bluuebunny/crossref_metadata_2025 huggingface dataset:
Territory, Contentious Issues, and International Relations
Authors: Hensel Paul R.
Published: September 2017

Territorial issues have been prominent causes of armed conflict and war in the modern era. This observation has led to a rapidly growing body of academic literature on the sources, management, and consequences of such issues. Although territory has gotten most of the scholarly attention, this literature has its roots in research on contentious issues that began in the 1960s. Academic research on contentious issues began with studies on issue areas in foreign policy analysis, focusing on such questions as how the foreign policy process differs from more traditional domestic policy processes. This line of research struggled to find mainstream acceptance until scholars began adopting a more substantive conception of issues, focusing on the nature of the values at stake. General patterns of foreign policy conflict and cooperation have been found to differ substantially across different issues. Importantly, territorial issues are the most frequent and most dangerous issues in armed conflict and war, leading scholars to focus much of their issue-related research on the dynamics of territorial contention.

Research on territory has stemmed from the main elements of issues theory that were developed earlier: issue salience, or the importance of the issue under contention; issue context, or recent interactions over the same issue; and institutional context, or the extent to which other actors and institutions are able to influence contention over this type of issue. Armed conflict is much more likely when the issue at stake is more salient, particularly when this salience involves intangible dimensions such as the presence of a state’s ethnic kin in the claimed territory. Greater issue salience also increases the likelihood of peaceful negotiations and nonbinding conflict management techniques like mediation. A recent history of armed conflict or failed negotiations over an issue increases the likelihood of armed conflict, bilateral negotiations, and nonbinding management. The normative and institutional context also appears to affect the likelihood of conflict and peaceful management over issues, although more remains to be done in this area.

The issues literature is beginning to make important strides beyond this initial work on territorial claim management. Scholars are beginning to geocode data on international borders, raising important potential benefits for the study of territory and perhaps other issues. International legal arguments appear to affect the management of territorial claims in systematic ways, and ending territorial claims seems to produce substantial improvements in relations between the former adversaries. The same general patterns seem to hold for river and maritime issues, as well as territorial issues, and these other issue types have more promising institutional contexts. Future research could benefit from considering additional issue types (including a recent effort to collect data on identity claims), as well as studying domestic and interstate issues.
Psychodynamic Psychotherapies
Authors: Minges Mary V. , Barber Jacques P.
Published: September 2017

Psychodynamic psychotherapies (PDP) is an umbrella term for a variety of therapeutic modalities that have evolved out of the psychoanalytic/psychodynamic tradition, each theorizing a trajectory of human development that includes an etiology of and treatment for psychopathology. PDPs have in common the belief that people have an unconscious mind that influences thoughts and behaviors outside of the individual’s awareness. These processes operate from birth till death and are responsible for adaptive and maladaptive functioning at the level of interpersonal relationships and daily living.

The psychodynamic therapist creates a case formulation for the individual seeking treatment, which incorporates a formal diagnosis with an understanding of the underlying dynamic factors contributing to the individual’s suffering. From this case formulation a treatment plan is created specific to the individual. During treatment, the therapist develops a strong working alliance while utilizing psychodynamic-specific techniques targeted at bringing insight into these unconscious thoughts and behaviors. Greater self-understanding enables greater choice ability and flexibility in functioning.

In contrast to prevalent views, empirical research has found support for the efficacy of PDP in the treatment of mental disorders, including but not limited to: depression, anxiety disorders, somatic disorders, and personality disorders. In general, PDP was found more effective than control conditions and not different from active treatments. PDP effects have been shown to remain stable post treatment.
Filicide in Australian Media and Culture
Authors: Little Janine , Tyson Danielle , Buiten Denise
Published: September 2017

Filicide is the deliberate act of a parent killing a child. The murder of a child by their own parent challenges many of our fundamental expectations about the role of parenthood, family, mothers, and fathers, prompting a sense of horror, outrage, and deep distress. It violates the idea of parental instincts of protection for children. While maternal and paternal filicide are committed in roughly equal numbers, filicide has historically been regarded as a female crime. Media coverage of mothers who commit filicide differs from coverage of fathers who commit the same crime, reflecting both pervasive gender tropes—of demonized mothers who shatter expected feminine and maternal norms and disempowered fathers or fathers acting out of mental illness—and evolving gendered discourses that medicalize women’s violence and position men who kill their children as anomalous monsters. The media’s portrayal of these tragic cases is often to treat them as “inexplicable”—and when attempting to find an explanation, relying on heavily gendered tropes, simplifications, or rationalizations. The position of children—especially those with disability—within the power dynamics of the family are seldom considered in these constructions.
Family and Home Literacy Across Time
Authors: Compton-Lilly Catherine
Published: September 2017

In 1982, Denny Taylor coined the term “family literacy” to reference the ways young children and their parents interact around texts. Since then, the term family literacy has generally been applied to the practices that occur in homes to support young children as they become readers and writers. However, 30 years later, this definition negates the full scope of possibilities that might inform our understandings of the literacy practices that occur within home spaces and among family members. These possibilities reflect two important trends increasingly recognized within literacy research communities. First, technological advances have affected the ways people read and write and the multimodal literacy practices that have come to define literacy in families and homes. These developments are often the focus of New Literacy Studies as defined by the New London Group and others. Second, while generally not addressed in terms of family literacy, a substantial and growing body of research has documented the out-of-school literacy practices of adolescents and youth. Many of these literacy practices are enacted and displayed in home settings. While connections between out-of-school literacy practices and family literacy are generally not explicit, homes and families provide significant social contexts that are critical to engaging in technological, peer-informed, and popular culture practices. In short, family literacy does not end once children learn to read. In contrast, family literacy assumes new forms and involves new modalities that both echo and extend the literacy practices found within families. This is significant, as it challenges conceptions of adolescent and youth literacy as being separate from the literacy practices of families.

To extend what is meant by family literacy, it is redefined as more than traditional activities that involve young children with texts. Instead, researchers are challenged to consider the full range of literacy practices that occur among family members and within homes across time. In doing this, family literacy and new literacy studies are brought together. Thus, the term family/home literacy is used to recognize not only the literacy practices that are enacted between children and parents, but the full range of literacy practices that occur among all family members—including siblings, extended family members, and friends. In short, family/home literacy practices are intertwined with home literacy affordances, which include the texts, opportunities, and technological resources that are available and used in homes. In order to explore family/home literacies over time, children’s literacy practices, including traditional and technological family/home literacy practices, are explored. Issues raised include parental mentoring of school-age children as they encounter new technologies at home, the adaptation of available resources by children as they move into and through adolescence, and transactions involving texts (both traditional and digital) among adolescents, young adults, and their parents.
Decolonization in Portuguese Africa
Authors: Aires Oliveira Pedro
Published: September 2017

The dissolution of Portugal’s African empire took place in the mid-1970s, a decade after the dismantling of similar imperial formations across Europe. Contrary to other European metropoles, Portuguese rulers were unwilling to meet the demands for self-determination in their dependencies, and thus mobilized considerable resources for a long, drawn-out conflict in Angola, Guinea, and Mozambique from 1961 to 1974. Several factors can explain Lisbon’s refusal to come to terms with the “winds of change” that had swept Africa since the late 1950s, from the belief of its decision-makers that Portugal lacked the means to conduct a successful “exit strategy” (akin to the “neocolonial” approach followed by the British, the French, or the Belgians), to the dictatorial nature of Salazar’s “New State,” which prevented a free and open debate on the costs of upholding an empire against the anti-colonial consensus that had prevailed in the United Nations since the early 1960s.

Taking advantage of its Cold War alliances (as well as secret pacts with Rhodesia and South Africa), Portugal was long able to accommodate the armed insurgencies that erupted in three of its colonies, thereby containing external pressures to decolonize. Through an approach that combined classic “divide and rule” tactics, schemes for population control, and developmental efforts, Portugal’s African empire was able to soldier on for longer than many observers expected. But this uncompromising stance came with a price: the armed forces’ dissatisfaction with a stalemate that had no end in sight. In April 1974, a military coup d’etat put an end to five decades of authoritarianism in the metropole and cleared the way for transfer of power arrangements in the five lusophone African territories. The outcome, though, would be an extremely disorderly transition, in which the political inexperience of the new elites in Lisbon, the die-hard attitude of groups of white settlers, the divisions among the African nationalists, and the meddling of foreign powers all played critical roles.
The History of Migrant Labor in South Africa (1800–2014)
Authors: Delius Peter
Published: September 2017

A pervasive system of migrant labor played a fundamental part in shaping the past and present of South Africa’s economy and society and has left indelible marks on the wider region. South Africa was long infamous for its entrenched system of racial discrimination. But it is also unique in the extent to which urbanization, industrialization, and rural transformation have been molded by migrant labor. Migrancy and racism fed off each other for over a century, shaping the lives and deaths of millions of people.
Sign Language Phonology
Authors: Brentari Diane , Fenlon Jordan , Cormier Kearsy
Published: September 2017

Sign language phonology is the abstract grammatical component where primitive structural units are combined to create an infinite number of meaningful utterances. Although the notion of phonology is traditionally based on sound systems, phonology also includes the equivalent component of the grammar in sign languages, because it is tied to the grammatical organization, and not to particular content. This definition of phonology helps us see that the term covers all phenomena organized by constituents such as the syllable, the phonological word, and the higher-level prosodic units, as well as the structural primitives such as features, timing units, and autosegmental tiers, and it does not matter if the content is vocal or manual. Therefore, the units of sign language phonology and their phonotactics provide opportunities to observe the interaction between phonology and other components of the grammar in a different communication channel, or modality. This comparison allows us to better understand how the modality of a language influences its phonological system.
Executive and Legislative Competition Over Natural Hazards Policies
Authors: Crow Deserai A.
Published: September 2017

As with countless other policy areas, natural hazard policy can be viewed as a jurisdictional competition between executive and legislative branches. While policymaking supremacy is delegated to the legislative branch in constitutional democracies, the power over implementation, budgeting, and grant-making that executive agencies enjoy means that the executive branch wields considerable influence over outcomes in natural hazards policymaking. The rules that govern federal implementation of complex legislative policies put the implementing agency at the center of influence over how policy priorities play out in local, county, and state processes before, during, and after disasters hit.

Examples abound related to this give-and-take between the legislative and executive functions of government within the hazards and disaster realm, but none more telling than the changes made to US disaster policy after September 11th, which profoundly affected natural hazards policy as well as security policy. The competition and potential for mismatch between legislative and executive priorities has been heightened since the Federal Emergency Management Agency (FEMA) was reorganized under the Department of Homeland Security. While this may appear uniquely American, the primacy of terrorism and other security-related threats not only dwarfs natural hazards issues in the United States, but also globally. Among the most professionalized and powerful natural hazards and disaster agencies prior to 9/11, FEMA has seen its influence diminished and its access to decision-makers reduced.

This picture of legislative and executive actors within the natural hazards policy domain who compete for supremacy goes beyond the role of FEMA and post-9/11 policy. Power dynamics associated with budgets, oversight and accountability, and relative power among executive agencies are ongoing issues important to understanding the competition for policy influence as natural hazards policy competes for attention, funding, and power within the broader domain of all-hazards policy.
Acute Response to a 2-Minute Isometric Exercise Test Predicts the Blood Pressure-Lowering Efficacy of Isometric Resistance Training in Young Adults
Authors: Somani Yasina B , Baross Anthony W , Brook Robert D , Milne Kevin J , McGowan Cheri L , Swaine Ian L
Published: September 2017

BACKGROUND

This work aimed to explore whether different forms of a simple isometric exercise test could be used to predict the blood pressure (BP)-lowering efficacy of different types of isometric resistance training (IRT) in healthy young adults. In light of the emphasis on primary prevention of hypertension, identifying those with normal BP who will respond to IRT is important. Also, heightened BP reactivity increases hypertension risk, and as IRT reduces BP reactivity in patients with hypertension, it warrants further investigation in a healthy population.

METHODS

Forty-six young men and women (24 ± 5 years; 116 ± 10/ 68 ± 8 mm Hg) were recruited from 2 study sites: Windsor, Canada (n = 26; 13 women), and Northampton, United Kingdom (n = 20; 10 women). Resting BP and BP reactivity to an isometric exercise test were assessed prior to and following 10 weeks of thrice weekly IRT. Canadian participants trained on a handgrip dynamometer (isometric handgrip, IHG), while participants in the UK trained on an isometric leg extension dynamometer (ILE).

RESULTS

Men and women enrolled in both interventions demonstrated significant reductions in systolic BP (P < 0.001) and pulse pressure (P < 0.05). Additionally, test-induced systolic BP changes to IHG and ILE tests were associated with IHG and ILE training-induced reductions in systolic BP after 10 weeks of training, respectively (r = 0.58 and r = 0.77; for IHG and ILE; P < 0.05).

CONCLUSIONS

The acute BP response to an isometric exercise test appears to be a viable tool to identify individuals who may respond to traditional IRT prescription.
Adoption of Stereotactic Body Radiotherapy for Stage IA Non–Small Cell Lung Cancer Across the United States
Authors: Holmes Jordan A. , Zagar Timothy M. , Chen Ronald C.
Published: September 2017

Background

Stereotactic body radiotherapy (SBRT) is a treatment option for stage I non–small cell lung cancer (NSCLC), providing a potentially curative therapy for patients who are nonsurgical candidates. This study describes the adoption of SBRT vs other treatment options across the United States, as well as commonly used dose-fractionation regimens.

Methods

We analyzed patients in the National Cancer Data Base. A total of 107 233 stage IA NSCLC patients diagnosed from 2008 to 2013 were included. We described the proportions of patients who received different surgical and radiation treatment options by year. A multivariable model was constructed to assess factors associated with patients receiving SBRT. In patients who received SBRT, we described the proportion of patients who received common dose/fractionation regimens.

Results

Use of SBRT increased from 6.7% to 16.3% from 2008 to 2013, with a corresponding decrease in lobectomy/pneumonectomy (49.5% to 43.7%). The rates of wedge resection, conventional radiotherapy, and no treatment remained relatively constant. Adoption of SBRT was lowest in small community centers (8.6% of patients by 2013). On multivariable analysis, older age and treatment at larger centers were associated with higher SBRT receipt, and black race and higher comorbidity were associated with lower SBRT receipt. There was statistically significant geographic variation. Common SBRT schemes were 10 Gy × 5 (19%), 18–20 Gy × 3 (31%), and 12 Gy × 4 (16%).

Conclusions

SBRT adoption has been modest over time and has not substantially replaced less curative treatments. Lack of access to this technology in smaller cancer centers may have partly contributed to the slow adoption.
Mixed poloidal–toroidal magnetic configuration and surface abundance distributions of the Bp star 36 Lyn★
Authors: Oksala M. E. , Silvester J. , Kochukhov O. , Neiner C. , Wade G. A. ,   the MiMeS Collaboration
Published: September 2017

Previous studies of the chemically peculiar Bp star 36 Lyn revealed a moderately strong magnetic field, circumstellar material and inhomogeneous surface abundance distributions of certain elements. We present in this paper an analysis of 33 high signal-to-noise ratio, high-resolution Stokes IV observations of 36 Lyn obtained with the Narval spectropolarimeter at the Bernard Lyot Telescope at Pic du Midi Observatory. From these data, we compute new measurements of the mean longitudinal magnetic field, Bℓ, using the multiline least-squares deconvolution (LSD) technique. A rotationally phased Bℓ curve reveals a strong magnetic field, with indications for deviation from a pure dipole field. We derive magnetic maps and chemical abundance distributions from the LSD profiles, produced using the Zeeman–Doppler imaging code InversLSD. Using a spherical harmonic expansion to characterize the magnetic field, we find that the harmonic energy is concentrated predominantly in the dipole mode (ℓ = 1), with significant contribution from both the poloidal and toroidal components. This toroidal field component is predicted theoretically, but not typically observed for Ap/Bp stars. Chemical abundance maps reveal a helium enhancement in a distinct region where the radial magnetic field is strong. Silicon enhancements are located in two regions, also where the radial field is stronger. Titanium and iron enhancements are slightly offset from the helium enhancements, and are located in areas where the radial field is weak, close to the magnetic equator.
Evaluation of a Commercially Available Enzyme‐Linked Immunosorbent Assay and a Liquid Chromatography–Tandem Mass Spectrometric Method for the Analysis of Glyphosate in Wheat, Oats, Barley, Malt, and Lentils
Authors: Tittlemier Sheryl A. , Drul Dainna , Lake Benjamin , Zirdum Tanya , Hammond Emily , Sobering Debbie , Lin Wen Jing , Tran Michael , Roscoe Mike
Published: September 2017

An accurate and precise ultra‐high performance liquid chromatography with tandem mass spectrometry (UHPLC‐MS/MS) method was validated for the analysis of glyphosate and its main transformation product (aminomethylphosphonic acid) in barley, malt, wheat, oats, and lentils. The validation data demonstrated good performance of the method. This UHPLC‐MS/MS method was also used to evaluate the performance of a commercially available enzyme‐linked immunosorbent assay (ELISA) test kit. For all of the grain matrices examined, the ELISA showed poor accuracy and precision at its stated lower working limit of 0.075 mg/kg; however, performance was acceptable at 0.30 mg/kg, as well as higher concentrations relevant to established maximum residue limits. At these relevant concentrations, the ELISA also produced results higher than the UHPLC‐MS/MS method. Although results from the two methods were linearly correlated, differences in the result values from the two methods differed among the grains studied and ranged from +1% for oats to +40% for glyphosate concentrations in barley. ELISA is a useful tool that is complemented by the comprehensive and sensitive UHPLC‐MS/MS method.
Reduced Gelatinization, Hydrolysis, and Digestibility in Whole Wheat Bread in Comparison to White Bread
Authors: Whitney Kristin , Simsek Senay
Published: September 2017

Wheat, an important crop in North Dakota and the United States, is often used for bread. Health concerns related to chronic diseases have caused a shift toward consumption of whole wheat bread. There has been some indication that the rate and amount of starch digestibility of whole wheat breads may be lower than for their refined flour counterparts. This research investigated the components of whole wheat bread that may reduce starch digestibility and impact nutritional quality. Six formulations of flour were used, which included two refined flours, two whole wheat flours, and two whole wheat flours with added starch. The starch was added to whole wheat flours to increase the starch level to that of the refined flour so that we can determine whether or not the dilution of the starch in whole wheat bread was a factor in lowering the estimated glycemic index (eGI) of whole wheat bread. White and whole wheat flours and breads were evaluated for chemical composition, baking quality by AACC International Approved Method 10‐09.01, and eGI by the Englyst assay. Whole wheat breads had significantly (P < 0.05) higher mineral, protein, arabinoxylan, and phenolic acid contents, as well as significantly (P < 0.05) lower eGI. The starch molecular weight was also significantly (P < 0.05) higher for whole wheat and whole wheat + starch breads compared with white breads. The eGIs of refined flour breads were 93.1 and 92.7, whereas the eGIs of whole wheat and whole wheat + starch breads ranged from 83.5 to 85.1. Overall, several factors in the whole wheat bread composition can be found to affect the quality and starch hydrolysis.
Epidemiological Features and Trends of Brown Spot of Pear Disease Based on the Diversity of Pathogen Populations and Climate Change Effects
Authors: Moragrega Concepció , Puig Mireia , Ruz Lídia , Montesinos Emilio , Llorente Isidre
Published: September 2017

Brown spot of pear, caused by the fungus Stemphylium vesicarium, is an emerging disease of economic importance in several pear-growing areas in Europe. In recent years, new control strategies combining sanitation practices and fungicide applications according to developed forecasting models have been introduced to manage the disease. However, the pathogenic and saprophytic behavior of this pathogen makes it difficult to manage the disease. In addition, climate change can also result in variations in the severity and geographical distribution of the disease. In this study, ecological and epidemiological aspects of brown spot of pear disease related to inoculum characterization and climate change impact were elucidated. The pathogenic variation in S. vesicarium populations from pear orchards and its relationship to inoculum sources (air samples, leaf debris, and infected host and nonhost tissues) was determined using multivariate analysis. In total, six variables related to infection and disease development on cultivar Conference pear detached leaves of 110 S. vesicarium isolates were analyzed. A high proportion of isolates (42%) were nonpathogenic to pear; 85% of these nonpathogenic isolates were recovered from air samples. Most isolates recovered from lesions (93%) and pseudothecia (83%) were pathogenic to pear. A group of pathogenic isolates rapidly infected cultivar Conference pear leaves resulted in disease increase that followed a monomolecular model, whereas some S. vesicarium isolates required a period of time after inoculation to initiate infection and resulted in disease increase that followed a logistic model. The latter group was mainly composed of isolates recovered from pseudothecia on leaf debris, whereas the former group was mainly composed of isolates recovered from lesions on pear fruit and leaves. The relationship between the source of inoculum and pathogenic/aggressiveness profile was confirmed by principal component analysis. The effect of climate change on disease risk was analyzed in two pear-growing areas of Spain under two scenarios (A2 and B1) and for three periods (2005 to 2009, 2041 to 2060, and 2081 to 2100). Simulations showed that the level of risk predicted by BSPcast model increased to high or very high under the two scenarios and was differentially distributed in the two regions. This study is an example of how epidemiological models can be used to predict not only the onset of infections but also how climate change could affect brown spot of pear.

[Formula: see text] Copyright © 2018 The Author(s). This is an open-access article distributed under the CC BY-NC-ND 4.0 International license .
Biological Facet of Segmental Bone Loss Reconstruction
Authors: Tosounidis Theodoros H. , Giannoudis Peter V.
Published: September 2017

The management of long bone defects continues to be associated with significant challenges for optimum and timely bone repair. When bone grafting is needed, essential parameters to be addressed include adequate volume, optimum density, and structural capacity as well as potent biological properties. Although the autologous iliac crest bone graft remains the gold standard, its reduced availability and donor site morbidity have made the clinicians to seek for other alternative options. Reamer irrigator aspirator graft with materials used as graft expanders along with inductive molecules and cellular augmentation constitute the current trend for optimum bone regeneration. This article presents the contemporary thinking of the biological facet of segmental bone loss reconstruction.
Cutaneous Light Chain Deposition Disease: A Report of 2 Cases and Review of the Literature
Authors: Hendricks Carlo , Fernández Figueras Maite T. , Liersch Julia , Martin-Urdà Maria-Teresa , López Dolores , Brochhausen Christoph , Röcken Christoph , Schaller Jörg
Published: September 2017

Light chain deposition disease (LCDD) is a rare systemic disorder with deposition of mostly monoclonal amorphous nonamyloid light chains in multiple organs. Renal involvement with rapidly progressing renal failure presents the dominant manifestation of LCDD. Approximately 20%–30% of patients show symptomatic cardiac or liver involvement. Cutaneous manifestations are extremely rare with only a few published cases. We report 2 additional cases of cutaneous LCDD without detectable systemic disease.
Borrelia Lymphocytoma Mimicking Butterfly Rash in a Pediatric Patient
Authors: Llamas-Velasco Mar , Paredes Bruno Emilio
Published: September 2017

A 5-year-old girl presented with a facial butterfly rash that persisted for 5 months without arthralgia, fever, malaise, photosensitivity, or other symptoms. Lupus erythematosus was clinically suspected. All blood tests were negative or within normal values. Skin biopsy showed a dense nodular superficial and deep inflammatory infiltrate of lymphocytes that reaches subcutaneous tissue. The most striking histopathological finding was plasma cells with some perifollicular accentuation. Borrelia polymerase chain reaction assay of the tissue was positive, and we made the diagnoses of borrelia lymphocytoma mimicking butterfly rash of lupus erythematosus. The lesions disappeared with amoxicillin followed by cefuroxime for 28 days. In children, a variety of diseases including lupus erythematous may lead to a butterfly rash that is usually short lasting and commonly associated with systemic symptoms. Borreliosis may be related with long-lasting facial erythema in children and may mimic lupus and present high titers of antinuclear antibodies. In any case, borrelial lymphocytoma has not been previously reported as a cause of butterfly rash, thus mimicking acute lupus in a child, as in our case. From a histopathological point of view, the presence of plasma cells in a pseudolymphomatous infiltrate is a clue for the right diagnosis. Therefore, we suggest that borrelia serology should be done in children with butterfly rash lasting more than a month and empirical antibiotic treatment should be tried even in cases with negative serology.
The Utility of a Wireless Implantable Hemodynamic Monitoring System in Patients Requiring Mechanical Circulatory Support
Authors: Feldman David S. , Moazami Nader , Adamson Philip B. , Vierecke Juliane , Raval Nir , Shreenivas Satya , Cabuay Barry M. , Jimenez Javier , Abraham William T. , O’Connell John B. , Naka Yoshifumi
Published: September 2017

Proper timing of left ventricular assist device (LVAD) implantation in advanced heart failure patients is not well established and is an area of intense interest. In addition, optimizing LVAD performance after implantation remains difficult and represents a significant clinical need. Implantable hemodynamic monitoring systems may provide physicians with the physiologic information necessary to improve the timing of LVAD implantation as well as LVAD performance when compared with current methods. The CardioMEMS Heart sensor Allows for Monitoirng of Pressures to Improve Outcomes in NYHA Class III heart failure patients (CHAMPION) Trial enrolled 550 previously hospitalized patients with New York Heart Association (NYHA) class III heart failure. All patients were implanted with a pulmonary artery (PA) pressure monitoring system and randomized to a treatment and control groups. In the treatment group, physicians used the hemodynamic information to make heart failure management decisions. This information was not available to physicians for the control group. During an average of 18 month randomized follow-up, 27 patients required LVAD implantation. At the time of PA pressure sensor implantation, patients ultimately requiring advanced therapy had higher PA pressures, lower systemic pressure, and similar cardiac output measurements. Treatment and control patients in the LVAD subgroup had similar clinical profiles at the time of enrollment. There was a trend toward a shorter length of time to LVAD implantation in the treatment group when hemodynamic information was available. After LVAD implantation, most treatment group patients continued to provide physicians with physiologic information from the hemodynamic monitoring system. As expected PA pressures declined significantly post LVAD implant in all patients, but the magnitude of decline was higher in patients with PA pressure monitoring. Implantable hemodynamic monitoring appeared to improve the timing of LVAD implantation as well as optimize LVAD performance when compared with current methods. Further studies are necessary to evaluate these findings in a prospective manner.
Comparison of Transperianal Ultrasound With Colonoscopy and Magnetic Resonance Imaging in Perianal Crohn Disease
Authors: Lee Eun Hye , Yang Hye Ran , Kim Ji Young
Published: September 2017

Objective:

Perianal fistulae and/or abscesses are common complications of Crohn disease (CD), especially in children. Magnetic resonance imaging (MRI) and gross examination under anesthesia are accurate diagnostic modalities for evaluating perianal lesions. Both methods, however, are expensive and have some limitations for use in children. This study aims to assess the accuracy of transperianal ultrasound (TPUS) and colonoscopic examination, compared with MRI, in pediatric patients with perianal CD (PACD).

Methods:

Thirty‐eight children and adolescents with PACD who underwent MRI, TPUS, and gross colonoscopic examination under sedation were included. Fistulae were classified according to Parks’ and St. James's University Hospital classifications. Abscesses were identified by their presence and location on each modality.

Results:

Fifty‐nine fistulae (26 superficial, 23 intersphincteric, 10 transsphincteric) and 16 abscesses were detected using MRI. Fifty‐nine fistulae and 10 abscesses were detected using TPUS. Forty‐five fistulae (sensitivity 76.3%, positive predictive value [PPV] 84.2%, and kappa value 0.296] and 9 abscesses (sensitivity 56.3%, PPV 90.0%, and kappa value 0.624) on TPUS corresponded with MRI findings. Forty‐six fistulae and fifteen abscesses were detected using colonoscopy. Forty fistulae (sensitivity 67.8%, PPV 89.9%, and kappa value 0.369) and 7 abscesses (sensitivity 43.8%, PPV 48.8%, and kappa value 0.304) on colonoscopy corresponded with MRI findings. With respect to abscess, agreement between TPUS and MRI was superior to that between colonoscopy and MRI (Spearman rho 0.651 vs 0.304, P = 0.007).

Conclusion:

TPUS is an appropriate, simple, and real‐time method for detecting perianal fistula and/or abscess, in children with PACD.
Neonatal Exposure to Hepatitis C Virus Antigens in Uninfected Children Born to Infected Mothers
Authors: Psaros Einberg Afrodite , Brenndörfer Erwin Daniel , Frelin Lars , Hallberg Lena , Sällberg Matti , Fischler Björn
Published: September 2017

Objective:

Vertical transmission of hepatitis C virus (HCV) infection is uncommon and occurs in approximately 5% of births from HCV‐infected mothers. The reason for the low transmission rate is unclear. We aimed to investigate whether there is evidence of HCV exposure also in the noninfected children born to HCV‐infected mothers by the presence of a detectable immune response.

Methods:

Serum and peripheral blood mononuclear cells from 9 HCV vertically infected children, 32 uninfected children born to HCV infected mothers, and 15 HCV chronically infected mothers, were analyzed. HCV‐RNA‐negative adults and children were used as controls. HCV‐specific T cell responses were analyzed by interferon gamma using an enzyme‐linked immunospot assay and 3H‐thymidine incorporation assay. HCV antibodies were also analyzed.

Results:

An HCV‐specific T cell response was detected in 73% (11/15) of the HCV‐infected mothers, 67% (6/9) of the vertically infected children, 56% (18/32) of the exposed but uninfected children and in 10% and 20% of the control groups, respectively. The 2 groups of HCV‐exposed children both had a significantly higher proportion of HCV‐specific T cell responders compared to pediatric controls (P = 0.01 and P = 0.02).

Conclusions:

HCV‐specific immune responses were more common in children born to HCV‐infected mothers, regardless of the presence of HCV RNA. We conclude that noninfected children born to HCV‐infected mothers may have been exposed to HCV antigens.
Research on prevalence of secondary conditions in individuals with disabilities: an overview
Authors: Moharić Metka
Published: September 2017

Individuals with disabilities may be at increased risk of a number of secondary conditions. Secondary conditions influence health status and quality of life. Many of these conditions are preventable and their consequences can be managed. Knowledge of the prevalence, course, and association with age of secondary conditions is needed for better prevention and management. The aim of present study was to review the available literature on the prevalence of secondary conditions in individuals with disability. We performed searches of electronic databases for studies published between 1980 and 2017 that provided information on the prevalence of secondary conditions in individuals with disabilities. The reference list of all relevant citations was also reviewed for further material. Nineteen papers were included. The findings indicate that (i) studies were mainly population-based descriptive studies, (ii) researchers used different questionnaires, (iii) the most common studied population are patients with spinal cord injury, and (iv) even though secondary conditions are different in different patient populations, the main secondary conditions are pain, spasticity, urinary tract infections, fatigue, depression, and sleep problems. The prevalence of each condition varies widely depending on the studied population and research methodologies across studies. There is still much information that remains to be obtained on the prevalence, definition, and conceptual organization of secondary conditions. There is also a lack of longitudinal studies on the natural course of these conditions.
A Teenager With Sickle Cell Disease and Scalp Swelling
Authors: Nelson Courtney E. , Scarfone Richard J.
Published: September 2017

An intracranial bleed with a midline shift is a potentially life-threatening clinical condition. We present the unusual case of a 13-year-old boy with sickle cell disease who had numerous emergency department visits for a scalp hematoma and was subsequently determined to have subdural and epidural hematomas with midline shift, associated with a skull bone infarction. We review the pathophysiology of this unusual condition and emphasize the importance of including it in the differential diagnosis of any child with sickle cell anemia presenting with a nontraumatic scalp hematoma.
Intervening in Interruptions: What Exactly Is the Risk We Are Trying to Manage?
Authors: Gao Jonathan , Rae Andrew John , Dekker Sidney W.A.
Published: September 2017

Interruptions are thought to be significantly associated with medication administration errors. Researchers have tried to reduce medication errors by decreasing or eliminating interruptions. In this article, we argue that interventions are often (perhaps unreflectively) based on one particular model of risk reduction—that of barriers placed between the source of risk and the object-to-be-protected. Well-intentioned interventions can lead to unanticipated effects because the assumptions created by the risk model are not critically examined. In this article, we review the barrier model and the assumptions it makes about risk and risk reduction/prevention, as well as the model’s incompatibility with work in healthcare. We consider how these problems lead to interruptions interventions with unintended negative consequences. Then, we examine possible alternatives, viz organizing work for high reliability, preventing safety drift, and engineering resilience into the work activity. These all approach risks in different ways, and as such, propose interruptions interventions that are vastly different from interventions based on the barrier model. The purpose of this article is to encourage a different approach for designing interruptions interventions. Such reflection may help healthcare communities innovate beyond old, ineffective, and often counterproductive interventions to handle interruptions.
Laparoscopic Surgery for Large Gastric Submucosal Tumors
Authors: Takahashi Kodai , Kanehira Eiji , Kamei Aya , Tanida Takashi , Sasaki Kazunori
Published: September 2017

Background:

In general, laparoscopic resection for gastric gastrointestinal stromal tumors (GISTs) >5 cm is not recommended. However, there is a lack of evidence to support this recommendation.

Patients and Methods:

This study included 108 patients who underwent laparoscopic surgery for gastric GISTs. Of the 108 patients, 23 had GISTs>5 cm. The aim of this study is to evaluate the oncological safety of laparoscopic surgery for large gastric GISTs. In addition, we performed a rapid systematic review of laparoscopic surgery for large gastric GISTs.

Results:

In our cases, all patients were performed R0 resection without capsular rupture and surgical margins were negative on pathologic examination. In all studies, en bloc resection was achieved without capsular rupture in all patients. The average positive surgical margins rate was 1.6% in total reports.

Conclusions:

The laparoscopic approach for large gastric GISTs>5 cm has been proposed as safe when performed by experienced surgeons.
Twelve-Month Efficacy and Safety Data for the “Stress Incontinence Control, Efficacy and Safety Study”: A Phase III, Multicenter, Prospective, Randomized, Controlled Study Treating Female Stress Urinary Incontinence Using the Vesair Intravesical Balloon
Authors: Winkler Harvey , Jacoby Karny , Kalota Susan , Snyder Jeffrey , Cline Kevin , Robertson Kaiser , Kahan Randall , Green Lonny , McCammon Kurt , Rovner Eric , Rardin Charles
Published: September 2017

Objectives

The “Stress Incontinence Control, Efficacy and Safety Study” (SUCCESS) is a phase III study of the Vesair Balloon in women with stress urinary incontinence who had failed conservative therapy, and either failed surgery, were not candidates for surgery, or chose not to have surgery. The safety and efficacy of the balloon at 12 months is reported for those participants in the treatment arm who elected to continue with the SUCCESS trial beyond the primary end point at 3 months.

Methods

The SUCCESS trial is a multicenter, prospective, single-blinded, randomized, sham-controlled study. Participants were randomized on a 2.33:1 basis to either Vesair Balloon placement or placebo. The primary efficacy end point was a composite of both a greater than 50% reduction from baseline on 1-hour provocative pad weight test and an at least 10-point improvement in symptoms on the Incontinence Quality of Life questionnaire assessed at the 3-month study visit. Patients in the treatment arm who opted to continue in the trial were followed up prospectively up to 12 months.

Results

A total of 221 participants were randomized, including 157 in the treatment arm and 64 in the control arm. Sixty-seven participants in the treatment arm (42.7% of participants enrolled) were evaluated at 12 months, with 56.3% achieving the composite end point and 78.7% having greater than 50% reduction in pad weight from baseline in a per-protocol analysis. In an intent-to-treat analysis treating all participants who did not continue with the balloon as failures, 24% of the participants achieved the composite end point and 33.6% had a greater than 50% reduction in pad weight from baseline. Treatment-related adverse events in this group included dysuria (40.1%), gross hematuria (36.9%), and urinary tract infection (26.1%).

Conclusions

In this phase III trial, symptom relief was maintained for those participants who continued therapy for 12 months. The balloon was found to be safe with no device- or procedure-related serious adverse events reported. Additional studies are warranted to determine which patient populations are more tolerant of the balloon and to assess the efficacy and safety of its longer-term use. Additional screening methods, including screening patients for balloon tolerability, are warranted to reduce participant withdrawals.
Health Literacy in Women Presenting to a Urogynecology Practice
Authors: Sripad Abhishek A. , Rupp Betty M. , Gage Jessica L. , Feliciano Katherine M. , Willis-Gray Marcella , Wu Jennifer M.
Published: September 2017

Objective

Health literacy (HL) is the degree to which an individual can obtain, process, and communicate basic health information to make appropriate health decisions. Understanding HL of patients can improve outcomes. Thus, we evaluated HL in women with pelvic floor disorders and investigated its relationship to patient demographics, reading level, and cognition.

Methods

We conducted a cross-sectional study with a convenience sample of English-speaking women 18 years or older, recruited from female pelvic medicine and reconstructive surgery clinics from July 2016 to January 1, 2017. Patients with severe visual impairment or severe cognitive impairment were excluded. We used the reading comprehension passages of the short form of Test of Functional Health Literacy in Adults to assess HL, the reading subscale of the Wide Range Achievement Test 3 for reading level, and the Self-administered Gerocognitive Exam for cognition.

Results

Among 196 participants, the mean age was 61.1 ± 13.3 years, 84.7% were white, and 54.1% were college educated. Most participants (95.4%) demonstrated adequate HL. Those with adequate HL were younger (60.5 ± 13.2 vs 71.8 ± 10.7, P = 0.01), had less cognitive impairment (12.5% vs 77.8%, P < 0.001), and more frequently had post–high school reading levels (70.1% vs 33.3%, P < 0.001).

Conclusions

Overall HL in the pelvic floor disorder population is high, but older patients with cognitive impairment and lower reading levels are at risk of inadequate HL. Lowering reading levels of educational materials and screening for cognitive impairment may be beneficial to patient understanding and health outcomes.