bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of Topical Recombinant Human Epidermal Growth Factor for Treatment of Diabetic Foot Ulcer
Authors: Yang Shaowei , Geng Zhijun , Ma Kui , Sun Xiaoyan , Fu Xiaobing
Published: May 2016

Diabetic foot ulceration is a major complication of diabetes mellitus. Recombinant human epidermal growth factor (rhEGF) is used topically in the treatment of diabetic foot ulcers. This meta-analysis was designed to evaluate if rhEGF increased the complete healing rate of diabetic foot compared with controls. We searched the MEDLINE, Cochrane Library, EMBASE, and Web of Knowledge databases (up to December 22, 2015). Studies were identified and selected, and data were extracted by 2 independent reviewers. A total of 4 randomized controlled trials including 294 patients were identified. The studies evaluated the rate of healing of diabetic foot that were treated with rhEGF or controls. On account of study heterogeneity, a random-effects model was performed, and the combined odds ratio (OR) indicated a significantly greater complete healing rate in patients treated with rhEGF compared to placebo. The ORs ranged from 1.66 to 14.64, with a combined OR of 4.36 (95% confidence interval = 1.48-12.81, P = .007). These results indicate that rhEGF is efficacious in the treatment of diabetic foot ulcers by increasing the rate of wound healing. These findings support the use of rhEGF in treating diabetic foot.
Evaluation of Physical Examination Tests for Thumb Basal Joint Osteoarthritis
Authors: Model Zina , Liu Andrew Y. , Kang Lana , Wolfe Scott W. , Burket Jayme C. , Lee Steve K.
Published: May 2016

Background: We compare the ability of 3 diagnostic tests to reproduce the pain of basilar joint arthritis (BJA): the grind test, the lever test (grasping the first metacarpal just distal to the basal joint and shucking back and forth in radial and ulnar directions), and the metacarpophalangeal extension test. Methods: Sixty-two patients with thumb BJA were enrolled. The 3 tests were performed in a random order on both hands of each patient. Prior to testing, patients reported their typical pain level and subsequently rated their pain after each test on a 0 to 10 scale, also specifying the extent to which the test reproduced their thumb pain (fully, partially, not at all). All patients had radiographs that displayed basal joint arthritis. A test was defined as positive for BJA if pain produced was greater than 0. Sensitivity and specificity for each test were calculated using the patients’ history of pain localized to the basal joint and BJA diagnosis on radiographs as the gold standard. Results: The lever test produced the greatest level of pain and best reproduced the presenting pain. The lever test also had the highest sensitivity, high specificity, and the lowest false-negative rate. The grind test had the lowest sensitivity, highest specificity, and highest false-negative rate. Conclusions: The lever test was the diagnostic test that best reproduced the pain caused by thumb basal joint osteoarthritis. We recommend using the lever physical examination test when evaluating the patient with suspected basal joint osteoarthritis. The often-quoted grind test is of limited diagnostic value.
Predictive Factors of Neurovascular and Tendon Injuries Following Dog Bites to the Upper Extremity
Authors: Alluri Ram K. , Pannell William , Heckmann Nathanael , Sivasundaram Lakshmanan , Stevanovic Milan , Ghiassi Alidad
Published: May 2016

Background: Dog bite injuries to the upper extremity can result in traumatic neurovascular and musculotendinous damage. Currently, there are no clear guidelines dictating which patients may benefit from early operative exploration. The purpose of this study was to identify clinical variables that were predictive of abnormal intraoperative findings in patients who sustained an upper extremity dog bite injury. Methods: All patients who presented to a level I trauma center between 2007 and 2015 with an upper extremity dog bite injury who underwent subsequent surgical exploration were retrospectively screened for inclusion in our study. Patients with inadequate documentation or preexisting neurovascular or motor deficits were excluded. Abnormalities on physical exam and injuries encountered during surgical exploration were recorded for each patient. Contingency tables were constructed comparing normal and abnormal nerve, tendon, and vascular physical exam findings with intact or disrupted neurovascular and musculotendinous structures identified during surgical exploration. Results: Between 2007 and 2014, 117 patients sustained a dog bite injury to the upper extremity, of which 39 underwent subsequent surgical exploration and were included in our analysis. Sixty-nine percent of patients with neuropraxia on exam had intraoperative nerve damage. Seventy-seven percent of patients with an abnormal tendon exam had intraoperative musculotendinous damage. One hundred percent of patients with an abnormal vascular physical exam had intraoperative arterial injury. Conclusions: To date, there are no clear guidelines on what clinical criteria indicate the need for operative exploration and possible repair of neurovascular structures in upper extremity dog bite injuries. In our study, nerve, tendon, and vascular abnormalities noted on physical exam were strongly predictive of discovering neurovascular and musculotendinous damage during surgical exploration.
Longitudinal Outcomes Following a Randomized Controlled Trial of Dynamic Splint Stretching for Carpal Tunnel Syndrome
Authors: Willis F. Buck , Fowler Brook
Published: May 2016

Background: The incidence of carpal tunnel syndrome (CTS) is 48 million patients in the United States. The purpose of this longitudinal study was to determine whether Dynasplint stretching (immediately after diagnosis) had an effect on a patient’s decision to seek surgical treatment for CTS. Methods: Fifty patients (10 men, 40 women, mean age 51.2 ± 12 years) were recruited for this randomized, controlled, longitudinal trial. Patients were diagnosed with CTS by physical examination and nerve conduction studies. The intervention used was Dynasplint stretching that delivered a prolonged duration of low load stretching. Patients who were randomly chosen for the Experimental category wore the device for two 30-minute sessions per day with regular increases in splint tension for 60 days. Control patients received nonsteroidal anti-inflammatory medication plus instructions on daily home stretching. Results: The final, longitudinal outcome showed a 72% reduction in surgery chosen by the experimental group (n = 25), compared with 38% reduction for control patients (n = 25). Conclusions: Immediate treatment with Dynasplint stretching showed a 2 to 1 reduction in surgery, with abundant financial savings.
Efficient Construction of Volar Wrist Splints
Authors: Meals Clifton , Castro Nathan J. , Moss David
Published: May 2016

Background: The aim was to test the null hypothesis that splint material, thickness, or longitudinal ridging does not affect the strength of a wrist splint. Methods: Ten splints were made according to each of 7 different splint designs (resulting in 7 groups of 10 splints each). All splints were the same length and were molded to approximate the contour of the volar hand, wrist, and forearm with the wrist in neutral. Three groups consisted of plaster splints of different thicknesses (8, 10, and 12 ply). Three additional groups included splints of the same thicknesses but with a longitudinal ridge. A single group was constructed from prefabricated fiberglass splinting material and did not involve a longitudinal ridge. Five splints in each group were subjected to 3-point bending mimicking flexion of the wrist and 5 were subjected to a 3-point bend mimicking wrist extension. Splints were loaded to failure using a servohydraulic load frame. Analysis of variance was used to compare splints. Results: Among the plaster splints, more layers of material and longitudinal ridging increased splint strength. Ridged 8-ply plaster splints exceeded the strength of nonridged 10-ply plaster splints. Ridged 8-ply plaster splints were similar in strength to fiberglass splints. Conclusions: The 8-ply ridged plaster splints may be a lighter, effective, and cheaper alternative to more common splint designs.
Trends in the Level of Evidence in Clinical Hand Surgery Research
Authors: Sugrue Conor M. , Joyce Cormac W. , Sugrue Ryan M. , Carroll Sean M.
Published: May 2016

Background: The application of evidence-based medicine (EBM) to the practice of hand surgery has been limited. Production of high-quality research is an integral component of EBM. With considerable improvements in the quality evidence in both orthopedic and plastic and reconstructive surgery, it is imperative that hand surgery research emulates this trend. Methods: A systematic review was performed on all hand surgery articles published in 6 journals over a 20-year period. The journals included Plastic and Reconstruction Surgery, Journal of Plastic, Reconstructive and Aesthetic Surgery, Journal of Hand Surgery–European Volume, Journal of Hand Surgery–American Volume, Journal of Bone & Joint Surgery, and the Bone & Joint Journal. The level of evidence of each article was determined using the Oxford level of evidence. The quality of methodology of randomized controlled trials (RCTs) was assessed using Jadad scale. Statistical analysis involved chi-squares and Student t test ( P < .05). Results: A total of 972 original hand surgery research articles were reviewed. There was a significant increase in the average level of evidence of articles published between1993 and 2013. High-quality evidence only accounted for 11.2% of evidence published, with a significant increase over the study period ( P = 0.001). Quantitative evaluation of the 26 published RCTs, using Jadad scale, revealed a progressive improvement in study design from 0.3 in 1993 to 3.33 in 2013. Conclusions: Hand surgery research has mirrored trends seen in other surgical specialties, with a significant increase in quality of evidence over time. Yet, high-quality evidence still remains infrequent.
Comparison of Dorsal Plate Fixation Versus Intramedullary Headless Screw Fixation of Unstable Metacarpal Shaft Fractures
Authors: Melamed Eitan , Hinds Richard M. , Gottschalk Michael B. , Kennedy Oran D. , Capo John T.
Published: May 2016

Background: Recently, intramedullary headless screw (IMHS) has shown promise as an alternative to dorsal plate fixation of metacarpal fractures. The purpose of this study was to assess the biomechanical performance of IMHS versus plating. We hypothesized that IMHS fixation provides inferior stability to plating. Methods: Metacarpal fracture model with 3-mm of volar gapping in forty-four human cadaveric metacarpals was created. The specimens were divided into 5 groups: Group 1, 1.5-mm non-locking plate; Group 2, 1.5-mm locking plate; Group 3, 2.0-mm non-locking plate; Group 4, 2.0-mm locking plate; and Group 5, 2.4-mm short cannulated IMHS. A 4-point bending model was used to assess load-to failure (LTF) and stiffness. Results: Mean LTF was 364 ± 130 N for 1.5-mm non-locking plates, 218 ± 94 N for 1.5-mm locking plates, 421 ± 86 N for 2.0-mm non-locking plates, 351 ± 71 N for 2.0-mm locking plates, and 75 ± 20 N for IMHS. Mean stiffness was 91 ± 12 N/mm for 1.5-mm non-locking plates, 110 ± 77 N/mm for 1.5-mm locking plates, 94 ± 20 N/mm for 2.0-mm non-locking plates, 135 ± 16 N/mm for 2.0-mm locking plates, and 55 ± 15 N/mm for IMHS. IMHS demonstrated significantly lower LTF and stiffness than plates. Conclusions: IMHS fixation of unstable metacarpal shaft fractures offers less stability compared to plating when loaded in bending. The LTF and stiffness of IMHS versus plating of metacarpal shaft fractures has not been previously quantified. Our results reveal that IMHS fixation is less favorable biomechanically and should be carefully chosen in regards to fracture stability.
Performance Outcomes After Metacarpal Fractures in National Basketball Association Players
Authors: Guss Michael S. , Begly John P. , Ramme Austin J. , Hinds Richard M. , Karia Raj J. , Capo John T.
Published: May 2016

Background: The aim was to determine whether players in the National Basketball Association (NBA) who sustain metacarpal fractures demonstrate decreased performance upon return to competition when compared with their performance before injury and that of their control-matched peers. Methods: Data for 32 NBA players with metacarpal fractures incurred over 11 seasons (2002-2003 to 2012-2013) were obtained from injury reports, press releases, and player profiles ( www.nba.com and www.basketballreference.com ). Player age, body mass index (BMI), position, shooting hand, number of years in the league, and treatment (surgical vs nonsurgical) were recorded. Individual season statistics for the 2 seasons immediately prior to injury and the 2 seasons after injury, including player efficiency rating (PER), were obtained. Thirty-two controls matched by player position, age, and performance statistics were identified. A performance comparison of the cohorts was performed. Results: Mean age at the time of injury was 27 years with an average player BMI of 24. Players had a mean 5.6 seasons of NBA experience prior to injury. There was no significant change in PER when preinjury and postinjury performances were compared. Neither injury to their shooting hand nor operative management of the fracture led to a decrease in performance during the 2 seasons after injury. When compared with matched controls, no significant decline in performance in PER the first season and second season after injury was found. Conclusion: NBA players sustaining metacarpal fractures can reasonably expect to return to their preinjury performance levels following appropriate treatment.
The Diagnosis and Management of Mallet Finger Injuries
Authors: Lamaris Gregory A. , Matthew Michael K.
Published: May 2016

Background: Mallet finger is a common injury of the extensor tendon insertion causing an extension lag of the distal interphalangeal joint. Methods: We reviewed the most current literature on the epidemiology, diagnosis, and management of mallet finger injuries focusing on the indications and outcomes of surgical intervention. Results: Nonoperative management has been advocated for almost all mallet finger injuries; however, complex injuries are usually treated surgically. There is still controversy regarding the absolute indications for surgical intervention. Conclusions: Although surgery is generally indicated in the case of mallet fractures involving more than one-third of the articular surface as well as in all patients who develop volar subluxation of the distal phalanx, a significant advantage of surgical management even in those complicated cases has yet to be clearly proven.
Surgical Approach and Anesthetic Modality for Carpal Tunnel Release
Authors: Foster Brock D. , Sivasundaram Lakshmanan , Heckmann Nathanael , Cohen Jeremiah R. , Pannell William C. , Wang Jeffrey C. , Ghiassi Alidad
Published: May 2016

Background: Carpal tunnel release (CTR) is commonly performed for carpal tunnel syndrome once conservative treatment has failed. Operative technique and anesthetic modality vary by surgeon preference and patient factors. However, CTR practices and anesthetic trends have, to date, not been described on a nationwide scale in the United States. Methods: The PearlDiver Patient Records Database was used to search Current Procedural Terminology codes for elective CTR from 2007 to 2011. Anesthetic modality (eg, general and regional anesthesia vs local anesthesia) and surgical approach (eg, endoscopic vs open) were recorded for this patient population. Cost analysis, patient demographics, regional variation, and annual changes in CTR surgery were evaluated. Results: We identified 86 687 patients who underwent carpal tunnel surgery during this 5-year time period. In this patient sample, 80.5% of CTR procedures were performed using general or regional anesthesia, compared with 19.5% of procedures performed using local anesthesia; 83.9% of all CTR were performed in an open fashion, and 16.1% were performed using an endoscopic technique. Endoscopic surgery was on average $794 more expensive than open surgery, and general or regional anesthesia was $654 more costly than local anesthesia. Conclusions: In the United States, open CTR under local anesthesia is the most cost-effective way to perform a CTR. However, only a small fraction of elective CTR procedures are performed with this technique, representing a potential area for significant health care cost savings. In addition, regional and age variations exist in procedure and anesthetic type utilized.
Monitoring activity of inpatient lower limb prosthetic users in rehabilitation using accelerometry: Validation study
Authors: Salih Salih A , Peel Nancye M , Burgess Kara
Published: May 2016

Purpose

Due to limited accuracy of self-reported activities of lower limb prosthetic users, there is increasing interest in providing accurate walking time for those who are mobilising using their prosthesis in the rehabilitation ward. The aim of this study was to test the accuracy of a tri axial accelerometer (ActivPAL) in measuring walking activity of amputee patients while using their prosthetic limb.

Method

For the study, 21 subjects wore accelerometer devices taped to the thigh on both the amputated and non-amputated side. Each subject was asked to perform a set of activity routines: walking with prosthesis for 5 minutes, self-propelling in a wheel chair for 3 minutes and being pushed in a wheel chair for 3 minutes. Each activity was observed and timed by a physiotherapist and the observed times were compared with the output from accelerometer monitoring.

Results

Using the Bland–Altman method, the mean difference between observed and ActivPal monitor for total time spent walking for the non-amputated side was 0.004 seconds (limits of agreement −0.09 to 0.10 seconds) and for amputated side was 0.11 seconds (limits of agreement −0.43 to 0.66 seconds). An analysis between monitored and observed time found the sensitivity for the non-amputated side was 90.5% and 86% for the amputated side.

Conclusion

The use of ActivPAL accelerometers in measuring walking time for an individual using a prosthesis is within acceptable levels of accuracy for continuous ambulation monitoring. It has potentially important clinical application for prescribing prostheses.
Small-vessel occlusion versus large-artery atherosclerotic strokes in diabetics: Patient characteristics, outcomes, and predictors of stroke mechanism
Authors: Ntaios G , Milionis H , Vemmos K , Makaritsis K , Ferrari J , Strbian D , Curtze S , Tatlisumak T , Michel P , Papavasileiou V
Published: May 2016

Introduction

Diabetes mellitus exerts a detrimental effect on cerebral vasculature affecting both macrovasculature and microvasculature. However, although ischaemic stroke is typically included among macrovascular diabetic complications, it is frequently omitted from microvascular diabetic complications. We aimed to compare the proportion of large-artery atherosclerotic and small-vessel occlusion strokes among diabetic stroke patients, explore their differences and outcomes, and assess potential mechanisms which may determine why some diabetic patients suffer large-artery atherosclerotic stroke whereas others suffer small-vessel occlusion stroke.

Methods

We pooled data of diabetic patients from four prospective ischaemic stroke registries (Acute Stroke Registry and Analysis of Lausanne (ASTRAL), Athens, Austrian, and Helsinki Stroke Thrombolysis Registries). Stroke severity and prognosis were assessed with National Institutes of Health Stroke Scale (NIHSS) and ASTRAL scores, respectively; functional outcome with three-month modified Rankin score (0–2 considered as favourable outcome). Logistic-regression analysis identified independent predictors of large-artery atherosclerotic stroke.

Results

Among 5412 patients, 1069 (19.8%) were diabetics; of them, 232 (21.7%) had large-artery atherosclerotic and 205 (19.2%) small-vessel occlusion strokes. Large-artery atherosclerotic stroke had higher severity than small-vessel occlusion stroke (median NIHSS: 6 vs. 3, p < 0.001), worse prognosis (median ASTRAL score: 23 vs. 19, p < 0.001), and worse three-month outcome (60.3% vs. 83.4% with favourable outcome, p < 0.001). In logistic-regression analysis, peripheral artery disease (odds ratio: 4.013, 95% confidence interval: 1.667–9.665, p < 0.01) and smoking (odds ratio: 1.706, 95% confidence interval: 1.087–2.675, p < 0.05) were independently associated with large-artery atherosclerotic strokes.

Conclusion

In the diabetic stroke population, small-vessel occlusion and large-artery atherosclerotic strokes occur with similar frequency. Large-artery atherosclerotic strokes are more severe and have worse outcome than small-vessel occlusion strokes. The presence of peripheral artery disease and smoking independently predicted large-artery atherosclerotic stroke.
Bypassing primary stroke centre reduces delay and improves outcomes for patients with large vessel occlusion
Authors: Mohamad Niwar Faisal , Hastrup Sidsel , Rasmussen Mads , Andersen Mikkel Strømgaard , Johnsen Søren Paaske , Andersen Grethe , Simonsen Claus Ziegler
Published: May 2016

Objective

In large-vessel occlusion, endovascular therapy is superior to medical management alone in achieving recanalisation. Reducing time delays to revascularisation in patients with large-vessel occlusion is important to improving outcome.

Patients and methods

A campaign was implemented in the Central Denmark Region targeting the identification of patients with large-vessel occlusion for direct transport to a comprehensive stroke centre. Time delays and outcomes before and after the intervention were assessed.

Results

A total of 476 patients (153 pre-intervention and 323 post-intervention) were included. They were treated with either intravenous tissue plasminogen activator or endovascular treatment (alone or in combination with intravenous tissue plasminogen activator). Endovascular therapy patients’ median system delay was reduced from 234 to 185 min (adjusted relative risk delay 0.79 (95% confidence interval: 0.67–0.93)). The in-hospital delay was the main driver with an adjusted relative risk delay of 0.76 (confidence interval: 0.62–0.94), while pre-hospital delay was almost significantly reduced with an adjusted relative delay of 0.86 (confidence interval: 0.71–1.04). This was achieved without increasing the intravenous tissue plasminogen activator-treated patients’ delay. Significantly more patients treated with endovascular therapy in the post-interventional period achieved functional independence (62% versus 43%), corresponding to an adjusted odds ratio of 3.08 (95% confidence interval: 1.08–8.78).

Conclusion

Direct transfer of patients with suspected large-vessel occlusion to a comprehensive stroke centre leads to shorter treatment times for endovascular therapy patients and is, in turn, associated with an increase in functional independence. We recorded no adverse effects on intravenous tissue plasminogen activator treatment times or outcome.
How I treat mycosis fungoides and Sézary syndrome
Authors: Whittaker Sean , Hoppe Richard , Prince H. Miles
Published: May 2016

Mycosis fungoides (MF) is the most common primary cutaneous T-cell lymphoma variant and is closely related to a rare leukemic variant, Sézary syndrome (SS). MF patients at risk of disease progression can now be identified and an international consortium has been established to address the prognostic relevance of specific biologic factors and define a prognostic index. There are a lack of randomized clinical trial data in MF/SS and evidence is based on a traditional “stage-based” approach; treatment of early-stage disease (IA-IIA) involves skin directed therapies which include topical corticosteroids, phototherapy (psoralen with UVA or UVB), topical chemotherapy, topical bexarotene, and radiotherapy including total skin electron beam therapy. Systemic approaches are used for refractory early-stage and advanced-stage disease (IIB-IV) and include bexarotene, interferon α, extracorporeal photopheresis, histone deacetylase inhibitors, and antibody therapies such as alemtuzumab, systemic chemotherapy, and allogeneic transplantation. However, despite the number of biologic agents available, the treatment of advanced-stage disease still represents an unmet medical need with short duration of responses. Encouragingly, randomized phase 3 trials are assessing novel agents, including brentuximab vedotin and the anti-CCR4 antibody, mogamulizumab. A broader understanding of the biology of MF/SS will hopefully identify more effective targeted therapies.
Cadherin2/4-signaling via PTP1B and catenins is critical for nucleokinesis during radial neuronal migration in the neocortex
Authors: Martinez-Garay Isabel , Gil-Sanz Cristina , Franco Santos J , Espinosa Ana , Molnár Zoltán , Mueller Ulrich
Published: May 2016

Cadherins are critical for the radial migration of excitatory projection neurons into the developing neocortical wall. However, the specific cadherins and the signaling pathways that regulate radial migration are not well understood. Here we show that cadherin 2 (CDH2) and CDH4 cooperate to regulate radial migration via the protein tyrosine phosphatase 1B (PTP1B) and α- and β-catenins. Surprisingly, perturbation of cadherin-mediated signaling does not affect the formation and extension of leading processes of migrating neocortical neurons. Instead, movement of the cell body and nucleus (nucleokinesis) is disrupted. This defect is partially rescued by overexpression of LIS1, a microtubule associated protein that has previously been shown to regulate nucleokinesis. Taken together our findings indicate that cadherin-mediated signaling to the cytoskeleton is critical for nucleokinesis of neocortical projection neurons during their radial migration.
Product Line Extension in Consumer Software Markets in the Presence of Free Alternatives
Authors: Baird Aaron , Miller Chadwick J. , Raghu T. S. , Sinha Rajiv K.
Published: May 2016

Hypercompetitive consumer software markets pit incumbents against free alternatives and pirates. Although the extant literature has studied firm level strategic responses to consumer heterogeneity and piracy, there is a lack of understanding of consumer reactions to digital goods choice sets that include firm product extensions such as the introduction of premium or free alternatives. With context-dependent preferences as the theoretical basis, this study systematically examines the impact of piracy controls and product line extensions on welfare in a consumer software market context (i.e., willingness to pay (WTP) and changes in consumer and producer surplus). In two controlled experiments using double-bound-dichotomous-choice WTP elicitation, we investigate how piracy controls and product line extensions impact two different platforms of the same software (PC Adobe applications and mobile Adobe applications) in terms of propensity to pirate and WTP. We show that introducing a premium or free vertical extension has different impacts on consumers’ WTP for the focal product depending on whether it is a low-cost or high-cost market even when controlling for individual differences, such as price fairness perceptions, product feature value, brand perceptions, etc. By contrast, piracy controls reduce piracy rates but have a limited impact on consumer WTP for the focal product in both contexts. By calculating the overall welfare of the market, we show that there is alignment in consumer and producer interests at current and estimated optimal price levels in both high-cost and low-cost markets. However, the introduction of a free product extension leads to a higher surplus in the high-cost market, whereas the introduction of the premium product extension leads to a higher surplus in the low-cost market.
Education in Emergencies: Case of a Community School for Syrian Refugees
Authors: Hos Rabia
Published: May 2016

With the break of the civil war in Syria, many Syrians have been displaced either internally or as refugees. Turkey, one of the leading host of Syrian refugees, has made changes to the policies to accommodate the needs of Syrians. Education is one of the most prominent needs of displaced refugee children. While 80 percent of refugee children living in camps have access to formal education, only small number of children living outside the camps are attending schools. With the increased number of children, many of the governmental organizations, municipalities, and NGOs have been involved in an effort to establish schools for Syrian refugee children living outside of the camps. This article reports the results of a study conducted at a newly established host community school for Syrian refugee children in the City of Gaziantep during the 2014-2015 school year. The aim of the study was to look at the experiences of administrators, teachers, and a parent who were involved in the establishment of the schools. The study made use of qualitative case study methodology, where interviews, focus group, and field notes were the data sources. The results of the study indicated that there were many systematic challenges involved in the establishment of the school, but nevertheless the teachers, administrators and the parents were happy to have the opportunity to be involved in this effort. The curriculum used in the school provided cultural relevance for the students and made their transition to the context easier. Although the school was established with support from the municipality for that year, there were not solid plans in place to provide sustainability of the school. This study provides a unique insight into the current status of Syrian refugee children living in Turkey and should serve as a bridge to policy makers in designing educational programs for refugees.
The Pulled Back View: The Illustrated Life of Ippen and the Visibility of Karma in Medieval Japan
Authors: Foxwell Chelsea
Published: May 2016

The Ippen hijiri-e (Illustrated Life of the Holy Man Ippen, 1299) by En'i is distinctive among medieval Japanese hagiographic emaki (picture handscrolls) for its use of a high, distant vantage point in each of the forty-eight scenes. This article situates the Ippen within the development of the landscape handscroll in East Asia. While the Ippen is usually understood as a biographical narative, it can also be seen as an ink landscape journey in handscroll form. A comparison between the Ippen hijiri-e, the Shōjūraigoji Six Realms paintings (before 1307), and the Yamai no sōshi (Scroll of Afflictions, 12th–13th centuries) suggests that the pulled back view also emphasizes the karmic interweaving of actions and individuals in the larger world.
Painted Palm-Leaf Manuscripts and the Art of the Book in Medieval South Asia
Authors: Kim Jinah
Published: May 2016

What was the main principle behind the design strategies developed to prepare painted palm-leaf manuscripts in medieval South Asia? How did various Indic religious communities design their manuscripts? By bringing together surviving painted manuscripts of heterogeneous religious traditions as well as contemporaneous sculptural representations and textual sources relating to the ritual practices involving books, this study suggests that a book was conceived and designed as a temple in Indic context. Taking innovative design strategies of twelfth-century Buddhist manuscripts as a starting point, it also demonstrates how a larger, architectural approach can help us better understand the art of the book in India.
Made by the Empire: Wang Xizhi's Xingrangtie and Its Paradoxes
Authors: Kern Martin
Published: May 2016

The essay explores the history of one of the most celebrated pieces of Chinese calligraphy, an early Tang tracing copy of Ritual to Pray for Good Harvest (Xingrangtie) by Wang Xizhi (303–ca. 361). The Tang paper slip with its fifteen characters is merely 8.9 cm wide but embedded into a scroll of 372 cm, with seals and colophons from three Chinese emperors and an illustrious line of connoisseurs. The essay explores the numerous paradoxes in the reception of both the scroll and the Wang Xizhi persona, with the scroll exemplifying the constructed nature of Wang's persona in its dialectic relationship to Chinese imperial culture.
Obscuring the Line between the Living and the Dead: Mortuary Activities inside the Grave Chambers of the Eastern Han Dynasty, China
Authors: Ligang Zhou
Published: May 2016

abstract:
The complex mortuary rituals practiced during the Han dynasty (206 b.c. to a.d. 220) in China are well documented in textual records dating to the period. However, these records, as well as more recent archaeological investigations, focus solely on mortuary treatment of the elite, completely overlooking the burial rites practiced by commoners in the same period. Based on my excavation of a group of Han dynasty commoner graves, I describe the mortuary treatment afforded to commoners in this period. I contend that a key structural feature, an exterior ramp constructed beside the vertical pit of some Han tombs that appeared in the early Eastern Han period, reflects people’s intention to enter the chamber and make offerings to the dead. There are also rare cases of reentering the chamber to make offerings after the funeral. This is supported by a secondary ramp built after the graves had been sealed. Considering the widely referenced fear of ghosts, reentering the tomb to make offerings after the funeral seems to obscure the line between the living and dead and was unusual. I argue that the emergence of such activity is a display of filial piety, a practice highly valued in Han society. The current study demonstrates that burial structures can reveal important aspects of burial rituals and provide new information about the funeral practices of common people in the Eastern Han dynasty.
The Curious Case of the Steamship on the Mekong
Authors: Tan Noel Hidalgo , Walker-Vadillo Veronica
Published: May 2016

Painted and engraved rock art appear at the Pak Ou caves, a complex of caverns containing Buddhist offerings and shrines located at the confluence of two rivers in Luang Prabang Province, Lao PDR. Faded red paintings and writing can be found on the cliff face housing the lower cave, colloquially known as the “Cave of a Thousand Buddhas,” while in the upper cave, red anthropomorphs and flowers along with black anthropomorphic figures are painted on the walls. This red and black rock art may predate the Buddhist use of the cave. However, one painting found in the upper cave 10 m from the entrance is unusual as it utilizes a green pigment, and resembles modern steamships that might have transited the upper Mekong. This article considers the historic context of the cave and significance of this Laotian rock art site, which has received little attention in academic literature thus far. Because boat imagery in rock art is not unheard of in Southeast Asia, we hope to highlight the potential for this art to illuminate episodes from the recent past.
Okinawa as Transported Landscape: Understanding Japanese Archaeological Remains on Tinian Using Ryūkyū Ethnohistory and Ethnography
Authors: Dixon Boyd
Published: May 2016

abstract:
The two islands of Okinawa and Tinian in the western Pacific are often linked in the modern archaeological literature by a common ethnic heritage in the early twentieth century, with Okinawan culture serving as a template for interpreting the archaeological remains of the Japanese sugarcane plantation era in Tinian. Tens of thousands of Okinawans immigrated to Tinian and other Commonwealth of the Northern Mariana Islands to be tenant farmers or contract laborers on the plantations between the 1920s and 1944, when they could no longer leave. Structural and functional parallels do indeed exist between the architectural remains of many farmsteads of the plantation era on both islands. The extent to which these archaeological remains on Tinian reflect a “transported landscape” from Okinawa versus a Japanese colonial construct is explored, using the vehicle of Okinawan ethnohistory and ethnography.
The 1960s Los Angeles Seminary Crisis
Authors: Donovan John T.
Published: May 2016

In the 1960s, tension arose between Cardinal James Francis McIntyre, archbishop of Los Angeles (1886–1979), and the priests of the Congregation of the Mission (or Vincentian Fathers) who were teaching at St. John’s Seminary in Camarillo. The fact that some seminary alumni had challenged McIntyre publicly on the question of race relations led the cardinal to suspect that the faculty was not adequately addressing church policy on obedience. This was exacerbated with the disclosure of the relaxation of rules at the St. Louis seminaries—Cardinal Glennon College and Kenrick Seminary—and by the publication of Seminary in Crisis , a book by Stafford Poole, C.M. McIntyre asked how the Vincentians could run seminaries in an inconsistent fashion, to which the Vincentians replied that they would respect the wishes of the ordinary. Despite the friction, McIntyre kept the Vincentians at St. John’s.
Malebranche on the Metaphysics and Epistemology of Particular Volitions
Authors: Walsh Julie , Stencil Eric
Published: May 2016

Nicolas Malebranche holds that God can act in two ways: by general volitions or by particular volitions. Malebranche is clear that general volitions are acts of God in accordance with the laws of nature or laws of grace, and always have a secondary cause that occasions the event. He is much less direct about how, exactly, to understand particular volitions and when, if ever, they occur. In this paper, we examine the nature and possibility of divine particular actions in Malebranche’s system by way of an analysis of his discussions of creation, original sin, and the Incarnation of Christ.
A Puzzle about Hume’s Theory of General Representation
Authors: Landy David
Published: May 2016

According to Hume’s theory of general representation, we represent generalities by associating certain ideas with certain words. On one understanding of this theory, calling things by a name does not represent any real qualities of those things or any real relations between them. This interpretation runs into difﬁculty when applied to Hume’s own use of such general terms throughout the Treatise . Because these distinctions do theoretical-explanatory work in Hume’s philosophical system, they require that the items so distinguished really are different. This reveals that Hume employs a more sophisticated understanding of the science of human nature than has previously been understood. While Hume is a thoroughgoing nominalist about terms in the language of the vulgar, he is a realist about the theoretical-explanatory terms of science.
Universality in Aristotle’s Ethics
Authors: Davia Carlo
Published: May 2016

This paper challenges the view that for Aristotle all judgments in ethics can hold true only “for the most part.” This paper makes three significant contributions to scholarship on Aristotle’s ethics: (i) it rejects as unpersuasive the textual evidence cited in favor of this view; (ii) it explains how the archery metaphor as Aristotle employs it reflects his commitment to the existence of universally true descriptive and prescriptive judgments; and (iii) by way of conclusion, the paper also offers historical reasons as to why Anglophone scholars in the past couple centuries have incorrectly ascribed to Aristotle the view that there are no truly universal judgments in ethics.
Better Prescribing in Correctional Facilities
Authors: Tamburello Anthony C. , Ferguson Elizabeth
Published: May 2016

Serious mental illness is highly prevalent in jails and prisons, and treatment with psychiatric medications is often required. However, operational factors and patient characteristics make prescribing in correctional settings uniquely challenging. The American Academy of Psychiatry and the Law has approved the formation of a working group to create a Resource Document examining best practices for prescribing psychiatric medications in these settings.
Doubled Narratives of Orphanhood in Melville’s Pierre
Authors: Weiser Karen
Published: May 2016

“Henceforth, cast-out Pierre hath no paternity, and no past”—so declares Melville’s Pierre in Pierre; or, the Ambiguities as he elects orphanhood, choosing to occupy a narrative of liberation invested with the kinship metaphors and sacred overtones of a revolutionary heritage. Both parricide and orphaned victim, agent and object, Pierre reveals the complex affective terrain of an autogenic authority. His choice is put into relief as the other characters also explore or break from all former ties of kinship. Melville sets the trope of elective orphanhood against the female sentimental orphan, a common protagonist of sentimental novels, whose authority is located in her ability to discipline herself into an intimate possession. This essay argues that Melville pushes these doubled tropes of orphanhood to excess in order to critique their currency as narratives of liberation.
La traducción literaria como máscara: aproximaciones a las Poesías Líricas de Gertrudis Gómez de Avellaneda
Authors: Popea Marina
Published: May 2016

Abstract: In the context of the modernization of the Cuban and Spanish cultural fields, around the middle of the nineteenth century, romanticism offered Cuban and Spanish women writers an opportunity to express themselves as subjects. However, confronted with the reluctance of the literary and cultural institutions to include them, they proceeded to develop various strategies to legitimize their literary work. Through the inclusion in her poetry of more or less free translations of various canonical romantic poets, Gertrudis Gómez de Avellaneda uses translation as a mask with which she can access discursive spaces related to the public sphere, legitimize women’s poetic activity, inscribe herself in a recognizable tradition, appropriate the literary fame of the translated authors, and display her virtuosity. In this way, she endowed her own poetry with authority. Through the modifications she makes to the translated poems and under the aegis of these canonical poets she is thus able to establish a feminine lyric subject and advocate for the inclusion of women in all aspects of the literary field.
Adult College Learners of British Sign Language: Educational Provision and Learner Self-Report Variables Associated with Exam Success
Authors: Allbutt John , Ling Jonathan
Published: May 2016

This study investigated educational provision and learner self-report factors associated with exam success for adult learners of British Sign Language (BSL) who were enrolled in either Level 1 or Level 2 courses. These levels are equivalent to the first and second year of a United Kingdom General Certificate of Secondary Education qualification. Two hundred thirty-five students from three further education colleges answered a self-report questionnaire covering a range of variables. Analysis of the data suggests that: (1) success rates differed markedly for Levels 1 and 2; (2) enhancements of educational provision, such as the use of extra conversational classes, appeared to play a role in increasing exam success rates; (3) individual factors associated with exam success varied between course level and between types of provision; (4) variables related to exam success at Level 2 were more numerous and more specifically related to the learning of sign language than those seen at Level 1; and (5) effect sizes seen for enhancements of educational provision were larger than for individual characteristics. These results offer insights into the factors that affect the success rates of people learning sign language.
Long-term response to thinning in a beech (Fagus sylvatica L.) coppice stand under conversion to high forest in Central Italy
Authors: Chianucci Francesco , Salvati Luca , Giannini Tessa , Chiavetta Ugo , Corona Piermaria , Cutini Andrea
Published: May 2016

European beech (L.) forests have a long history of coppicing, but the majority of formerly managed coppices are currently under conversion to high forest. The long time required to achieve conversion requires a long-term perspective to fully understand the implication of the applied conversion practices. In this study, we showed results from a long-term (1992â2014) case-study comparing two management options (natural evolution andperiodic thinning) in a beech coppice in conversion to high forest. Leaf area index, litter production, radiation transmittance and growth efficiency taken as relevant stand descriptors, were estimated using both direct and indirect optical methods. Overall, results indicated that beech coppice showed positive and prompt responses to active conversion practices based on periodic medium-heavy thinning. A growth efficiency index showed that tree growth increased as the cutting intensity increased. Results from the case study supported the effectiveness of active conversion management from an economic (timber harvesting) and ecological (higher growth efficiency) point of view.Fagus sylvatica
Error Analysis in Spin Measurement using Synchro-ballistic Method and its Improvement
Authors: Sahani Prem , Mohapatra S. , Panda H. S. , Sarkar S. , Alam M.
Published: May 2016

Error analysis of spin measurement using synchro-ballistic method is presented in this paper. Error in the spin measurement varies as the projections of marker move away from axis of symmetry, and the reason for variation of error is explained. An improvement to synchro-ballistic method is proposed for spin measurement, which reduces the error in measured spin, and an algorithm for implementation of same is provided. Results of improved synchro-ballistic method are compared with the theoretical estimation of spin from muzzle velocity.
Organizing for Better Lives
Authors: Berman Daniel M.
Published: May 2016

Todd Jailer, Miriam Lara-Meloy, and Maggie Robbins, The Workers' Guide to Health and Safety (Berkely, CA: Hesperian, 2015), 576 pages, $34.95, paperback.The new Workers' Guide to Health and Safety—with drawings on every page—is a fun read, which is an unusual thing to say about a book with such a serious intent. Garrett Brown, an industrial hygienist with decades of experience as an inspector and activist in California, Mexico, and Bangladesh, claimed with some justification that of all the books on occupational health and safety, "almost none…are accessible to workers or their organizations." The Workers' Guide is the first major book aimed at organizing for healthier conditions in the labor-intensive export industries of countries like Bangladesh and China, Mexico's maquiladora frontier, in Central America and Southeast Asia, and even in the United States itself, where for many, working and living conditions are being beaten down.Click here to purchase a PDF version of this article at the Monthly Review website.