-recalcitrant hand eczema and prurigo nodularis cases; for allergic contact dermatitis and alopecia areata, there are conflicting responses to dupilumab, possible stemming from pathophysiological heterogeneity.

Daily practice data support the continued use of dupilumab for atopic dermatitis. The only safety signal is an increased risk for conjunctivitis; mechanistic studies into dupilumab-associated conjunctivitis should lead to risk mitigation strategies. Prospective, controlled evaluations are needed for dupilumab in hand eczema and prurigo nodularis. A precision medicine-driven drug-development approach is essential to assess dupilumab for diseases with heterogeneous pathophysiologies, such as alopecia areata and allergic contact dermatitis.
How Might Maternal Poverty Impact the Course of Neonatal Opioid Withdrawal Syndrome?
Authors: Wachman Elisha M.
Published: May 2019

Neonatal Opioid Withdrawal Syndrome (NOWS) is an increasing problem in the midst of the current opioid epidemic, frequently associated with pharmacologic treatment and prolonged hospitalizations. NOWS is a highly variable condition with many clinical and genetic variables contributing to the clinical course. Social variables such as maternal poverty remain understudied. In this commentary, we review one of the first studies of the association between maternal poverty and infant hospital length of stay in infants with NOWS. This has important implications for designing population level interventions to improve NOWS outcomes.
Trajectories of Pain Intensity Over 1 Year in Adults With Disabling Subacute or Chronic Neck Pain
Authors: Pico-Espinosa Oscar J. , Côté Pierre , Hogg-Johnson Sheilah , Jensen Irene , Axén Iben , Holm Lena W. , Skillgate Eva
Published: May 2019

Objectives:

The objectives of this study were to describe the 1-year trajectories of disabling subacute or persistent neck pain and to investigate whether baseline age, sex, pain characteristics, and depressive symptoms are associated with such trajectories.

Study Design and Setting:

Participants (n=617) included in a randomized controlled trial provided weekly pain intensity ratings by responding to text messages over 1 year. We used latent class mixed model analyses to identify clusters of individual trajectories. Thereafter, we used logistic regression to determine the association between baseline age, sex, pain characteristics, depressive symptoms and treatment, and trajectories of neck pain.

Results:

Six different clusters of trajectories were identified. Most participants (73%) followed a trajectory of decreasing pain throughout follow-up. The remaining experienced unfavorable trajectories: persistent pain of high intensity (22%) and slightly (3%) or highly (2%) fluctuating levels of pain reaching high levels of pain intensity. Pain intensity at baseline: odds ratio (OR): 3.76 (95% confidence interval [CI]: 2.49-5.68), depressive symptoms: OR: 3.46 (95% CI: 2.01-5.95), younger age: OR: 2.29 (95% CI: 1.48-3.54), female sex: OR: 1.51 (95% CI: 1.01-2.26), and sudden onset of pain: OR: 1.74 (95% CI: 1.13-2.69) were associated with unfavorable trajectories.

Conclusions:

Most individuals with disabling subacute or chronic neck pain show improvement in pain intensity over a year. However, a quarter present unfavorable trajectories. High pain intensity at baseline, depressive symptoms, younger age, female sex, and sudden onset of pain are factors associated with unfavorable trajectories.
Third Place Award: Characterization and incidence of occult posterior malleolar fractures
Authors: Gee Shawn , Harris Mitchell C. , Anderson Claude , Ryan Paul
Published: May 2019

Background:

Occult fractures of the posterior malleolus are often missed by primary care providers and radiologists. Delayed treatment of posterior malleolar fractures can be problematic because of the potential for malunion, arthritis, or instability. The incidence and characterization of missed posterior malleolar fractures has not been reported in the literature.

Methods:

A retrospective review was performed of all ankle fractures with CT scans from 2005 to 2015 at a single institution. Inclusion criteria included age older than 18 yr and posterior malleolar fracture as seen on CT scan. Exclusion criteria included distal tibial shaft fractures and pilon fractures. Forty-six patients were identified with the above criteria. Data collected included whether a fracture was missed on initial radiographs by a board-certified radiologist, and the size and angle of the posterior malleolar fragment.

Results:

Of the 46 patients with posterior malleolar fractures, nine (19.5%) were missed on the radiology report. Seven of 46 (15.2%) were not described on all plain films prior to the CT scan. Two of seven (28.6%) radiographically occult fractures underwent open reduction and internal fixation of the posterior malleolar fragment. The average angle of occult posterior malleolar fractures relative to the transmalleolar axis was quite variable, with an average of 17 degrees (SD 11 degrees, range −20 degrees to 50 degrees).

Conclusions:

With a 15% incidence of occult posterior malleolar fractures, a CT scan or multiple orthogonal views can be helpful to avoid missed fractures. Given the wide variability of fracture angle, a single external rotation view is unlikely to prevent all missed fractures on initial radiographic interpretations.

Level of Evidence:

Level III, retrospective cohort study.
Lumbar Spinal Stenosis and Degenerative Spondylolisthesis
Authors: Ilyas Haariss , Udo-Inyang Inyang , Savage Jason
Published: May 2019

The Spine Patient-Reported Outcomes Related Trial (SPORT) is arguably one of the most impactful and insightful studies conducted in spine surgery. Designed as a prospective, multicenter study with randomized and observational cohorts, SPORT has provided vast data on the pathogenesis, treatment effects, clinical outcomes, cost effectiveness of disk herniation, lumbar spinal stenosis, and degenerative spondylolisthesis. With regards to spinal stenosis and degenerative spondylolisthesis, SPORT has demonstrated a sustained benefit from surgical intervention at 2, 4, and 8 years postoperatively. Myriad subgroup analyses have subsequently been performed that have also resulted in clinically relevant findings. These analyses have assessed incidence and risk factors for reoperations and intraoperative complications, impact of patient comorbidities and host factors, influence of epidural injections, patient decision-making, and role of nonoperative therapy. This has resulted in significant findings that may allow spine surgeons to optimize patient outcomes while managing expectations appropriately.
Association of family history of tumors with clinicopathological characteristics and prognosis of colorectal cancer
Authors: Shan Tao , Chen Shuo , Chen Xi , Lin Wanrun , Li Wei , Ma Jiancang , Wu Tao , Cui Xijuan , Li Wang , Kang Ya’an , Yang Wenbin
Published: May 2019

To investigate the association of family history of malignant tumors with clinicopathological characteristics of colorectal cancer, and its effects on prognosis. We conducted a retrospective review of pathological and follow-up data of patients with colorectal cancer treated in our hospital from January 2010 to December 2015. Of 870 patients undergoing surgery, 737 received follow-up (84.7%). Among them, 192 (26.1%) were family history of malignant neoplasm-positive [MN-FH (+)] and 545 (73.9%) were family history of malignant neoplasm-negative [MN-FH (–)]. MN-FH (+) patients had earlier disease onset, smaller tumor diameter, lower rate of lymph node metastasis, and lower depth of invasion. There were significant differences in BMI between the groups (P<0.05) but no differences in sex or tumor differentiation grade (P>0.05). Rates of Her-2 and p53 protein expression in MN-FH (+) patients were 34.3 and 40.5%, respectively, compared with 22.2 and 26.3% in MN-FH (–) patients. In stage 3, significantly higher Her-2 and p53 protein expression rates were observed in MN-FH (+) than in MN-FH (–) patients. Fluorescence in-situ hybridization showed significantly higher Her-2 expression in MN-FH (+) than in MN-FH (–) patients. The 3 and 5-year overall survival, disease-free survival, and progression-free survival were significantly lower in MN-FH (+) than in MN-FH (−) patients (P<0.05). MN-FH (+) patients with colorectal cancer had earlier disease onset and smaller tumor area, lower invasion depth, a lower rate of lymph node metastasis, and earlier TNM tumor stage at diagnosis than MN-FH (–) patients. BMI value distribution significantly differed between groups. However, long-term prognosis was worse for MN-FH (+) than MN-FH (–) patients, suggesting that internal pathogenic genes play a more crucial role than external environmental factors in prognosis. Family history of tumors could be an independent prognostic factor for colon cancer.
Use of the Ciliation Index to Distinguish Invasive Melanoma From Associated Conventional Melanocytic Nevi
Authors: Lang Ursula E. , Love Nicholas R. , Cheung Christine , McCalmont Timothy H. , Kim Jinah
Published: May 2019

Our understanding of melanoma precursors and progression to melanoma has developed as a result of advances in the field of molecular diagnostics. We now better understand the potential for genetic heterogeneity within a single lesion. Combined tumors can pose a diagnostic challenge when deciding the line between benign and malignant, which in turn has direct implications for patient management. Primary cilia (PC) are ubiquitous sensory organelles that have essential functions in cellular proliferation, differentiation, and development. The ciliation index (percentage of ciliated melanocytes) has been shown to reliably differentiate melanoma, which fail to ciliate, from melanocytic nevi, which retain PC. We therefore analyzed the potential for using the ciliation index to differentiate benign and malignant components in combined melanocytic lesions. We collected patient samples (n = 10) of unequivocal combined lesions with both melanoma and associated nevus components. Melanocytes were highlighted with SOX10 and costained with gamma-Tubulin and acetylated alpha-Tubulin to highlight the basal body and cilium, respectively. The number of melanocytes retaining cilia under high-power microscopy was examined. The melanoma component had average of 4% ciliation (SD: 7%), whereas the associated nevus component was significantly higher with 59% ciliation (SD: 17%). These data show that PC may be a reliable means of distinguishing benign from malignant components within a single tumor. The ciliation index may be a helpful tool in distinguishing challenging cases of combined lesions of melanoma in situ with a dermal nevus component from invasive melanoma, thus promoting improved staging and clinical management.
Women's Health Initiative clinical trials: potential interactive effect of calcium and vitamin D supplementation with hormonal therapy on cardiovascular disease
Authors: Jiang Xuezhi , Nudy Matthew , Aragaki Aaron K. , Robbins John A. , Manson JoAnn E. , Stefanick Marcia L. , O'Sullivan David M. , Shikany James M. , LeBlanc Erin S. , Kelsey Anita M. , Cauley Jane , Martin Lisa W. , Payne Martha E. , Johnson Karen C. , Howard Barbara , Schnatz Peter F.
Published: May 2019

Objective:

Data in humans and nonhuman primates have suggested a possible synergistic effect of vitamin D and calcium (CaD) and estrogen on the cardiovascular disease (CVD) risk factors. Using randomized trial data we explored whether the effect of menopausal hormone therapy (HT) on CVD events is modified by CaD supplementation.

Methods:

A prospective, randomized, double-blind, placebo-controlled trial was implemented among postmenopausal women in the Women's Health Initiative. A total of 27,347 women were randomized to the HT trials (0.625 mg/d of conjugated equine estrogens [CEE] alone for women without a uterus vs placebo; or 0.625 mg of CEE in addition to 2.5 mg of medroxyprogesterone acetate daily [CEE + MPA] for women with a uterus vs placebo). After 1 year, 16,089 women in the HT trial were randomized to the CaD trial and received either 1,000 mg of elemental calcium carbonate and 400 IU of vitamin D3 daily or placebo. The mean (SD) duration of follow-up after CaD randomization was 6.2 (1.3) years for the CEE trial and 4.6 (1.1) years for the CEE + MPA trial. CVD and venous thromboembolism events evaluated in this subgroup analysis included coronary heart disease, stroke, pulmonary embolism, all-cause mortality, plus select secondary endpoints (total myocardial infarction, coronary revascularization, deep venous thrombosis, cardiovascular death, and all CVD events). Time-to-event methods were used and models were fit with a Cox proportional hazards regression model.

Results:

In the CEE trial, CaD significantly modified the effect of CEE on stroke (P interaction = 0.04). In the CaD-placebo group, CEE's effect on stroke was harmful (hazard ratio [95% confidence interval] = 2.19[1.34-3.58]); however, it was neutral in the CaD-supplement group (hazard ratio [95% confidence interval] = 1.07[0.66-1.73]). We did not observe significant CEE-CaD interactions for coronary heart disease, total CVD events, or any of the remaining endpoints. In the CEE + MPA trial, there was no evidence that the effect of CEE + MPA on any of CVD endpoints was modified by CaD supplementation.

Conclusions:

CaD did not consistently modify the effect of CEE therapy or CEE + MPA therapy on CVD events. However, the increased risk of stroke due to CEE therapy appears to be mitigated by CaD supplementation. In contrast, CaD supplementation did not influence the risk of stroke due to CEE + MPA.
Emotional Intelligence and Burnout in Plastic Surgery Residents: Is There a Relationship?
Authors: Bin Dahmash Abdulmajeed , Alhadlaq Abdulmajeed S. , Alhujayri Abdulaziz K. , Alkholaiwi Feras , Alosaimi Nawaf A.
Published: May 2019

Background:

The specific role of emotional intelligence (EI) in the field of plastic surgery has not been investigated. We aim to investigate the relationship between EI and the individual components of burnout among plastic surgery residents in Saudi Arabia.

Methods:

In this cross-sectional study, all plastic surgery residents (n = 37) in Riyadh, Saudi Arabia, were invited to participate in a questionnaire based study in March 2018. The survey contained a validated measure of burnout (Maslach Burnout Inventory-Human Services Survey), validated measure of EI (Trait Emotional Intelligence Questionnaire-Short Form), and evaluated residents’ demographics, professional and personal risk factors, and career satisfaction.

Results:

The overall rate of high burnout was 37.9%, with 72.4% residents reporting high level of emotional exhaustion (EE), 41% reporting high depersonalization (DP) and 41% reporting low sense of personal accomplishment (PA). EI has shown to have a significant negative relationship with EE (95% confidence interval CI, −9.061 to −1.374; P = 0.010), DP (95% CI, −5.747 to −1.974; P < 0.001), and a significant positive correlation with PA (95% CI, 1.398–5.439; P = 0.002). Significant risk factors for burnout included dissatisfaction with plastic surgery as a career choice, dissatisfaction with income, and dissatisfaction with the role in the operating room (P < 0.05).

Conclusions:

We found a positive correlation between higher levels of EI and sense of personal achievement, whereas a negative correlation was observed between higher level of EI and EE and DP among the residents in this study. Plastic surgery residents who are satisfied with their salary have lower EE and DP. Residents who are satisfied with their role in the operating room have a better sense of PA.