bluuebunny/crossref_metadata_2025 huggingface dataset:
Critical Management Studies and Paradox
Authors: van Bommel Koen , Spicer André
Published: September 2017

This chapter examines the role of Critical Management Studies (CMS) in the exploration of paradoxes in organizations. CMS focuses on the study of paradoxes in organizational life and aims to address these paradoxes in order to reveal and question structures of oppression and contribute to a progressive force for emancipatory change. The paradoxical aspects of CMS are discussed and various paradoxes addressed by its scholars are explained. These paradoxes are examined from diverse theoretical traditions such as feminism, queer theory, colonialism, and the work of Marx, Weber, and Foucault. Notwithstanding this theoretical pluralism, CMS’ aim is to uncover the often unseen dynamics that shape almost all core organizational processes. The value of considering paradoxes from a CMS perspective is also discussed. Finally, suggestions about how to locate and examine hidden paradoxes are offered and a research agenda around CMS and paradox is presented.
The Eleusinian Projector
Authors: Gatton Matt
Published: September 2017

The Mysteries of Eleusis in ancient Greece were the foremost sect of the mystery religions that dominated the eastern Mediterranean sphere for almost 2,000 years. The staying power of the Eleusinian rite stemmed from its convincing presentation of an otherworldly drama about the goddesses Demeter and Persephone. Initiates endured a harrowing experience in darkness that somehow evoked death, before seeing beatific visions, the climax of which was the appearance of the goddess manifest as light. How was the apparition of the goddess conjured? This study surveys extant epigraphical and archaeological information to formulate a research question: could the anaktoron have acted as a box of light, a fire illuminating figurines and projecting their images out into the darkened telesterion? A set of experiments was performed that confirmed the operational feasibility of an ‘Eleusinian Projector.’ The appearance of the goddess as light can be explained physically as well as mythologically.
Status Non-Citizens
Authors: Bosniak Linda
Published: September 2017

This chapter focuses on the condition of persons inhabiting liberal democratic states in which they lack the legal status of citizenship. Notwithstanding the great variations among categories and across jurisdictions, it is possible to distill a profile of the rights and liabilities of status non-citizens in broad terms and this chapter offers one such profile. It does so, however, by situating the subject in a broader discussion of what status non-citizenship consists in analytically, and of how this status relates to other modes of citizenship denial or marginalization.
Statelessness, ‘In-Between’ Statuses, and Precarious Citizenship
Authors: Lori Noora A.
Published: September 2017

This chapter explains why a growing number of people across the globe experience precarious citizenship--they cannot gain access to secure and permanent legal statuses for protracted periods. Ambiguous and temporary legal statuses are spreading because they represent a strategic government response to avoid resolving dilemmas about citizenship (especially questions about the incorporation of minorities, refugees, or labor migrants) by postponing those decisions, perhaps indefinitely. Moreover, the very processes of boundary-enforcement (biometric IDs and deportations) have pulled more people into the documentary power of the state without providing them a secure place within it. Four categories are discussed: 1) individuals who cannot obtain national identity documents and become stateless; 2) individuals who may have identity documents but lack residency authorization and become ‘illegal’; and a spectrum of groups with temporary statuses that are neither stateless nor fully unauthorized, including (3) temporary humanitarian protection or (4) temporary labor statuses.
Liberal and Republican Conceptions of Citizenship
Authors: Honohan Iseult
Published: September 2017

This chapter examines what it means to be a citizen within liberal and republican political theories - liberalism as the dominant political philosophy of our time, and republicanism as bringing to the fore a new focus on citizenship. Evolving in different historical contexts, liberalism and republicanism represent alternative perspectives on the problem of politics; they share the value of freedom, but interpret and prioritise it differently vis a vis other values. This entails differences in their conceptions of citizenship, and in their potential responses to contemporary challenges of diversity (of gender, culture and religion) and of transnational interdependence.
Economic Theories of Citizenship Ascension
Authors: DeVoretz Don , Irastorza Nahikari
Published: September 2017

This chapter discusses the economic costs and benefits of citizenship acquisition for immigrants, their countries of naturalization and origin. While most studies addressing the economic effects of naturalization focus on costs and mostly benefits for immigrants, there are two important gaps in the literature: the effect of naturalization on residents and overall economy of the destination and home countries. Based on a modern economic model of citizenship ascension, which combines human capital theory and immigration and citizenship policies, the chapter addresses a series of key questions as follows: how and why does the economic citizenship premium vary by gender, immigrant source country, entry path and waiting period for citizenship ascension? And how do specific policies such as dual citizenship in both sending and host countries affect the size of the economic premium for the three parties involved in the process, namely, immigrants and their countries of origin and destination?
Syria’s Economic History
Authors: Matar Linda
Published: September 2017

This chapter provides a reading of the economic history of Syria before the 2011 uprising with a specific focus on the investment practices that had intensified inequality and the objective undercurrents for the war in Syria. In tackling this issue, the chapter adopts a political-economic approach, which relies on unraveling the history of class formation and the way that resources within the country were managed after Syria’s independence. It concludes that the particular social class responsible for investment, the principal facet of resource allocation in a developing country, was plagued with short-sighted avarice that progressively deprived and immiserated the Syrian working population.
History, Memory, and Querencia
Authors: Rodriguez Sylvia
Published: September 2017

Archaeologists, historians, and geographers link Hispano or vecino ethnogenesis in the late eighteenth century to the occupation of a land base, while at the heart of modern Nuevomexicano identity formation is the paradoxical condition of being simultaneously dispossessed and place-based. The modern Hispano ethnoscape combines themes of land loss, displacement, and a deep longing to remain on the land, captured by the term querencia, which refers both to place and love of place. The social imaginary of a commons is central to contemporary land grant and acequia activists—long lost to land grant heirs, but still operative as a principle of water governance among community irrigation associations. Access to and control over a water source remains a key feature of Hispano as well as Pueblo traditional adaptations and modern place-based identities.
The Southwest Archaic
Authors: McBrinn Maxine , Vierra Bradley
Published: September 2017

Our understanding of the Archaic period in the American Southwest is much greater than before the advent of cultural resource management and mandated environmental impact statements, but it is still understudied. Research on this period relies largely on analyses of stone and bone material remains and has focused on subsistence, technology, and landscape use. Regional patterns, north to south and east to west, differ throughout this period. Increasing numbers of cultural features are being found, now that archaeologists are looking for them. Additionally, broader classes of material culture are being used to examine questions of social identity, ritual practices, gender roles, and other non-economic aspects of life.
Hopi History Prior to 1600
Authors: Bernardini Wesley , Adams E. Charles
Published: September 2017

The Hopi region is an iconic “tribal” society of the Southwest, with geographic and cultural continuity stretching back more than a millennium. The tribe has been the subject of ethnographic and archaeological study for more than 100 years, featuring a uniquely long-running dialogue with oral tradition and blurring of boundaries between ethnography and archaeology. The Hopi population stems from a combination of local groups and diverse immigrants, reflected in a social and religious organization that preserves the histories and identities of discrete clan groups. The interplay between migration and social organization recognized in ancestral Hopi sites has led to a broader re-evaluation of migration and identity across the region and in other middle-range societies. A distinctively Hopi material culture began to emerge in the early fourteenth century, and by the time of Spanish contact had crystallized into the form still visible today.
Mesoamerican Connections
Authors: Nelson Ben A. , Fish Paul R. , Fish Suzanne K.
Published: September 2017

This chapter reviews the evidence for Mesoamerican presence or influence in the U.S. Southwest. Objects, symbols, and practices of apparent Mesoamerican origin, especially in the Hohokam region, include copper bells, macaws, shell trumpets, and other similar objects. The explanations that archaeologists have proposed for such presence come down to agricultural displacement, trade, and coercive domination. The review shows that Mesoamerican connections are of several different kinds, suggesting that there may be several different explanations. One explanation that is strongly indicated is the acquisition by local leaders of distant objects and symbols of supernatural power in order certify their ritual competence.
Navajo Archaeology
Authors: Thompson Kerry F. , Towner Ronald H.
Published: September 2017

The dominant anthropological and archaeological narrative of “Navajo” culture is that upon entering the northwestern New Mexico in the sixteenth century, bands of Athapaskan hunter-gatherers began an acculturative process that led them to adopt and assimilate Pueblo, Spanish, Mexican, and American cultural institutions. The anthropological and archaeological concept “Navajo,” created through Western scholarship by non-Diné, does not align with Diné worldview or conceptions of self and history. Instead, it reaffirms Western scholarship as legitimate, while it marginalizes and brands Diné history as “alternative,” or as not really history. A review of theories that underlie Navajo archaeological literature reveals that the genesis of the erroneous tenets about Diné culture stem from late nineteenth- and early twentieth-century ideas that researchers have only recently begun to re-examine.
Early Colonial Period
Authors: Pavao-Zuckerman Barnet , Jenks Kelly L.
Published: September 2017

An unfortunate conceptual divide within archaeological scholarship has traditionally divided Native history into “before” and “after” European colonialism. Past research emphasized the disruption wrought by the arrival of Europeans in the Southwest via the introduction of epidemic diseases, market economies, material goods, and alien plants and animals. Recent research emphasizes that many of the early colonial period strategies for cultural persistence were merely variations on the same processes that occurred throughout the Southwest for millennia. When faced with new challenges, Native southwestern groups used many of the same tools, including migration, economic intensification, and cultural expression, in the service of survival, cultural persistence, and revitalization.
Territorial and Early Statehood Periods
Authors: Majewski Teresita , Jelinek Lauren E.
Published: September 2017

The archaeology of the territorial and early statehood periods (1850–1917) in the American Southwest was virtually terra incognita until the advent of government-mandated archaeology in the 1960s. Subsequent work has shown that historical archaeology has much to contribute to a fuller understanding of this dynamic and formative time in U.S. history. Historical-archaeological investigations have demonstrated that although the United States formally exerted control over Arizona, Colorado, and New Mexico by the last half of the nineteenth century, the interactions among its Indigenous, Spanish, and Mexican inhabitants strongly influenced the territory’s historical trajectory into the nineteenth and early twentieth centuries. This chapter provides a historic context and a selective overview of archaeological studies that relate to the key themes of shifting economies and cultural heterogeneity.
The Built Environment
Authors: Adler Michael
Published: September 2017

The most intensively studied societies within Southwest archaeology—the Ancestral “Pueblos”—have been defined by their architecture. Stark village ruins of stone and adobe, some perched high in cliff settings, dot much of the region and are today its major tourist attractions. But as this chapter demonstrates, the architecture and built landscapes of the greater Southwest were vastly more diverse, ranging from the ephemeral wikiup-like structures of early hunter-gatherers, to the various pithouse forms and configurations of the Archaic and later periods, to the monumental trincheras, ball courts, and platform mounds of the southern Southwest, to the great kivas, great houses, and road systems of the Chacoan world. This chapter surveys that diversity and considers the way the built environment has been mobilized as evidence to make claims about social and political organization, religion practice, cosmology, mobility, and scale of collective labor projects within studies of ancient Southwest communities.
Anthropogenic Landscapes
Authors: Roos Christopher I.
Published: September 2017

It has been suggested that anthropogenic burning may have altered Southwest landscapes at a large scale. Southwestern biomes vary in their propensity for and their susceptibility to anthropogenic burning practices. Anthropogenic burning to enhance the productivity of wild plant foraging or agriculture was probably limited in scale; on the other hand, fire use in hunting, religious practice, and warfare may have impacted larger scales, though at lower intensity. Middle-elevation forests, woodlands, and grasslands were the biotic zones most likely to be impacted by anthropogenic burning, but sophisticated mimicry of natural fire regimes means that the evidence of such impact is ambiguous.
Movement and Migration
Authors: Cameron Catherine M. , Ortman Scott G.
Published: September 2017

Movement is a fundamental concept among Native peoples of the American Southwest, and early archaeologists adopted a strong interest in migration from Native groups with whom they interacted. Over the past two decades, southwest archaeologists have made significant contributions to method and theory in migration studies, including ways of identifying migrants as they move across the landscape, the ways in which migrants interact with Indigenous residents, and the size of migrating groups. Study has focused especially on the vast thirteenth- through fifteenth-century population movements that resulted in dramatic changes in population distribution, particularly in the northern Southwest. The passage of the Native American Graves Protection and Repatriation Act (NAGPRA) initiated a re-engagement with contemporary Native peoples that has transformed perspectives on the relative importance of movement (and sedentism) and has produced new understandings of how social identity was constructed in the ancient Southwest.
The Direct Historical Approach
Authors: Ware John A.
Published: September 2017

The direct historical approach investigates the past by working backward in time from the known ethnographic present to the unknown pre-colonial past. The approach assumes historical connection between past and present and promises to yield insights into the contingent facts of particular culture histories. Popular in the late nineteenth and early twentieth centuries, especially in the Pueblo Southwest, the direct historical approach was abandoned partly because of its early reliance on Native oral traditions. In recent years, revival of the approach has been hampered by assumptions about colonial impacts and historical disjunctions. This chapter argues that the demise of the direct historical approach was premature and that its revival is essential to a comprehensive understanding of both pre-colonial past and ethnographic present.
Minerals
Authors: Duff Andrew I. , Habicht-Mauche Judith A. , Shackley M. Steven
Published: September 2017

This chapter discusses the procurement of clay, temper, and mineral pigments (including lead) used to make pottery, as well as tool stone, salt, and turquoise, by people in the Southwest. This chapter also discusses the distribution of these minerals and the analytical means used by archaeologists to source them. Some of these materials were available near residences, while others were located at greater distances, requiring trade relationships or sojourns to acquire. When resources were procured from considerable distances, their procurement was often enmeshed in ritual. The procurement and circulation of these resources are critical to models of social, political, and economic interaction in Southwest archaeology.
Historical Linguistics
Authors: Hill Jane H.
Published: September 2017

The Comparative Method in historical linguistics distinguishes resemblances among languages due to vertical transmission from those due to horizontal transmission, and from resemblances due to non-historical factors like chance. Alternative phylogenetic methods that seek long-range connections among languages have not been shown to consistently detect this distinction. Derived from the Comparative Method are the study of language contact and areal connections, lexicostatistical dating methods and linguistic-paleontological methods for reconstructing cultural knowledge. Methodological debates in historical linguistics, and application of these methods to cases in the linguistic history of the Southwest, are reviewed, suggesting that, in spite of the paucity of available data for many languages, historical linguistic methods have an important role to play in developing hypotheses about Southwestern prehistory.
Evolutionary and Complexity Theory
Authors: Kohler Timothy A.
Published: September 2017

Echoes of all the major approaches to applying evolutionary theory and method to the archaeological record can be found in the Southwest. Prior to about 1980, cultural evolutionary approaches were quite common; after that time, until the mid-1990s, selectionism was the dominant approach. More recently, human behavioral ecology and, to a smaller degree, dual inheritance theory have oriented most evolutionary research, while at the same time, research that draws on the theories and methods of complex adaptive systems has become more prominent. All of these approaches are likely to contribute to solving the grand challenges facing archaeology in the Southwest.
Traditional Cultural Properties
Authors: Ferguson T.J. , Kuwanwisiwma Leigh
Published: September 2017

Traditional cultural properties are significant because of the role they play in the retention and transmission of historically rooted beliefs, customs, and practices of a living traditional community. They are routinely identified and evaluated as historic properties during research activities needed for compliance with Section 106 of the National Historic Preservation Act, which requires federal agencies to consider the effects of their undertakings on cultural resources. To be eligible for the National Register of Historic Places, traditional cultural properties need to be tangible places (a district, site, building, structure or object), must meet one or more of the National Register eligibility criteria, must have integrity of relationship and condition, must have been important for at least fifty years, and must have definable boundaries. The methods and concepts pertinent to research of traditional cultural properties in the Southwest are reviewed in this chapter.
Diversity of Diatrypaceae Species Associated with Dieback of Grapevines in South Africa, with the Description of Eutypa cremea sp. nov.
Authors: Moyo Providence , Mostert Lizel , Spies Christoffel F.J. , Damm Ulrike , Halleen Francois
Published: September 2017

Recent studies in grape-growing areas including Australia, California, and Spain have revealed an extensive diversity of Diatrypaceae species on grapevines showing dieback symptoms and cankers. However, in South Africa, little is known regarding the diversity of these species in vineyards. The aim of this study was, therefore, to identify and characterize Diatrypaceae species associated with dieback symptoms of grapevine in South Africa. Isolates were collected from dying spurs of grapevines aged 4 to 8 years old, grapevine wood showing wedge-shaped necrosis when cut in cross section as well as from perithecia on dead grapevine wood. The collected isolates were identified based on morphological characters and phylogenetic analyses of the internal transcribed spacer region (ITS) and β-tubulin gene. Seven Diatrypaceae species were identified on grapevine, namely Cryptovalsa ampelina, C. rabenhorstii, Eutypa consobrina, E. lata, E. cremea sp. nov., Eutypella citricola, and E. microtheca. The dying spurs yielded the highest diversity of species when compared with the wedge-shaped necrosis and/or perithecia. C. ampelina was the dominant species in the dying spurs, followed by E. citricola, whereas E. lata was the dominant species isolated from the wedge-shaped necroses and perithecia. These results confirm E. lata as an important grapevine canker pathogen in South Africa, but the frequent association of C. ampelina with spur dieback suggests that this pathogen plays a more prominent role in dieback than previously assumed. In some cases, more than one species were isolated from a single symptom, which suggests that interactions may be occurring leading to decline of grapevines. C. rabenhorstii, E. consobrina, E. citricola, E. microtheca, and E. cremea are reported for the first time on grapevine in South Africa.
Deep Sequencing Uncovers Rice Long siRNAs and Its Involvement in Immunity Against Rhizoctonia solani
Authors: Niu Dongdong , Zhang Xin , Song Xiaoou , Wang Zhihui , Li Yanqiang , Qiao Lulu , Wang Zhaoyun , Liu Junzhong , Deng Yiwen , He Zuhua , Yang Donglei , Liu Renyi , Wang Yanli , Zhao Hongwei
Published: September 2017

Small RNA (sRNA) is a class of noncoding RNA that can silence the expression of target genes. In rice, the majority of characterized sRNAs are within the range of 21 to 24 nucleotides (nt) long, whose biogenesis and function are associated with a specific sets of components, such as Dicer-like (OsDCLs) and Argonaute proteins (OsAGOs). Rice sRNAs longer than 24 nt are occasionally reported, with biogenesis and functional mechanism uninvestigated, especially in a context of defense responses against pathogen infection. By using deep sequencing, we identified a group of rice long small interfering RNAs (lsiRNAs) that are within the range of 25 to 40 nt in length. Our results show that some rice lsiRNAs are differentially expressed upon infection of Rhizoctonia solani, the causal agent of the rice sheath blight disease. Bioinformatic analysis and experimental validation indicate that some rice lsiRNAs can target defense-related genes. We further demonstrate that rice lsiRNAs are neither derived from RNA degradation nor originated as secondary small interfering RNAs (siRNAs). Moreover, lsiRNAs require OsDCL4 for biogenesis and OsAGO18 for function. Therefore, our study indicates that rice lsiRNAs are a unique class of endogenous sRNAs produced in rice, which may participate in response against pathogens.
Prime Time for Shared Decision Making
Authors: Spatz Erica S. , Krumholz Harlan M. , Moulton Benjamin W.
Published: September 2017

(Abstracted from JAMA 2017;317(13):1309–1310)

Washington State passed legislation in 2007 incentivizing shared decision making as an alternative option to traditional forms and procedures for informed consent for certain procedures. This requires patients to sign an attestation that they used a certified decision aid and discussed risks, benefits, and alternatives.
Implementing a Health System–wide Patient Blood Management Program with a Clinical Community Approach
Authors: Frank Steven M. , Thakkar Rajiv N. , Podlasek Stanley J. , Ken Lee K. H. , Wintermeyer Tyler L. , Yang Will W. , Liu Jing , Rotello Leo C. , Fleury Thomas A. , Wachter Pat A. , Ishii Lisa E. , Demski Renee , Pronovost Peter J. , Ness Paul M.
Published: September 2017

Background

Patient blood management programs are gaining popularity as quality improvement and patient safety initiatives, but methods for implementing such programs across multihospital health systems are not well understood. Having recently incorporated a patient blood management program across our health system using a clinical community approach, we describe our methods and results.

Methods

We formed the Johns Hopkins Health System blood management clinical community to reduce transfusion overuse across five hospitals. This physician-led, multidisciplinary, collaborative, quality-improvement team (the clinical community) worked to implement best practices for patient blood management, which we describe in detail. Changes in blood utilization and blood acquisition costs were compared for the pre– and post–patient blood management time periods.

Results

Across the health system, multiunit erythrocyte transfusion orders decreased from 39.7 to 20.2% (by 49%; P < 0.0001). The percentage of patients transfused decreased for erythrocytes from 11.3 to 10.4%, for plasma from 2.9 to 2.2%, and for platelets from 3.1 to 2.7%, (P < 0.0001 for all three). The number of units transfused per 1,000 patients decreased for erythrocytes from 455 to 365 (by 19.8%; P < 0.0001), for plasma from 175 to 107 (by 38.9%; P = 0.0002), and for platelets from 167 to 141 (by 15.6%; P = 0.04). Blood acquisition cost savings were $2,120,273/yr, an approximate 400% return on investment for our patient blood management efforts.

Conclusions

Implementing a health system-wide patient blood management program by using a clinical community approach substantially reduced blood utilization and blood acquisition costs.
Hip Surveillance for Children With Cerebral Palsy: A Survey of the POSNA Membership
Authors: Shore Benjamin J. , Shrader Michael W. , Narayanan Unni , Miller Freeman , Graham H. Kerr , Mulpuri Kishore
Published: September 2017

Background:

Currently, hip surveillance programs for children with cerebral palsy exist in Europe, Australasia, and parts of Canada, but a neuromuscular hip surveillance program has yet to be adopted in the United States. The purpose of this study was to report the current orthopaedic practice of hip surveillance in children with cerebral palsy, identify areas of practice variation, and suggest steps moving forward to generate guidelines for national neuromuscular hip surveillance.

Methods:

The entire membership of the Pediatric Orthopaedic Society of North America (POSNA) was surveyed in 2016 for information regarding their practice for hip surveillance in children with cerebral palsy. Detailed information regarding timing, frequency, and practice of hip surveillance was obtained in answers to 26 different questions.

Results:

A survey response rate of 27% was obtained (350/1300 members) during the study period. The majority of respondents treated pediatric patients exclusively (97%), worked in an academic practice (70%), and was affiliated with a university (76%). In total, 18% (69/350) of respondents followed a regular cerebral palsy hip surveillance program, about half of whom (44%, 30/69) had adopted the Australian guidelines. Respondents agreed that a dislocated hip in a child with cerebral palsy was painful (90% agreement) and should be prevented by hip surveillance (93% agreement). Furthermore, 93% of respondents indicated they would follow a national surveillance program if one was in place. Age (79%), Gross Motor Function Classification System (81%), and migration percentage (MP) (78%) were all identified as critical elements to a hip surveillance program. The majority of respondents felt that a hip “at risk” for hip displacement had a MP between 20% and 30% (57% of respondents), whereas surgery should be utilized once the MP exceeded 40% (50% of respondents).

Conclusions:

Results from this survey demonstrate 90% of respondents agree that a dislocated hip could be painful and 93% would follow a national surveillance program if available. At a societal level, we have the ability to standardize cerebral palsy hip surveillance, thereby decreasing practice variation and improving quality of care delivery.

Levels of Evidence:

Level V.
Eye Protection: Survey of Dermatologists and Office Staff
Authors: Pate David A. , Kampp Jeremy T.
Published: September 2017

BACKGROUND

Splash injuries to mucosal membranes during procedures have been well documented in dermatology and carry a potential risk of blood-borne virus transmission. The risk to the ocular mucosa can be minimized with proper eye protection.

OBJECTIVE

To examine the prevalence of wearing eye protection during dermatologic procedures by physicians, trainees, and office staff in dermatology.

METHODS

A Cross-sectional observational study of US dermatologists, residents, nurses, and medical assistants was performed regarding eye protection during dermatologic procedures.

RESULTS

The rates of wearing eye protection in every dermatologic procedure are as follows: dermatologists 42.3%, residents/fellows 39.6%, and nurses/medical assistants 25%. Ninety-eight percent of respondents thought blood-borne illnesses could be transmitted by splash injury. The rates of having splash injury during your career are as follows: dermatologists 73.1%, residents/fellows 16.7%, and nurses/medical assistants 50%. The rates of having a splash injury within the last year are as follows: dermatologists 11.5%, residents/fellows 8.3%, and nurses/medical assistants 35.7%.

CONCLUSION

The use of eye protection is an important component of the personal protective equipment to help prevent transmission of blood-borne illnesses. Dermatologists and staff should strive to increase awareness and the use of face masks with eye shields or face mask with separate eye protection in every dermatologic procedure.
MC225, a Novel Probe for P-glycoprotein PET Imaging at the Blood–brain Barrier: In Vitro Cardiovascular Safety Evaluation
Authors: Fusi Fabio , Durante Miriam , Gorelli Beatrice , Perrone Maria Grazia , Colabufo Nicola Antonio , Saponara Simona
Published: September 2017

The P-glycoprotein (P-gp) substrate MC225, at concentrations ≤10 nM, is a valuable radiotracer for positron emission tomography imaging of P-gp function in rats and mice. The aim of this study was to evaluate its potential toxic hazard toward the cardiovascular system through an in-depth analysis of its effects on rat aorta rings, on CaV1.2 channel current (ICa1.2) of A7r5 cells and on Langendorff-perfused rat heart. In aortic rings, MC225 relaxed phenylephrine-induced contraction in a concentration-dependent and endothelium-independent manner, with an IC50 value of about 1 μM. At concentrations ≥3 μM, it antagonized the response to cumulative concentrations of K+. MC225, 1 and 10 μM, inhibited ICa1.2 by 15% and 31%, respectively, without affecting either current activation or inactivation kinetics. In Langendorff-perfused rat hearts, only 10 μM MC225 significantly decreased left ventricular pressure and increased coronary perfusion pressure while reducing heart rate and prolonging the cardiac cycle length as well as the atrioventricular conduction time (PQ interval) on the electrocardiogram. Lower concentrations of the drug were ineffective. These findings demonstrate that MC225-induced cardiovascular effects took place at concentrations that are at least 2 orders of magnitude higher than those allowing in vivo measurement of P-gp function. Therefore, MC225 represents a promising positron emission tomography tool for in vivo straightforward P-gp quantification.
Antibiotic Use in Hospitalized Children With Respiratory Viruses Detected by Multiplex Polymerase Chain Reaction
Authors: Goriacko Pavel , Saiman Lisa , Zachariah Philip
Published: September 2017

Background:

Multiplex polymerase chain reaction–based methods are increasingly used to detect respiratory pathogens in children. While rapid identification of viruses has been shown to reduce antibiotic use, the impact of detecting specific viruses on antibiotic utilization has not been ascertained. This study compared antibiotic utilization among hospitalized children who tested positive for different respiratory viruses at admission.

Methods:

A single-center study of hospitalized children under 21 years of age who tested positive at admission for at least 1 respiratory virus by multiplex polymerase chain reaction from October 1, 2012 to October 1, 2015 was performed. Multivariable logistic regression was used to determine the association of testing positive for specific viruses with the use of antibiotics for ≥ 2 days, adjusted for demographic and clinical characteristics.

Results:

The study included 1416 patients with a median age of 2.1 years (interquartile range: 0.6–6.2 years). Patients positive for influenza (odds ratio: 2.0, 95% confidence interval: 1.1–3.4) and human metapneumovirus (odds ratio: 2.0, 95% confidence interval: 1.1–3.7) were more likely to receive ≥ 2 days of treatment compared with patients positive for respiratory syncytial virus (RSV). Other variables affecting prolonged use of antibiotics included respiratory support, primary nonrespiratory diagnosis, complex comorbid conditions and admission to the intensive care unit.

Conclusions:

Providers are more likely to use antibiotics in non-RSV–infected patients compared with RSV. These trends likely represent concern about bacterial superinfection and may reflect lack of familiarity with these pathogens.
Cannabis constituent synergy in a mouse neuropathic pain model
Authors: Casey Sherelle L. , Atwal Nicholas , Vaughan Christopher W.
Published: September 2017

Cannabis and its psychoactive constituent Δ9-tetrahydrocannabinol (THC) have efficacy against neuropathic pain, however, this is hampered by their side effects. It has been suggested that co-administration with another major constituent cannabidiol (CBD) might enhance the analgesic actions of THC and minimise its deleterious side effects. We examined the basis for this phytocannabinoid interaction in a mouse chronic constriction injury (CCI) model of neuropathic pain. Acute systemic administration of THC dose-dependently reduced CCI-induced mechanical and cold allodynia, but also produced motor incoordination, catalepsy, and sedation. Cannabidiol produced a lesser dose-dependent reduction in allodynia, but did not produce the cannabinoid side effects. When co-administered in a fixed ratio, THC and CBD produced a biphasic dose-dependent reduction in allodynia. At low doses, the THC:CBD combination displayed a 200-fold increase in anti-allodynic potency, but had lower efficacy compared with that predicted for an additive drug interaction. By contrast, high THC:CBD doses had lower potency, but greater anti-allodynic efficacy compared with that predicted for an additive interaction. Only the high dose THC:CBD anti-allodynia was associated with cannabinoid side effects and these were similar to those of THC alone. Unlike THC, the low dose THC:CBD anti-allodynia was not cannabinoid receptor mediated. These findings demonstrate that CBD synergistically enhances the pain-relieving actions of THC in an animal neuropathic pain model, but has little impact on the THC-induced side effects. This suggests that low dose THC:CBD combination treatment has potential in the treatment of neuropathic pain.
Advancing Value-Based Population Health Management Through Payer–Provider Partnerships: Improving Outcomes for Children With Complex Conditions
Authors: Peele Pamela , Keyser Donna , Lovelace John , Moss Deborah
Published: September 2017

Population health management (PHM) approaches to improve cost and quality remain limited. To address this gap, stakeholders within an integrated delivery and financing system in Western Pennsylvania designed, implemented, and tested a value-based care model for children with medically complex conditions that could be scaled across the broader pediatric population. The model included: (1) a multilevel, interdisciplinary infrastructure; (2) actionable analytics reports to guide continuous quality improvement; (3) alternative provider payments; (4) consumer-directed spending accounts; and (5) shared savings with practices. Four practices caring for 215 children (<age 21) with medically complex conditions participated in the demonstration. Quality and cost outcomes were compared between the intervention group and a comparison group using propensity scores. The program generated cost savings over a 2-year performance period, although the difference between the intervention and comparison groups was not significant, likely because of the small N. Quality of care was maintained or improved for the intervention group from baseline to the end of the performance period. This model is an example of how real-world laboratories that leverage strong payer-provider partnerships can be a useful platform for testing value-based PHM models with the potential to reduce healthcare costs while maintaining or improving care quality.
Technology Solutions to Support Care Continuity in Home Care: A Focus Group Study
Authors: Dowding Dawn W. , Russell David , Onorato Nicole , Merrill Jacqueline A.
Published: September 2017

Background:

Elevated hospital readmission rates from home care are an indicator of poor care quality, and rates are particularly high for patients with heart failure. Readmissions may be avoided by optimizing continuity of care.

Purpose:

To explore perceptions among home care clinicians of the barriers they face and the information they need to improve care continuity for patients with heart failure.

Methods:

Focus groups were conducted with teams of home care clinicians at a large certified home healthcare agency in the Northeastern United states.

Results:

In total, there were 61 participants across 6 focus groups. Three overarching themes emerged: continuity of care and communication on care transitions, maintaining continuity of care during a home care episode (with subthemes tracking signs and symptoms and patient teaching), and health information technology (HIT) characteristics to support communication and care continuity.

Conclusions:

Our study highlights areas of improvement for HIT solutions that could support care delivery for patients with heart failure in a home care setting.

Implications:

Home care agencies planning to introduce technology can use these findings to assess if and how potential systems can support nurses to provide continuity of care across healthcare organizations and home care visits.
Current opinion in otolaryngology: update on vascular injuries in craniomaxillofacial fractures
Authors: Illing Elisa , Burgin Sarah Jo , Schmalbach Cecelia E.
Published: September 2017

Purpose of review

The primary purpose of this chapter is to define current recommendations for vascular work-up of patients with craniomaxillofacial (CMF) trauma with emphasis on imaging to include intraoperative fluorescence, angiography, and surgical exploration. The second goal is to review current management recommendations for observation versus surgical exploration based on the neck zones of injury.

Recent findings

Over the past two decades, endovascular techniques are increasingly utilized, particularly in zones I and III of the neck. Additionally, modern advances in radiographic technology have allowed for selective exploration of penetrating zone II injuries. A high suspicion for blunt cerebrovascular injury should be maintained for patients with high-speed deceleration mechanisms of injury, with a majority of patients managed with medical therapy or conservative monitoring over surgical intervention.

CMF fractures are associated with vascular injuries to the intracranial carotid system, extracranial carotid system, or vertebral artery system. A thorough understanding of at risk patients, optimal work-up, and timely treatment algorithms is imperative given the devastating sequellae of stroke and death.
Detection of newly defined superantigenic toxin genes and coagulase gene polymorphism in Staphylococcus aureus isolates
Authors: Al-Ajealy Bareq A. , Al-Shukri Maysa S.M. , Al-Jumaily Hassan S.
Published: September 2017

The current study aims to use coagulase (coa) polymorphism gene to identify Staphylococcus aureus isolated from stool samples, evaluate the efficiency of these methods in discriminating variable strains, and compare these subtypes with antibiotypes. A total of 100 specimens were collected from patients in Babylon province, Iraq, between July 2016 and September 2016. Twenty S. aureus strains were isolated and identified using standard laboratory microbiological tests. The bacterial isolates were then examined by coa gene restriction fragment length polymorphism genotyping. Out of 20 isolates, coa gene types were classified, and the amplification products showed multiple size bands (500, 600, 700, 800, and 900-bp bands). Coa gene PCR restriction fragment length polymorphisms exhibited seven patterns that ranged from one to four fragments with AluI digestion. The results have demonstrated that many variants of the coa gene are present. At least one type of S. aureus newly described enterotoxin gene (staphylococcal enterotoxins) was harboring in all 20 (100%) of the isolates. The most frequently encountered gene were sei (100.%), seh (5%), seg (65%). Many S. aureus isolates carry at least one of the enterotoxin genes, and (95%) strains harbored more than one toxin gene coding.
It Is Time for Routine Screening for Perinatal Mood and Anxiety Disorders in Obstetrics and Gynecology Settings
Authors: Accortt Eynav Elgavish , Wong Melissa S.
Published: September 2017

Importance

Women are 2 to 3 times more likely than men to experience depression in their lifetime, and the greatest risk occurs during the reproductive years. As an obstetrics and gynecology physician or provider, you will likely encounter women who are at risk of development or relapse of a mental disorder during this vulnerable time.

Objective

The aim of this review is to examine theory and research on mood and anxiety disorders during the perinatal period with an emphasis on screening recommendations.

Evidence Acquisition

A PubMed and PsycINFO search for English-language publications about perinatal mood and anxiety disorders and screening was performed and included studies on subtopics.

Results

The literature reviewed suggests that perinatal mood and anxiety symptoms are prevalent and have significant consequences, and best practices for early detection are through routine depression and anxiety screening in the obstetrics setting. This includes overcoming barriers to care and use of liaison services to potentially reduce risk.

Conclusions and Relevance

High-quality prenatal care systems should develop the capacity for depression and anxiety risk assessment and treatment. Providers should routinely screen using validated screening tools, provide maternal mental health education, and be aware of the various medical, psychological, and complementary approaches for treating mood and anxiety disorders, to best guide and refer patients. The use of this practice will increase the quality of life in pregnant women with depression and anxiety and may help to reduce the likelihood of adverse birth outcomes, postpartum mental health problems, and adverse effects on offspring.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completing this activity, the learner should be better able to name 3 adverse birth outcomes related to prenatal symptoms of depression and anxiety; identify symptoms, prevalence, and consequences of depression and anxiety in pregnancy and postpartum; and contrast and apply reliable, valid, and widely used screening tools to assess for depression and anxiety and practice appropriate referral for this population.
Screening for Preeclampsia: US Preventive Services Task Force Recommendation Statement
Authors: Bibbins-Domingo Kirsten , Grossman David C. , Curry Susan J. , Barry Michael J. , Davidson Karina W. , Doubeni Chyke A. , Epling John W. , Kemper Alex R. , Krist Alex H. , Kurth Ann E. , Landefeld C. Seth , Mangione Carol M. , Phillips William R. , Phipps Maureen G. , Silverstein Michael , Simon Melissa A. , Tseng Chien-Wen
Published: September 2017

(Abstracted from JAMA 2017;317(16):1661–1667)

Approximately 4% of pregnancies in the United States are affected by preeclampsia, defined as new-onset hypertension (or worsening hypertension in patients with existing hypertension) after 20 weeks' gestation, combined with either new-onset proteinuria or other symptoms involving multiple organ systems. This disorder is associated with poor maternal and fetal outcomes, including maternal mortality, maternal stroke, low birth weight, and stillbirth.
Melanotic Translocation Renal Cell Carcinoma With a Novel ARID1B-TFE3 Gene Fusion
Authors: Antic Tatjana , Taxy Jerome B. , Alikhan Mir , Segal Jeremy
Published: September 2017

A 36-year-old male was found to have a 7.0 cm left upper pole renal mass on renal ultrasound. Following nephrectomy, the mass was grossly ill-demarcated, friable and red-brown, invading renal parenchyma, hilar fat and the renal vein. Microscopically, the tumor had a nested and papillary architecture. The cells demonstrated abundant clear and eosinophilic cytoplasm and focal intracytoplasmic melanin pigment. Nucleoli were prominent. By immunohistochemistry, the tumor was positive for TFE3; HMB-45 stained approximately 5% of tumor cells corresponding to the histologic melanin pigment, which was confirmed with Fontana-Masson stain with bleach. Immunostains for PAX8, CD10, MiTF, and CAIX were negative; keratins Cam 5.2 and AE1/AE3 were focally positive. Targeted next-generation sequencing revealed an ARID1B-TFE3 gene fusion. Melanotic Xp11 renal cell carcinoma is a rare, pigment containing translocation variant demonstrating overlapping features with melanoma and is usually associated with an SFPQ-TFE3 gene fusion. The patient is alive and without evidence of disease 7 years after his diagnosis. The combination of high grade histopathology, the presence of melanin, absent PAX8, keratin positivity, and relatively indolent clinical behavior with a unique translocation may warrant recognition as a distinct renal cell carcinoma translocation subtype.