bluuebunny/crossref_metadata_2025 huggingface dataset:
The Political Economy of Energy Innovation
Authors: Dasgupta Shouro , Cian Enrica De , Verdolini Elena
Published: May 2017

This chapter empirically investigates the effects political economy factors on energy innovation in a sample of 20 countries between 1995 and 2010. We use various proxies for energy innovation and focus on the role of environmental policy, good governance, political orientation, and the distribution of resources to energy intensive industries. We show that political economy factors affect the incentives to engage in energy-related innovation even in the presence of stringent environmental policy. Specifically, good governance and left-wing governments provide incentives for greater R&D resources to the energy sector, while a larger distribution of resources toward energy intensive sectors can induce market-size effects and lobby for larger energy R&D allocation. This implies that, in order to move towards a greener economy, countries should combine environmental policy with a general improvement of institutions, consider the influence of government’s political orientation on environmental policies and the size of energy-intensive sectors.
Towards a Political Economy Framework for Wind Power
Authors: Davidson Michael R. , Kahrl Fredrich , Karplus Valerie J.
Published: May 2017

The authors propose a general taxonomy of the political economy challenges to wind power development and integration, highlighting the implications in terms of actors, interests, and risks. Applying this framework to three functions in China’s electricity sector—planning and project approval, generator cost recovery, and balancing area coordination—the authors find evidence of challenges common across countries with significant wind investments, despite institutional and industry characteristics that are unique to China. The authors argue that resolving these political economy challenges is as important to facilitating the role of wind and other renewable energies in a low-carbon energy transition as providing dedicated technical and energy policy support. China is no exception.
Political Economy of Nigerian Power Sector Reform
Authors: Ogunleye Eric Kehinde
Published: May 2017

The Nigerian power sector reform is necessitated by the chronically poor performance of the sector and has as its compass the 2005 Electric Power Sector Reform Act and the Road Map for Power Sector Reform 2010. Implementing the reform has resulted in significant progress that includes unbundling and privatization of the long-standing government-owned monopoly in the power sector and a move towards achieving a cost-reflective electricity tariff. This chapter provides a comprehensive assessment of the reform, isolating the major challenges facing it, and focusing on political economy developments surrounding regulatory, institutional, legislative, and fiscal issues, with achieving energy security and mainstreaming clean renewable energy being the main theme running through the analysis.
The Archaeological Record
Authors: Hazarika Manjil
Published: May 2017

This chapter attempts to address the prehistoric ‘people’ responsible for the array of sites found, albeit sporadically, across the entire length and breadth of Northeast India. Conspicuously, the historiography of archaeological research in this area painfully surprises us in that, barring a handful of sites of both prehistoric and historical contexts, most of the sites are yet to be properly studied or excavated and treated with recent developments in the field of archaeological science. Nevertheless, sites like Ambari, Daojali Hading, Nongpok Keithelmanbi, Pynthorlangtein, Sarutaru, Sekta, Selbalgiri 2, Vadagokugiri have proved to be of immense potential in studying the ‘people’ and their cultures and, in a broader sense, in the reconstruction of history. This chapter deals with the major findings related to the pre-Neolithic and Neolithic cultures discovered to date.
Introduction
Authors: Murray Sarah E.
Published: May 2017

Chapter 1 provides an introduction to evidentiality, its expression across languages, and related notions, such as modality and (not‐)at‐issue content. Evidentiality is the encoding of source of information, which is grammatically marked in many languages. While every language could have a means of indicating source of information, of expressing evidentiality, not all languages have grammatical evidentials. Crosslinguistically, evidential systems can vary along several dimensions, including number of evidential distinctions, grammatical category, and whether or not evidentials are obligatory. This chapter lays out the background assumptions of the book as well as gives an overview of the literature and issues.
Methodists and Holiness in North America
Authors: Case Jay R.
Published: May 2017

Baptists in nineteenth-century North America were known as eager proselytizers. They were evangelistic, committed to the idea of a believers’ church in which believers’ baptism was the norm for church membership and for the most part fervent revivalists. Baptist numbers soared in the early nineteenth-century United States though at the cost of generating much internal dissent, while in Canada New Light preachers such as Henry Alline were influential, but often had to make headway against an Anglican establishment. The Baptist commitment to freedom of conscience and gathered congregations had been hardened over the centuries by the experience of persecution and that meant that they were loath to qualify the freedom of individual congregations. The chapter concentrates on exposing the numerous divisions in the Baptist family, the most basic of which was the disagreement over the nature of the atonement, which separated General (Arminian) from Particular (Calvinist) Baptists. Revivals induced further divisions between Regular Baptists who were reserved about them and Separate Baptists who saw dramatic conversions and fervent outbursts as external signs of inward grace. Calvinistic Baptists took a dim view of efforts to induce conversions as laying too much trust in human agency. Though enthusiasm for missions gripped American and Canadian Baptists alike, there were those who feared that missionary societies would erode congregational autonomy. Dissent over slavery and abolition constituted the biggest single division in North American Baptist life. Southern Baptists developed biblical defences of slavery and were annoyed at attempts to keep slaveholders out of missionary work. As a result they formed a separate denomination, the Southern Baptist Convention, in 1845. Baptists had been successful in converting black slaves and black Baptists such as the northerner Nathaniel Paul were outspoken abolitionists. In the South after the Civil War, though, blacks marched out of white denominations to form associations of their own, often with white encouragement. Finally, not the least cause of internal dissent were disputes over ecclesiology, with J.M. Graves and J.R. Pendleton, the founders of Old Landmarkism, insisting with renewed radicalism on denominational autonomy. The chapter suggests that by the end of the century, Baptists embodied the tensions in Dissenting traditions. Their dissent in the public square intensified the possibility of internal disagreement, even schism, their tradition of Christian democracy proving salvifically liberating but ecclesiastically messy. While they stood for liberty and religious equality, they were active in anti-Catholic politics and in seeking to extend state activism in society through the Social Gospel movement.
The Induction of Synaesthesia in Non-Synaesthetes
Authors: Terhune Devin B. , Luke David P. , Kadosh Roi Cohen
Published: May 2017

In this chapter we review research examining the induction of synaesthesia with training, posthypnotic suggestion, and pharmacological agents in non-synaesthetes. Each of these methods has been shown to produce different aspects of synaesthesia, but none have produced experiences that have been corroborated using neuroimaging assays. Nevertheless, the close parallels between induced and congenital synaesthesias have the potential to illuminate different facets of this condition. We argue that training may be a valuable model for studying the learning mechanisms underlying congenital synaesthesia, posthypnotic suggestion may have greater utility in the experimental manipulation of this condition, and the administration of pharmacological agents may serve as a useful tool for studying the development of synaesthesia or for large-scale studies of induced synaesthesia. Induced synaesthesias also raise important questions regarding espoused criteria for demarcating synaesthesia from other phenomena.
The Sensory Ecology of Birds
Authors: Martin Graham R.
Published: May 2017

The natural world contains a huge amount of constantly changing information. Limitations on, and specializations within, sensory systems mean that each species receives only a small part of that information. In essence, information is filtered by sensory systems. Sensory ecology aims to understand the nature and functions of those filters for each species and sensory system. Fluxes of information, and the perceptual challenges posed by different natural environments, are so large that sensory and behavioural specializations have been inevitable. There have been many trade-offs in the evolution of sensory capacities, and trade-offs and complementarity between different sensory capacities within species. Many behavioural tasks may have influenced the evolution of sensory capacities in birds, but the principal drivers have been associated with just two tasksforaging and predator detection. The key task is the control of the position and timing of the approach of the bill towards a target. Other tasks, such as locomotion and reproduction, are achieved within the requirements of foraging and predator detection. Information thatguides behaviours may often be sparse and partial and key behaviours may only be possible because of cognitive abilities which allow adequate interpretation of partial information. Human modifications of natural environments present perceptual challenges that cannot always be met by the information available to particular birds. Mitigations of the negative effects of human intrusions into natural environments must take account of the sensory ecology of the affected species. Effects of environmental changes cannot be understood sufficiently by viewing them through the filters of human sensory systems.
Sleep Health Promotion: Practical Information for Physical Therapists
Authors: Siengsukon Catherine F. , Al-dughmi Mayis , Stevens Suzanne
Published: May 2017

Sleep disturbances occur in one third of the US population, and the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control has deemed insufficient sleep to be a public health problem. Knowledge about sleep and skills to screen sleep disorders and to promote sleep health have been recommended for physical therapists. Furthermore, in survey studies, physical therapists overwhelmingly agree that sleep is important for health and poor sleep impairs function. Sleep is critical for the proper functioning of the body, including immune function, tissue healing, pain modulation, cardiovascular health, cognitive function, and learning and memory. Sleep disruptions occur across the life span and in individuals with various conditions that are typically treated by physical therapists. Therefore, the purpose of this perspective paper is to (1) discuss the relevance of sleep to physical therapist practice, (2) recommend tools to screen for the 3 most common sleep disorders, and (3) provide suggestions for how therapists can integrate sleep health in prevention, health promotion, and wellness interventions.
Investigation of Potential Causes of Peach Skin Streaking
Authors: Hu Meng-Jun , Peng Congyue , Melgar Juan Carlos , Schnabel Guido
Published: May 2017

Peach skin streaking is a previously undescribed skin discoloration affecting red-blush peach cultivars in Georgia and South Carolina. Streaked peach fruit have been observed in the field close to harvest. The cause of streaking is still unknown but one hypothesis is that atmospheric pollutants may be involved. The goal of this study was to establish proof of concept that commonly found air pollutants can produce streaks on peach skin similar to those observed in commercial orchards and investigate the susceptibility of peach fruit during maturation. Common reactive byproducts of atmospheric pollutants, including sulfuric acid (H2SO4), nitric acid (HNO3), and hypochlorite acid (HCl), at concentrations up to 10 μg/ml did not produce streaking under field conditions when applied at week 3, 2, and 1 prior to commercial harvest. However, sodium hypochlorite (NaClO) in the form of Clorox solution and chlorine dioxide (ClO2) at 100 μg/ml generated from the Aquamira water treatment solution produced streaking symptoms on detached peach fruit under controlled conditions and in the field. Peach fruit were most susceptible to streaking closest to harvest, suggesting that NaClO and ClO2 interfere with pigment formation.
Thiophanate-Methyl Resistance and Fitness Components of Colletotrichum musae Isolates from Banana in Brazil
Authors: Vieira Willie Anderson dos Santos , Lima Waléria Guerreiro , Nascimento Eduardo Souza , Michereff Sami Jorge , Reis Ailton , Doyle Vinson P. , Câmara Marcos Paz Saraiva
Published: May 2017

Anthracnose, caused by Colletotrichum musae, is the most important postharvest disease of banana and is widely distributed among the banana production regions in Brazil. Although thiophanate-methyl is a fungicide frequently used in Brazilian banana orchards to control Sigatoka leaf spot, Collettotrichum populations are also exposed, resulting in the evolution of fungicide resistance and the inability to manage banana anthracnose. We investigated 139 Brazilian isolates of C. musae for thiophanate-methyl sensitivity in vitro. The 50% mycelial growth inhibition (EC50) values varied between 0.003 and 48.73 μg/ml. One-hundred and thirty isolates were classified as sensitive, with EC50 values ranging from 0.003 to 4.84 μg/ml, while the remaining nine isolates were considered moderately resistant, with EC50 values ranging between 10.43 and 48.73 μg/ml. Resistant or highly resistant isolates (EC50 > 100 μg/ml) were not found. A substitution of TAC for TTC at codon 200 in a coding region of the β-tubulin gene was associated with the moderately resistant phenotype. Applications of thiophanate-methyl formulation to detached banana fruit at the label rate (500 μg/ml) showed low efficacy in controlling the moderately resistant isolates on banana fruits. However, there is no indication of a reduction in fitness associated with fungicide resistance as sensitive and moderately resistant isolates do not differ with respect to mycelial growth rate (P = 0.098), spore production (P = 0.066), spore germination (P = 0.366), osmotic sensitivity (P = 0.051), and virulence (P = 0.057). Our results revealed absence of adaptability cost for the moderately resistant isolates, suggesting that they can be dominant in population if the fungicide continue to be applied.
Best Practices for Population Genetic Analyses
Authors: Grünwald N. J. , Everhart S. E. , Knaus B. J. , Kamvar Z. N.
Published: May 2017

Population genetic analysis is a powerful tool to understand how pathogens emerge and adapt. However, determining the genetic structure of populations requires complex knowledge on a range of subtle skills that are often not explicitly stated in book chapters or review articles on population genetics. What is a good sampling strategy? How many isolates should I sample? How do I include positive and negative controls in my molecular assays? What marker system should I use? This review will attempt to address many of these practical questions that are often not readily answered from reading books or reviews on the topic, but emerge from discussions with colleagues and from practical experience. A further complication for microbial or pathogen populations is the frequent observation of clonality or partial clonality. Clonality invariably makes analyses of population data difficult because many assumptions underlying the theory from which analysis methods were derived are often violated. This review provides practical guidance on how to navigate through the complex web of data analyses of pathogens that may violate typical population genetics assumptions. We also provide resources and examples for analysis in the R programming environment.
Guillain-Barré Syndrome in Pregnancy
Authors: Pacheco L.D. , Saad A.F. , Hankins G.D. , Chiosi G. , Saade G.
Published: May 2017

(Obstet Gynecol. 2016;128(5):1105–1110)

Guillain-Barré syndrome is defined as a progressive neurological disease that causes the acute onset of symmetric ascending motor weakness, which at times results in respiratory failure and autonomic dysfunction. When this syndrome occurs during pregnancy it has been associated with increased maternal mortality (10%). In addition, over 35% of the affected pregnant women with this disorder require respiratory support. Recent reports have noted an association between Guillain-Barré syndrome and infection with the Zika virus in pregnant women. This report reviewed the autoimmune nature of the syndrome and described its clinical characteristics in addition to providing up-to-date evidence for the diagnosis and management of the disease, especially during pregnancy.
Hyperglycaemia and Risk of Adverse Perinatal Outcomes: Systematic Review and Meta-analysis
Authors: Farrar D. , Simmonds M. , Bryant M. , Sheldon T.A. , Tuffnell D. , Golder S. , Dunne F. , Lawlor D.A.
Published: May 2017

(BMJ. 2016;354:i4694)

Gestational diabetes increases the risk for some adverse perinatal outcomes such as macrosomia and cesarean section. However, uncertainty exists regarding the most appropriate glucose threshold at oral glucose tolerance testing (OGTT) to define gestational diabetes. The present study aimed to evaluate the association between maternal glucose concentrations and adverse perinatal outcomes in women without gestational diabetes or preexisting diabetes, and to determine whether there are obvious evidence-based glucose thresholds that can identify women at increased risk of adverse perinatal outcomes.
Temporal Trends in Late Preterm and Early Term Birth Rates in 6 High-income Countries in North America and Europe and Association With Clinician-initiated Obstetric Interventions
Authors: Richards J.L. , Kramer M.S. , Deb-Rinker P. , Rouleau J. , Mortensen L. , Gissler M. , Morken N.H. , Skjærven R. , Cnattingius S. , Johansson S. , Delnord M. , Dolan S.M. , Morisaki N. , Tough S. , Zeitlin J. , Kramer M.R.
Published: May 2017

(JAMA. 2016;316(4):410–419)

Late preterm and early term births occurring either spontaneously or through obstetric interventions such as labor induction or cesarean delivery have raised concerns due to the risks of adverse neonatal and childhood outcomes. Hence guidelines in the United States now recommend avoiding nonmedically indicated elective deliveries (labor induction or cesarean delivery) before 39 weeks gestation. This study aimed to evaluate temporal trends since 2006 in late preterm and early term birth rates among 6 countries in North America and Europe, and to determine any association between the temporal trends and changes in clinician-initiated obstetric interventions.
Confirmed Severe Maternal Morbidity is Associated With High Rate of Preterm Delivery
Authors: Kilpatrick S.J. , Abreo A. , Gould J. , Greene N. , Main E.K.
Published: May 2017

(Am J Obstet Gynecol 2016;215:233.e1–233.e7)

Approximately 2% of all births (50,000 women) in the United States are affected by severe maternal morbidity (SMM) with this number growing every year. It is not surprising that this increase in SMM mirrors a similar increase in maternal mortality. SMM events include things like hemorrhage ≥4 units, disseminated intravascular coagulation leading to a hysterectomy, sepsis, and critical care unit admission. It is imperative we better understand the risks and develop interventions to help prevent SMM, with the hope of also reducing maternal mortality. In order to achieve this goal, there have been recent efforts to screen for women who suffer SMM and perform a detailed review of these cases. This has been in an effort to better understand the causes of SMM and ultimately prevent poor maternal outcomes. The purpose of this study was to identify the risks factors associated with true SMM including the relationship between SMM and preterm delivery.
Abnormally Invasive Placenta—Prevalence, Risk Factors and Antenatal Suspicion: Results From a Large Population-based Pregnancy Cohort Study in the Nordic Countries
Authors: Thurn L. , Lindqvist P.G. , Jakobsson M. , Colmorn L.B. , Klungsoyr K. , Bjarnadóttir R.I. , Tapper A.M. , Børdahl P.E. , Gottvall K. , Petersen K.B. , Krebs L. , Gissler M. , Langhoff-Roos J. , Källen K.
Published: May 2017

(BJOG. 2016;123:1348–1355)

An abnormally invasive placenta (AIP), caused by abnormal invasion of the chorionic villi into the myometrium, presents a significant risk of hemorrhage, peripartum hysterectomy, and other complications. It has been reported to occur in 2 to 90 per 10,000 births. Risk factors include placenta previa, prior cesarean section (CS) especially in combination with placenta previa, and increasing maternal age and parity. Fewer complications have been observed when a planned operative delivery is undertaken in patients with AIP. Therefore, antenatal suspicion of AIP is important in the management of these patients. This study aimed to assess prevalence, risk factors, risk groups and antenatal suspicion of AIP as part of the Nordic Obstetric Surveillance Study.
Clinical Management of Medications in Pregnancy and Lactation
Authors: Temming L.A. , Cahill A.G. , Riley L.E.
Published: May 2017

(Am J Obstet Gynecol. 2016;214(6):698–702)

Studies have shown that use of prescription and over-the-counter medications during pregnancy and lactation is quite high. A clinical case was presented regarding a patient with long-standing depression who was taking a selective serotonin reuptake inhibitor (SSRI) and discovered she was now pregnant. The question was posed as to whether she should continue the drug.
Impact of Surgeon Annual Volume on Short-term Maternal Outcome in Cesarean Delivery
Authors: Drukker L. , Hants Y. , Farkash R. , Grisaru-Granovsky S. , Shen O. , Samueloff A. , Sela H.Y.
Published: May 2017

(Am J Obstet Gynecol. 2016;215(1):85.e1–85.e8)

Surgeon volume is known to be associated directly with morbidity and mortality rates in surgical procedures. Cesarean delivery (CD) is correlated to increased maternal morbidity including hemorrhage, infection, pelvic organ damage, and increased number of hospital readmissions. This study aimed to investigate whether annual surgeon volumes had an impact on outcomes in CDs.
Severe Maternal Morbidity in a Large Cohort of Women With Acute Severe Intrapartum Hypertension
Authors: Kilpatrick S.J. , Abreo A. , Greene N. , Melsop K. , Peterson N. , Shields L.E. , Main E.K.
Published: May 2017

(Am J Obstet Gynecol. 2016;215(1):91.e1–91.e7)

Adverse effects of hypertensive disorders of pregnancy such as stroke, eclampsia, hemolysis, elevated liver enzymes, low platelet count syndrome, renal failure, and disseminated intravascular coagulation are commonly associated with high rates of maternal morbidity and mortality in the United States. The present study aimed to analyze existing management patterns in a large group of women with severe intrapartum hypertension, to determine the maternal morbidity associated with severe intrapartum hypertension and compare it to that in women without severe hypertension.
Platelet Count and Transfusion Requirements During Moderate or Severe Postpartum Haemorrhage
Authors: Jones R.M. , de Lloyd L. , Kealaher E.J. , Lilley G.J. , Precious E. , Burckett st Laurent D. , Hamlyn V. , Collis R.E. , Collins P.W.
Published: May 2017

(Anaesthesia. 2016;71:648–656)

Postpartum hemorrhage is a leading cause of maternal morbidity and mortality worldwide. Depletion of coagulation factors and platelets can occur during obstetric hemorrhage. Reduction in coagulation factors and its management by replacement with fresh frozen plasma, cryoprecipitate, and fibrinogen concentrate have been addressed in earlier studies. However, there are few data addressing the need for platelet transfusion during postpartum hemorrhage. Current guidelines suggest transfusion may be indicated when the platelet count is <75×109/L. This study evaluated data from a previous study investigating the effect of fibrinogen on postpartum hemorrhage progression to assess the association between baseline platelet count and the need for platelet transfusion during postpartum hemorrhage.
Do Labetalol and Methyldopa Have Different Effects on Pregnancy Outcome? Analysis of Data From the Control of Hypertension In Pregnancy Study (CHIPS) Trial
Authors: Magee L.A. , Singer J. , Lee T. , Rey E. , Ross S. , Asztalos E. , Murphy K.E. , Menzies J. , Sanchez J. , Gafni A. , Gruslin A. , Helewa M. , Hutton E. , Koren G. , Lee S.K. , Logan A.G. , Ganzevoort J.W. , Welch R. , Thornton J.G. , Moutquin J.-M.
Published: May 2017

(BJOG. 2016;123:1143–1151)

The Control of Hypertension In Pregnancy Study (CHIPS trial) investigated the impact of a target blood pressure (BP) on maternal and perinatal outcomes by randomizing women with gestational or preexisting hypertension to a diastolic BP target of 100 (“less tight” control group) versus 85 mm Hg (“tight” control group). The present study, a secondary analysis of the CHIPS trial data, aimed to compare pregnancy outcomes between women taking methyldopa or labetalol while considering the allocation of these patients to the “less tight” or “tight” control group.
Maintenance Tocolysis With Nifedipine in Threatened Preterm Labour: 2-Year Follow-up of the Offspring in the APOSTEL II Trial
Authors: van Vliet E. , Seinen L. , Roos C. , Schuit E. , Scheepers H. , Bloemenkamp K. , Duvekot J.J. , van Eyck J. , Kok J.H. , Lotgering F.K. , van Baar A. , van Wassenaer-Leemhuis A.G. , Franssen M.T. , Porath M.M. , van der Post J. , Franx A. , Mol B. , Oudijk M.A.
Published: May 2017

(BJOG. 2016;123(7):1107–1114)

Preterm birth is associated with an increased risk of perinatal morbidity and mortality, with the earlier the birth the greater the risk. Some of the complications resulting from preterm delivery lead to impairments with long-term consequences. Hence delivery postponement through tocolytic drug use is a management goal when women develop preterm delivery. Short-term tocolysis of 48 hours to allow administration of antenatal steroids has been found to be effective. However, several studies have shown that maintenance tocolysis beyond 48 hours does not significantly prolong pregnancy. The Assessment of Perinatal Outcome with Sustained Tocolysis in Early Labour (APOSTEL II) trial assessed maintenance tocolysis with nifedipine. This current follow-up study of APOSTEL II aimed to assess the effect of nifedipine maintenance tocolysis on neurodevelopment, as measured in 2-year-old infants whose mothers participated in the study.
Duration of Motor Block With Intrathecal Ropivacaine Versus Bupivacaine for Cesarean Section: A Meta-analysis
Authors: Malhotra R. , Johnstone C. , Halpern S. , Hunter J. , Banerjee A.
Published: May 2017

(Int J Obstet Anesth. 2016;27:9–16)

Bupivacaine is a local anesthetic commonly used for spinal anesthesia. It provides a quick onset and sustained duration of sensory block but its prolonged duration of motor block is sometimes considered a disadvantage of the drug. Ropivacaine is another local anesthetic that has been used for spinal anesthesia. It is considered to have a shorter duration of motor block. This current meta-analysis was undertaken to examine the difference in duration of motor block as well as several secondary outcomes when ropivacaine was used compared with bupivacaine for spinal anesthesia for cesarean section.
Myoclonus-like Involuntary Movements Following Cesarean Delivery Epidural Anesthesia
Authors: Kang H.Y. , Lee S.W. , Hong E.P. , Sim Y.H. , Lee S.M. , Park S.W. , Kang J.M.
Published: May 2017

(J Clin Anesth. 2016;34:392–394)

Arising from the central nervous system, myoclonus is a sudden, brief, involuntary shock-like muscle contraction. Research has shown that spinal myoclonus following neuraxial anesthesia is rare. This article reported on a case of myoclonus-like involuntary movement that occurred during recovery from epidural anesthesia administered for a cesarean delivery.
Bronchopulmonary sequestration
Authors: Estes Mary Ellen Zator
Published: May 2017

Bronchopulmonary sequestration (BPS) is a lung mass that does not communicate with the tracheobronchial tree or the pulmonary arterial vasculature, and thus does not play a role in oxygenation. This article discusses the etiology of BPS, as well as its pathophysiology, signs and symptoms, imaging studies used to diagnose, and treatment options in both pediatric and adult patients.
Identifying delirium in older adults with pre-existing mental illness
Authors: Bennett Courtney
Published: May 2017

Acute delirium complicates care and can be easily overlooked in older adults with preexisting mental illness. Evidence-based measures have demonstrated that early diagnosis, identification, and correction of modifiable factors can lead to improved care and less morbidity in these patients.
Associations Between Physical Pain, Pain Management, and Frequency of Nonmedical Prescription Opioid Use Among Young Adults: A Sex-specific Analysis
Authors: Evans Tristan I. , Liebling Elliott J. , Green Traci C. , Hadland Scott E. , Clark Melissa A. , Marshall Brandon D.L.
Published: May 2017

Objectives:

We sought to determine sex-specific associations between experiences of physical pain, pain management, and frequency of nonmedical prescription opioid (NMPO) use among young adults.

Methods:

Among participants enrolled in the Rhode Island Young Adult Prescription Drug Study, we identified associations between physical pain in the past 6 months, pain history, pain management, polysubstance use, and weekly NMPO use. In sex-specific models, independent correlates of weekly NMPO use were identified via modified stepwise Poisson regression.

Results:

Of 199 participants, the mean age was 24.6, and 65.3% were male. The racial composition was 16.6% black, 60.8% white, and 22.1% mixed or other race. A total of 119 (59.8%) participants reported weekly or greater NMPO use. The majority of male (86.2%) and female (84.1%) participants reported ever experiencing severe pain. A majority of males (72.3%) and females (81.2%) reported that they engaged in NMPO use to treat their physical pain, and one-quarter (26.9%) of males and one-third (36.2%) of females had been denied a prescription from a doctor to treat severe pain. Among males, frequent NMPO use was independently associated with white race (P < 0.001) and reporting greater physical pain (P = 0.002). Among females, older age (P = 0.002) and monthly or greater nonmedical benzodiazepine use (P = 0.001) were independently associated with weekly NMPO use.

Conclusions:

Among young men in Rhode Island, physical pain may be related to frequent NMPO use. More research is needed to identify sex-specific, pain-related factors that are linked with NMPO use to improve harm reduction and pain management interventions.
Disposition of Remifentanil in Obesity
Authors: Kim Tae Kyun , Obara Shinju , Egan Talmage D. ,   The Remifentanil Pharmacokinetics in Obesity Investigators
Published: May 2017

Background

The influence of obesity on the pharmacokinetic (PK) behavior of remifentanil is incompletely understood. The aim of the current investigation was to develop a new population PK model for remifentanil that would adequately characterize the influence of body weight (among other covariates, e.g., age) on the disposition of remifentanil in the general adult population. We hypothesized that age and various indices of body mass would be important covariates in the new model.

Methods

Nine previously published data sets containing 4,455 blood concentration measurements from 229 subjects were merged. A new PK model was built using nonlinear mixed-effects modeling. Satisfactory model performance was assessed graphically and numerically; an internal, boot-strapping validation procedure was performed to determine the CIs of the model.

Results

Body weight, fat-free body mass, and age (but not body mass index) exhibited significant covariate effects on certain three-compartment model parameters. Visual and numerical assessments of model performance were satisfactory. The bootstrap procedure showed satisfactory CIs on all of the model parameters.

Conclusions

A new model estimated from a large, diverse data set provides the PK foundation for remifentanil dosing calculations in adult obese and elderly patients. It is suitable for use in target-controlled infusion systems and pharmacologic simulation.
Risks of Cardiovascular Adverse Events and Death in Patients with Previous Stroke Undergoing Emergency Noncardiac, Nonintracranial Surgery
Authors: Christiansen Mia N. , Andersson Charlotte , Gislason Gunnar H. , Torp-Pedersen Christian , Sanders Robert D. , Føge Jensen Per , Jørgensen Mads E.
Published: May 2017

Background

The outcomes of emergent noncardiac, nonintracranial surgery in patients with previous stroke remain unknown.

Methods

All emergency surgeries performed in Denmark (2005 to 2011) were analyzed according to time elapsed between previous ischemic stroke and surgery. The risks of 30-day mortality and major adverse cardiovascular events were estimated as odds ratios (ORs) and 95% CIs using adjusted logistic regression models in a priori defined groups (reference was no previous stroke). In patients undergoing surgery immediately (within 1 to 3 days) or early after stroke (within 4 to 14 days), propensity-score matching was performed.

Results

Of 146,694 nonvascular surgeries (composing 98% of all emergency surgeries), 5.3% had previous stroke (mean age, 75 yr [SD = 13]; 53% women, 50% major orthopedic surgery). Antithrombotic treatment and atrial fibrillation were more frequent and general anesthesia less frequent in patients with previous stroke (all P < 0.001). Risks of major adverse cardiovascular events and mortality were high for patients with stroke less than 3 months (20.7 and 16.4% events; OR = 4.71 [95% CI, 4.18 to 5.32] and 1.65 [95% CI, 1.45 to 1.88]), and remained increased for stroke within 3 to 9 months (10.3 and 12.3%; OR = 1.93 [95% CI, 1.55 to 2.40] and 1.20 [95% CI, 0.98 to 1.47]) and stroke more than 9 months (8.8 and 11.7%; OR = 1.62 [95% CI, 1.43 to 1.84] and 1.20 [95% CI, 1.08 to 1.34]) compared with no previous stroke (2.3 and 4.8% events). Major adverse cardiovascular events were significantly lower in 323 patients undergoing immediate surgery (21%) compared with 323 successfully propensity-matched early surgery patients (29%; P = 0.029).

Conclusions

Adverse cardiovascular outcomes and mortality were greatly increased among patients with recent stroke. However, events were higher 4 to 14 days after stroke compared with 1 to 3 days after stroke.
Progress in the pathogenesis and treatment of cardiac manifestations of neonatal lupus
Authors: Izmirly Peter , Saxena Amit , Buyon Jill P.
Published: May 2017

Purpose of review

To provide new insights into pathogenesis, prevention and management of cardiac manifestations of neonatal lupus (cardiac neonatal lupus) and issues pertinent to all anti-SSA/Ro positive individuals of childbearing age.

Recent findings

Antibody specificity with high risk for cardiac neonatal lupus remains elusive, but high titers of Ro60, Ro52 or Ro52p200 antibodies appear to be required. Varying antibody specificities to the p200 region of Ro52 can induce first-degree block in a rodent model. In consideration of the contribution of macrophages to inflammation and fibrosis in cardiac neonatal lupus, hydroxychloroquine (HCQ) is being considered as preventive therapy. Cord blood biomarkers support the association of fetal reactive inflammatory and fibrotic components with the development and morbidity of cardiac neonatal lupus. Data from U.S. and French registries do not provide evidence that the prompt use of fluorinated steroids in cases of isolated block significantly alters fetal/neonatal morbidity or mortality.

The search for a high-risk cardiac neonatal lupus antibody profile remains, but high-titer antibodies to Ro60 and R052 are a consistent finding, and this may guide the need for fetal echocardiographic surveillance. The uniform use of fluorinated steroids to prevent progression of cardiac neonatal lupus or reduce mortality does not appear justified. HCQ, based on diminishing an inflammatory component of cardiac neonatal lupus, is under consideration as a potential preventive approach.
Socioeconomic consequences of systemic lupus erythematosus
Authors: Barber Megan R.W. , Clarke Ann E.
Published: May 2017

Purpose of review

The present review addresses recent literature investigating the socioeconomic consequences of systemic lupus erythematosus (SLE). We highlight the latest updates on health disparities affecting the SLE population, the direct and indirect economic costs of the disease, and less quantifiable costs such as reduced health-related quality of life (HRQoL).

Recent findings

Health disparities continue to exist among socially disadvantaged populations, including African Americans, Hispanics, and patients with decreased educational attainment and in poverty. Direct and indirect costs are substantial. Recent work provides updated cost estimates for patients with SLE outside of North America, including those in developing countries. Previous research has largely focused on costs of the general SLE population and those with renal manifestations or active SLE, whereas recent research addresses special populations such as hospitalized and pregnant patients and glucocorticoid users. Patients with SLE and their caregivers experience a substantially reduced HRQoL.

SLE is a costly disease that disproportionately affects disadvantaged populations. Future economic studies should measure not only direct costs, but also incorporate indirect costs and the HRQoL of both patients with SLE and their caregivers. All these components are essential to provide a comprehensive assessment of the socioeconomic consequences of SLE and an appreciation of the potential impact of novel therapies.
Intramedullary Nailing for Pilon Nonunions
Authors: Haller Justin M. , Githens Michael , Dunbar Robert
Published: May 2017

Nonunions are uncommon sequelae of tibial pilon fractures, but they can present a challenging problem to the treating surgeon. Treatment strategies can range from isolated bone grafting to revision plating depending on the type of nonunion and patient factors. Here, we present our technique and clinical results for intramedullary nailing of tibial pilon nonunions.
Therapeutic Drug Monitoring for Perampanel in Japanese Epilepsy Patients: Influence of Concomitant Antiepileptic Drugs
Authors: Yamamoto Yoshiaki , Usui Naotaka , Nishida Takuji , Takahashi Yukitoshi , Imai Katsumi , Kagawa Yoshiyuki , Inoue Yushi
Published: May 2017

Background:

Perampanel is a new antiepileptic drug (AED) that acts as a noncompetitive α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA) receptor antagonist and is mainly metabolized by cytochrome P450 (CYP) 3A4. This study evaluated the influence of concomitant AEDs on the serum concentration profile of perampanel.

Methods:

A total of 215 serum samples obtained from 76 patients aged 12 years or older were analyzed for routine therapeutic drug monitoring, and the concentration-to-dose ratio (CD ratio) of perampanel was compared among patients on various AED regimens.

Results:

In patients not taking concomitant enzyme-inducing AEDs, the mean CD ratio was 3963 ng·mL−1·mg−1·kg−1 (range: 1793–13,299). By contrast, the mean CD ratio was lower in patients using enzyme-inducing AEDs [1760 (range: 892–3090), 2256 (range: 700–4703), and 1120 (range: 473–1853) ng·mL−1·mg−1·kg−1 in patients taking phenytoin, phenobarbital, and carbamazepine, respectively], and carbamazepine had a significantly greater reduction in the CD ratio compared with phenytoin or phenobarbital (P < 0.001). Twenty-one patients responded with ≥50% reduction of seizure frequency from baseline, and their mean serum perampanel concentration was 450 ng/mL (range: 85–1500).

Conclusions:

There is a large interindividual variation in CD ratio of perampanel because its metabolism is highly susceptible to interactions with enzyme-inducing AEDs. Therapeutic drug monitoring could be clinically useful for determining the influence of AED CYP3A4 inducers on perampanel concentrations.
Microsurgical Hepatic Artery Reconstruction Using Ikuta A-II Double Clamp
Authors: Okochi Masayuki , Okochi Hiromi , Sakaba Takao , Momiyama Masanori , Ueda Kazuki
Published: May 2017

We performed hepatic artery (HA) reconstruction on 24 patients between January 2010 and October 2016. Six of 24 patients used an Ikuta type A-II vascular clamp (A-II group). The mean age was 38.0 years (range, 1–61 years). There was no blood leakage at the anastomosed site in any of the patients. No patients required an additional vascular clamp, and none developed HA thrombosis. Eighteen of 24 patients used a conventional vascular clamp. The mean age was 36.1 years (range, 1–65 years; conventional group). Sixteen of 18 patients required an additional vascular clamp due to blood leakage from the HA. There was no significant difference between the 2 groups in mean age or diameter of the recipient HA. However, there was a significant difference in the proportion of patients who required an additional vascular clamp (n < 0.001). The Ikuta type A-II clamp is an effective vascular clamp for reconstruction of the HA in living donor liver transplantation.
Cardiac Rehabilitation Outcomes by Ethnocultural Background
Authors: Findlay Briar , Oh Paul , Grace Sherry L.
Published: May 2017

Background:

Patients of diverse ethnocultural backgrounds are underrepresented among participants and, hence, little is known about their outcomes. The objectives of this study were to compare cardiac rehabilitation (CR) utilization, cardiovascular risk factor reduction (blood pressure, lipids, anthropometrics), and functional capacity between white and ethnocultural minority patients participating in CR across Canada.

Methods:

The study was a retrospective, observational cohort study using the Canadian Cardiac Rehab Registry (CCRR). Participants from an ethnocultural minority (n ≥ 25) were propensity-matched to white participants based on sociodemographic and clinical characteristics. CR outcomes were compared.

Results:

In the CCRR, 3848 (53.8%) participants had an ethnocultural background reported. Of those, whites (n = 3630) and South Asians (n = 26), Southeast Asians (n = 45), and Arab/West Asians (n = 37) minorities had sufficient representation in the registry to be analyzed. In the matched sample, 364 (97.1%) participants completed a discharge assessment. Southeast Asian participants adhered to (96.5%, P = .02) and completed (88.2%, P = .02) CR more often than white participants (90.2% and 55.6%, respectively). Southeast Asian participants had significantly lower diastolic blood pressure (P = .002) at CR discharge than matched white participants. No other differences in outcomes or functional capacity were observed.

Conclusions:

Ethnocultural minorities make up a small proportion of CR participants in Canada. However, when they do participate, they achieve similar CR outcomes compared with white participants. CR programs should seek to ensure ethnoculturally diverse patients are referred to their programs and ensure their programs are culturally sensitive to the needs of the preponderant ethnocultural groups in their catchment areas.
EFFECTS OF INTRAVITREAL RANIBIZUMAB AND BEVACIZUMAB ON THE RETINAL VESSEL SIZE IN DIABETIC MACULAR EDEMA
Authors: Kurt Muhammed Mustafa , Çekiç Osman , Akpolat Çetin , ELÇIOGLU Mustafa
Published: May 2017

Purpose:

The goal of this study was to assess the effects of a single injection of intravitreal ranibizumab (RAN) or bevacizumab (BEV) on the retinal vessel size in eyes with diabetic macular edema.

Materials and Methods:

In total, 32 patients were enrolled in the RAN group, and 30 patients were included in BEV group. Each of these groups was also subdivided into two others groups: a study group and a control group. The study groups were composed of the injected eyes, whereas the noninjected fellow eyes served as the control groups. The patients underwent complete ophthalmic examinations, including optical coherence tomography and fundus fluorescein angiography, and the primary outcome measures included the central retinal artery equivalent, central retinal vein equivalent, and artery-to-vein ratio.

Results:

In the RAN study group (n = 32), the preinjection mean central retinal artery equivalent (175.42 μm) decreased to 169.01 μm after 1 week, and to 167.47 μm after 1 month (P < 0.001), whereas the baseline central retinal vein equivalent (235.29 μm) decreased initially to 219.90 μm after 1 week, and to 218.36 μm after 1 month (P < 0.001). In the BEV study group (n = 30), the preinjection central retinal artery equivalent (150.21 μm) decreased to 146.25 μm after 1 week, and to 145.89 μm after 1 month (P < 0.001); whereas the baseline central retinal vein equivalent (211.87 μm) decreased initially to 204.59 μm after 1 week and was 205.24 μm after 1 month (P < 0.001). The preinjection artery-to-vein ratio values changed significantly (P = 0.001) after 1 week and after 1 month in the RAN group, but no significant alteration in the artery-to-vein ratio was observed in the BEV group (P = 0.433). In both the RAN (n = 32) and BEV (n = 30) control groups, none of the 3 parameters changed throughout the study period, when compared with the baseline.

Conclusion:

The results of this study showed that both RAN and BEV injections significantly constricted the retinal blood vessel diameters.
INFLAMMATORY CHOROIDAL NEOVASCULAR MEMBRANE
Authors: D'souza Palmeera , Ranjan Ratnesh , Babu Upendra , Kanakath Anuradha V. , Saravanan Veerappan R.
Published: May 2017

Purpose:

To assess the long-term visual and anatomical outcomes after intravitreal anti–vascular endothelial growth factor therapy for inflammatory choroidal neovascular membrane (CNVM).

Methods:

Retrospective case series of 15 consecutive cases of newly diagnosed inflammatory CNVM who were treated with intravitreal bevacizumab or ranibizumab injections.

Results:

The study included 8 women and 7 men with mean age at presentation with CNVM of 40.53 ± 17.46 years (range, 11–70 years), and mean follow-up duration after anti–vascular endothelial growth factor therapy was 20.53 ± 14.53 months (range, 6–48 months). All eyes had classic CNVM confirmed by fluorescein angiography, most commonly located in the peripapillary area (8 eyes, 53.3%), followed by juxtafoveal (4 eyes, 26.7%), and subfoveal location (3 eyes, 20%). All CNVMs showed complete resolution with mean 2.6 ± 1.2 injections per eye. Preinjection mean best-corrected visual acuity of logarithm of minimum angle of resolution 0.79 ± 0.76 (approximate Snellen equivalent 20/123) and mean central macular thickness of 435.9 ± 190.2 μm improved significantly to mean best-corrected visual acuity of logarithm of minimum angle of resolution 0.46 ± 0.43 (approximate Snellen equivalent 20/58) and mean central macular thickness of 262.13 ± 108.70 μm (P value 0.02 and <0.0001, respectively) at the final visit. Recurrence was seen in 26.7% eyes (4/15), all of which regressed with single injection. Only complication noted was subretinal fibrosis in one eye (6.7%).

Conclusion:

For inflammatory CNVM, in addition to immunosuppression in cases with active inflammation, anti–vascular endothelial growth factor therapy seems as a very effective treatment modality resulting in significant visual improvement and foveal flattening. Incidence of major complications is rare, and the recurrence rate seems low.