bluuebunny/crossref_metadata_2025 huggingface dataset:
Homeland Security
Authors: Cadwalader George
Published: January 2018

The terrorist attacks of September 11, 2001 caused a seismic shift in how the United States organizes and executes the mission of securing the homeland. The creation and growth of the Department of Homeland Security is the most visible manifestation of this change. However, the homeland security discipline contemplates shared responsibilities and a unity of effort among all levels of government, the private sector, and the general public. The wide array of stakeholders, alongside an expanding definition of what constitutes homeland security, presents complex challenges for policymakers. With the perspective of the more than fifteen years that have elapsed since 9/11, this chapter examines the evolution of homeland security from a near-exclusive focus on terrorism to a broader “all hazards” approach, the relationship between homeland security and national security, the roles of leading actors, and contemporary issues.
The United States and Iran
Authors: Takeyh Ray
Published: January 2018

Implementing deterrent and compellent strategies are among the most critical tasks of the national security decision maker. However, as the case of U.S.-Iranian relations since 1979 demonstrates, deterring another state from taking action—especially if it considers those steps to be in its national interests—or compelling it to adopt policies in line with one’s own preferences but which represent a setback to the goals of the other state can be a difficult proposition. In addition, the Iran relationship demonstrates howthe use of deterrent and compellent instruments must be weighed against costs and other second- and third-order effects which may cause the policymaker to accept a less than optimal outcome in order to avoid greater complications in other areas.
Local Food Movements
Authors: Noll Samantha , Werkheiser Ian
Published: January 2018

Books and articles supporting a local food movement have become commonplace, with popular authors such as Wendell Berry, Barbara Kingsolver, and Michael Pollan espousing the virtues of eating locally. At the same time, others have critiqued the local food movement as failing to achieve its stated ends or as having negative unintended consequences. This chapter provides a general analysis of local food movements, specifically separating this complex phenomenon into three distinct sub-movements. During this analysis, the chapter pays particular attention to how sub-movements conceptualize people, food, and the roles that individuals, communities, and political institutions play when trying to bring about change. It argues that understanding these sub-movements is necessary for understanding and interacting with both local food’s supporters and its detractors.
Who You Are Is What You Eat
Authors: Vogt Katja
Published: January 2018

This chapter discusses ancient analyses of hunger and thirst, as well as ancient thought about the role of food in cultural identity. The chapter starts with a sketch of hunger and eating in Homer’s Odyssey, argues that Plato considers hunger and thirst as paradigmatic desires, reconstructs Aristotle’s conception of moderation as it relates to food, and explores relativist and skeptic arguments about eating-related diversity and disagreement. The central proposal is that ancient philosophers ask questions about eating that are worth including in food ethics today: questions about the nature of desire, the ways in which people should and should not shape food-related desires, and the ways in which they navigate different cultures by sharing or not sharing their eating habits.
The Ethics of Being a Foodie
Authors: Wolf Susan
Published: January 2018

The chapter defines foodies as people who are enthusiasts about food for aesthetic reasons and explores the reasons behind the morally tinged antipathy many people have toward foodies so defined. Setting aside concerns with elitism and snobbishness that pertain to any activity or passion that is associated with privilege, and objections that are based on a negative stereotype that is inessential to foodieism, the chapter considers what criticisms might apply specifically to foodieism in contrast to other bourgeois interests. Criticisms and attitudes based on the (sometimes unexpressed) thought that food is a low or bestial pleasure are discussed and rejected. Thus, the chapter concludes that there need be no tension between ethics and foodieism.
Concerning Cattle
Authors: Comstock Gary
Published: January 2018

Should people include beef in their diet? This chapter argues that the answer is “no” by reviewing what is known and not known about the presence in cattle of three psychological traits: pain, desire, and self-consciousness. On the basis of behavioral and neuroanatomical evidence, the chapter argues that cattle are sentient beings who have things they want to do in the proximal future, but they are not self-conscious. The piece rebuts three important objections: that cattle have injury information but not pain; that cattle have goal-directed behavior but not desire; and that the absence of evidence for bovine self-consciousness should not be taken as evidence that cattle lack self-consciousness. In sum, what is known about cattle cognition shifts the moral burden of proof on to the beef eaters.
Epigraphic Evidence
Authors: Chaniotis Angelos
Published: January 2018

Greek and Latin inscriptions—epitaphs, dedications, manumission records, lists of members of voluntary associations, laws, treaties, decrees, cult regulations, stamps on bricks and pottery, graffiti, and honorary inscriptions for masters and patrons—provide evidence concerning the terminology of unfree labour, attitudes towards slavery, and the origins, life, feelings, occupations, price, and legal conditions of slaves especially in urban areas from roughly the sixth century BC (Greece) and the third century BC (Italy) to Late Antiquity. Certain conventions—for example, regarding indicators of an individual’s status—mean that the use of epigraphic material for studying the complexities of slavery requires careful consideration of contexts: time, space, local traditions, addressees, language, and epigraphic habits.
SSET Project: Cost-effectiveness Analysis of Surgical Specialty Emergency Trays in the Emergency Department
Authors: Humphries Laura S. , Shenaq Deana S. , Teven Chad M. , Park Julie E. , Song David H.
Published: January 2018

Background:

We hypothesize that reusable, on-site specialty instrument trays available to plastic surgery residents in the emergency department (ED) for bedside procedures are more cost-effective than disposable on-site and remote re-usable operating room (OR) instruments at our institution.

Methods:

We completed a cost-effectiveness analysis comparing the use of disposable on-site kits and remote OR trays to a hypothetical, custom, reusable tray for ED procedures completed by PRS residents. Material costs of existing OR trays were used to estimate the purchasing and use-cost of a custom on-site tray for the same procedures. Cost of per procedure ‘consult time’ was estimated using procedure and resident salary.

Results:

Sixteen bedside procedures were completed over a 4.5 month period. A mean of 2.14 disposable kits were used per-procedure. Mean consultation time was 1.66 hours. Procedures that used OR trays took 3 times as long as procedures that used on-site kits (4 vs. 1.1 hours). Necessary, additional instruments were unavailable for 75% of procedures. Mean cost of using disposable kits and OR trays was $115.03/procedure versus an estimated $26.67/procedure cost of using a custom tray, yielding $88.36/procedure cost-savings. Purchase of a single custom tray ($1,421.55) would be redeemed after 2.3 weeks at 1 procedure/day. Purchasing 4 trays has projected annual cost-savings of $26,565.20.

Conclusion:

The purchase of specialized procedure trays will yield valuable time and cost-savings while providing quality patient care. Improving time efficiency will help achieve the Accreditation Council of Graduate Medical Education (ACGME) goals of maintaining resident well-being and developing quality improvement competency.
Clinical Features and Outcomes of Post-Traumatic Silent Sinus Syndrome
Authors: Wladis Edward J. , Kersten Robert C. , Vagefi M. Reza , Pinheiro-Neto Carlos , Shinder Roman , Kim H. Jane
Published: January 2018

Purpose:

To identify demographic features and clinical outcomes associated with post-traumatic silent sinus syndrome.

Methods:

A retrospective review was carried out at 3 academic medical centers to identify all cases of post-traumatic silent sinus syndrome. Clinical features and management strategies were recorded. Postoperative outcomes were assessed, and statistical analyses were performed via a dedicated computerized software package.

Results:

Twenty cases were identified (14 men and 6 women, mean age = 44.2 years). Seven patients underwent sinus surgery as the sole means of treatment, and the mean pre- and postoperative enophthalmos measurements were 2.86 and 1.93 mm. Alternatively, 13 patients underwent combined orbital reconstruction and sinus surgery, respectively; the mean pre- and postoperative enophthalmos measurements were 3.42 and 0.39 mm, respectively. The change in enophthalmos was statistically significantly greater in patients who underwent sinus surgery and orbital reconstruction (p = 0.00028). Among patients who underwent sinus surgery alone, one patients (14.2%) experienced complete resolution of enophthalmos, as compared with 10 patients (76.9%) who underwent combined procedures.

Conclusions:

This study represents the largest published cohort of patients with post-traumatic silent sinus syndrome. Combined orbital reconstruction and sinus surgery results in greater reductions of enophthalmos and a markedly improved chance of postoperative symmetry of globe position.
The Link Between Cerebrovascular Hemodynamics and Rehabilitation Outcomes After Aneurysmal Subarachnoid Hemorrhage
Authors: Brooks Forrest A. , Ughwanogho Uvieoghene , Henderson Galen V. , Black-Schaffer Randie , Sorond Farzaneh A. , Tan Can Ozan
Published: January 2018

Objective

The aim of the study was to assess the relation between cerebrovascular function early after aneurysmal subarachnoid hemorrhage onset and functional and rehabilitation outcomes.

Design

Observational cohort study of subarachnoid hemorrhage patients (n = 133) admitted to rehabilitation (n = 49), discharged home (n = 52), or died before discharge (n = 10). We obtained hemodynamic markers of cerebral autoregulatory function from blood flow velocities in the middle cerebral artery and arterial pressure waveforms, recorded daily on days 2–4 after symptom onset, and functional independence measure (FIM) scores and FIM efficiency for those admitted to acute rehabilitation.

Results

Compared to those discharged home, the range of pressures within which autoregulation is effective was lower in patients admitted to rehabilitation (4.6 [0.2] vs. 3.9 [0.2] mm Hg) and those who died (2.7 [0.4], P = 0.04). For those admitted to rehabilitation, autoregulatory range and the ability of cerebrovasculature to increase flow were related to discharge FIM score (R
2 = 0.33 and 0.43, P < 0.01) and efficiency (R
2 = 0.33 and 0.47 P < 0.01). The latter marker, along with subarachnoid hemorrhage severity and admission FIM, explained 84% and 69% of the variability in discharge FIM score and efficiency, respectively, even after accounting for age.

Conclusions

Early cerebrovascular function is a major contributor to functional outcomes after subarachnoid hemorrhage and may represent a modifiable target to develop therapeutic approaches.

To Claim CME Credits

Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME

CME Objectives

Upon completion of this article, the reader should be able to: (1) Define cerebral autoregulation; (2) Explain the importance of the integrity of cerebral autoregulation for longer-term functional and rehabilitation outcomes after aneurysmal subarachnoid hemorrhage; and (3) Theorize why treatment strategies that may be effective in reducing large-vessel vasospasms after an aneurysmal subarachnoid hemorrhage might not always translate into improved functional outcomes.

Level

Advanced

Accreditation

The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Effect of Surgery First Orthognathic Approach on the Temporomandibular Joint
Authors: Pelo Sandro , Saponaro Gianmarco , De Angelis Paolo , Gasparini Giulio , Garagiola Umberto , Moro Alessandro
Published: January 2018

Introduction:

Correction of severe malocclusions with skeletal discrepancies requires orthodontic treatment in combination with orthognathic surgery. Even though conventional orthognathic surgery (COS) is a common and well-accepted approach its influence on the signs and symptoms of temporomandibular disorders (TMDs) is still debated. Recently with the introduction of surgery first approach, a different timing for the management of dentoskeletal imbalances has been proposed. The present study is aimed at assessing the relationship between surgery first approach and temporomandibular joint (TMJ) disorders.

Methods:

The study sample consisted of 24 patients who were selected to be treated with surgery first approach. Clinical follow-ups after surgery were performed every week for the first month, at 3 months, 6 months, and at 1 year. A radiological follow-up was performed at 1 week and at 1 year after the operation with a panorex and a latero-lateral teleradiograph. To assess the effect of surgery first approach on the TMDs signs and symptoms, a clinical assessment was performed 4 days before surgery (T1), 6 months after surgery (T2), and 1 year postoperatively (T3).

Results:

The results of the authors’ study show that pain assessment revealed a general improvement of this symptom in correspondence to TMJ and masticatory muscles except in the masseter and neck region. Also joint noises, TMJ functioning, migraine, and headache underwent a considerable improvement.

Conclusion:

Surgery first approach is an innovative orthognathic procedure and, by undergoing surgery first approach, patients with pre-existing TMJ dysfunction may experience a significant improvement or even resolution of the TMDs signs and symptoms.
External Validation of University of Wisconsin's Clinical Criteria for Obtaining Maxillofacial Computed Tomography in Trauma
Authors: Harrington Amanda W. , Pei Kevin Y. , Assi Roland , Davis Kimberly A.
Published: January 2018

Objectives:

Patients sustaining multisystem trauma are at risk for oral and maxillofacial fractures. Although the University of Wisconsin established criteria to help guide the clinician in obtaining additional cross-sectional imaging to evaluate possible facial fractures, it has not been externally validated. Our aim was to evaluate whether the University of Wisconsin's Criteria is generalizable to external institutions through validation and to report modern practice patterns at a level 1 trauma center.

Methods:

A retrospective case study was performed of all patients who had computed tomography of the facial bones (CT face) at a tertiary, academic, Level 1 trauma center over the 6-month period ending on June 30, 2015. The electronic medical record was reviewed for the 5 University of Wisconsin criteria (bony step off or instability, periorbital ecchymosis, malocclusion, tooth absence, and glasgow coma scale). Final interpretation of CT face findings by board-certified radiologists (facial fractures, intracranial hemorrhage, and cervical spine injury) were also captured. Our modeling was similar to that described by the reference study, the internal validation study. Sensitivity, specificity, negative, and positive predictive values with 95% confidence intervals were evaluated. A P < 0.05 was considered significant.

Results:

The presence of any ≥1 of the 5 criteria identified on physical examination resulted in 81% sensitivity for any facial fracture, which is lower than the sensitivity initially described (98%) and subsequently internally validated (97%). The absence of all 5 physical examination criteria had a negative predictive value of 60%, again lower than that initially described (87%) and then internally validated (81%).

Conclusion:

We were unable to validate the University of Wisconsin criteria for predicting facial fractures. These criteria may be institutionally specific and not generalizable to other trauma centers. Further research to refine the criteria for CT of the face is needed to improve resource allocation.
The RES complex is required for efficient transformation of the precatalytic B spliceosome into an activated Bact complex
Authors: Bao Penghui , Will Cindy L. , Urlaub Henning , Boon Kum-Loong , Lührmann Reinhard
Published: January 2018

The precise function of the trimeric retention and splicing (RES) complex in pre-mRNA splicing remains unclear. Here we dissected the role of RES during the assembly and activation of yeast spliceosomes. The efficiency of pre-mRNA splicing was significantly lower in the absence of the RES protein Snu17, and the recruitment of its binding partners, Pml1 (pre-mRNA leakage protein 1) and Bud13 (bud site selection protein 13), to the spliceosome was either abolished or substantially reduced. RES was not required for the assembly of spliceosomal B complexes, but its absence hindered efficient Bact complex formation. ΔRES spliceosomes were no longer strictly dependent on Prp2 activity for their catalytic activation, suggesting that they are structurally compromised. Addition of Prp2, Spp2, and UTP to affinity-purified ΔRES B or a mixture of B/Bact complexes formed on wild-type pre-mRNA led to their disassembly. However, no substantial disassembly was observed with ΔRES spliceosomes formed on a truncated pre-mRNA that allows Prp2 binding but blocks its activity. Thus, in the absence of RES, Prp2 appears to bind prematurely, leading to the disassembly of the ΔRES B complexes to which it binds. Our data suggest that Prp2 can dismantle B complexes with an aberrant protein composition, suggesting that it may proofread the spliceosome's RNP structure prior to activation.
Non‐Negative Word Order In Breton: Maintaining Verb‐Second
Authors: Kennard Holly J.
Published: January 2018

This paper examines variation in Breton word order patterns in non‐negative utterances across speakers of different ages. Not only has there been some disagreement on how best to characterise unmarked word order in Breton, it has also been claimed that younger speakers of so‐called Neo‐Breton overuse subject‐initial word order under influence from French. Data from fieldwork provide a complex picture of word order variability. This seems to be driven by a number of factors, including the nature of the subject (lexical or pronominal), regional variation among older speakers, and a corresponding lack of regional features among younger speakers. Rather than overusing subject‐initial word order, the Neo‐Breton speakers tend to avoid this word order pattern when other word orders are available, such that the verb‐second pattern is being maintained.
Mandatory misrepresentation
Authors: Bunney Julie
Published: January 2018

The ethical use of college membership in the statement of political opinion.
A fast and reliable method for monitoring of prophage‐activating chemicals
Authors: Xu Juan , Kiesel Bärbel , Kallies René , Jiang Feng‐Lei , Liu Yi , Maskow Thomas
Published: January 2018

Bacteriophages, that is viruses that infect bacteria, either lyse bacteria directly or integrate their genome into the bacterial genome as so‐called prophages, where they remain at a silent state. Both phages and bacteria are able to survive in this state. However, prophages can be reactivated with the introduction of chemicals, followed by the release of a high number of phage particles, which could infect other bacteria, thus harming ecosystems by a viral bloom. The basics for a fast, automatable analytical method for the detection of prophage‐activating chemicals are developed and successfully tested here. The method exploits the differences in metabolic heat produced by Escherichia coli with (λ+) and without the lambda prophages (λ−). Since the metabolic heat primarily reflects opposing effects (i.e. the reduction of heat‐producing cells by lysis and enhanced heat production to deliver the energetic costs for the synthesis of phages), a systematic analysis of the influence of the different conditions (experimentally and in silico) was performed and revealed anoxic conditions to be best suited. The main advantages of the suggested monitoring method are not only the possibility of obtaining fast results (after only few hours), but also the option for automation, the low workload (requires only few minutes) and the suitability of using commercially available instruments. The future challenge following this proof of principle is the development of thermal transducers which allow for the electronic subtraction of the λ+ from the λ‐ signal.
How can we protect youth from putative vaping gateway effects without denying smokers a less harmful option?
Authors: Gartner Coral
Published: January 2018

Commentary to: Gateway effects and electronic cigarettes
Investigation of the effect of rapid and slow external pH increases on Enterococcus faecalis biofilm grown on dentine
Authors: Stenhouse M , Zilm P , Ratnayake J , Cathro P
Published: January 2018

Background

Calcium hydroxide is a common endodontic medicament and has an antimicrobial effect by increasing the localized pH within the root canal. However, Enterococcus faecalis has shown some resistance to calcium hydroxide.

Methods

A flow cell apparatus was used to grow an E. faecalis biofilm on dentine discs. Following 4 weeks growth in Todd Hewitt Broth, flow cells were exposed to either a rapid or slow increase to pH 11.5 or 12.5. Cellular viability was determined using serial plating and the number of colony‐forming units was normalized against the cellular protein content. Scanning electron microscopy was carried out to qualitatively observe the effects of the different rates of pH increase.

Results

A significant difference in viability between the pH rapid and slow groups was not shown in this study. Compared with pH 11.5 solutions, pH 12.5 solutions were more effective at killing bacteria although some E. faecalis still survived.

Conclusions

Enterococcus faecalis did not adapt and develop a greater resistance to high pH following a slow rise in pH compared with a rapid rise in pH. As expected, pH 12.5 was more effective in reducing bacterial numbers compared with pH 11.5 although E. faecalis was not completely eliminated.
Adopting innovation in gynaecology: The introduction of e‐consult
Authors: Mann Rebecca , van de Weijer Peter H. M.
Published: January 2018

Objective

To describe the development of an e‐consultation service as part of the triaging and grading process of referrals and to report on the efficacy and safety of such a service.

Methods

All gynaecology e‐consults in the study period June 2015 to March 2016 were retrospectively reviewed. The outcomes of interest were the initial reduction in first face‐to‐face hospital visits, and the rate of re‐referrals. Acute admission for the same reason, a subsequent diagnosis of underlying (pre)‐malignancy, or patient death from the condition related to the index referral were selected as measures for patient safety.

Results

Seven thousand and forty‐two (7042) referrals were made to the gynaecology service in the 10 month study period. After exclusion of referrals to colposcopy and the early pregnancy clinic, 4738 e‐referrals remained. Of these, 1013 referrals (21.4%) were triaged for an e‐consult. One hundred and forty‐seven patients (14.5%) with an initial e‐consult were re‐referred within 6 months for the same condition. The reduction in face‐to‐face contacts was 18.2% (866/4738). No death and/or acute admission for the same reason as stated in the initial referral occurred among the patients with e‐consultation and none were later diagnosed with an underlying (pre)‐malignancy.

Conclusion

E‐consultation was effective at reducing the number of first outpatient face‐to‐face contacts without notable compromise of the quality of care or patient safety. E‐consultation allows specialists to provide expert clinical guidance, management and support to the referring provider when appropriate. Topics for further study include patient benefits and satisfaction, and further assessment of the social, economic and financial impacts on all parties involved.
A systematic review of population pharmacokinetics of valproic acid
Authors: Methaneethorn Janthima
Published: January 2018

Aims

Population pharmacokinetics is an essential tool that helps guide individualized dosing regimens. The aims of this systematic review are to provide knowledge concerning population pharmacokinetics of valproic acid (VPA) and to identify factors influencing VPA pharmacokinetic variability.

Methods

PubMed and Embase databases were systematically searched from inception to June, 2017. Relevant articles from reference lists were also included. All population pharmacokinetic studies of VPA conducted in humans and that employed a nonlinear mixed effect modelling approach were included in this review.

Results

Twenty‐six studies were included in this review. Most studies characterized VPA pharmacokinetics as a one‐compartment model. Three studies reported a two‐compartment model. Body weight, dose and age were significant predictors for VPA volume of distribution (Vd). The estimated Vd for one‐compartment models ranged from 8.4 to 23.3 l. For two‐compartment models, peripheral volumes of distribution ranged from 4.08 to 42.1 l. Frequently reported significant predictors for VPA clearance (CLVPA) included body weight, VPA dose, concomitant medications, gender and age. The estimated CLVPA ranged from 0.206 to 1.154 l h−1 and the inter‐individual variability ranged from 13.40 to 35.90%. Two studies reported population pharmacokinetics/pharmacodynamics of VPA in patients with epilepsy. Seventeen studies evaluated the performance of their final models.

Conclusions

Significant predictors influencing VPA pharmacokinetics as well as model methodologies are highlighted in this review. For clinical application, CLVPA could be predicted using body weight, VPA dose, concomitant medications, gender or age. For future research, there is a knowledge gap regarding population pharmacokinetics/pharmacodynamics of VPA in a population other than epileptic patients.
Transforming identities through Transforming Care: How people with learning disabilities experience moving out of hospital
Authors: Head Annabel , Ellis‐Caird Helen , Rhodes Louisa , Parkinson Kathie
Published: January 2018

Accessible Summary

People with learning disabilities talked about what it was like to move out of hospital.

People talked about how important their relationships with other people were. People wanted to feel comfortable with new members of staff so that they felt safe and happy in their new home.

People talked about how moving out of hospital changed how they thought about themselves. When they were in hospital, people sometimes thought that they were “bad.” But after they moved, some people started to think that they were a different person. It is important for everyone to think about how they talk to people when they are in hospital, and when they have moved out.

People can do really well living in their own home, rather than in hospital.

Background

People with learning disabilities are moving out of hospitals as part of the Transforming Care programme, although thus far their views on how they have experienced this have not been researched.

Materials and Methods

A qualitative design was used to explore how people with learning disabilities experienced moving as part of Transforming Care. Eleven people took part in semi‐structured interviews; they were supported by Key Support People (n = 9) who knew them well. A social constructionist Grounded Theory approach was used in analysis.

Results and Discussion

People reported that their relationships with other people, including friends, family and staff, played a significant role in how they experienced the move. Moving was also an opportunity for people to shift their ideas about who they were as a person and opened up a wider array of stories about their identity.

Conclusions

A number of recommendations are discussed, relevant for staff working in this field to support positive transitions out of hospital.
Comparing impact on the family and insurance coverage in children with cerebral palsy and children with another special healthcare need
Authors: Schaible B. , Colquitt G. , Caciula M. C. , Carnes A. , Li L. , Moreau N.
Published: January 2018

Background

Families and caregivers of children with special healthcare needs (CSHCN) often experience financial difficulties, have unmet physical and mental health needs, and are at increased risk of marital problems due to the stress caused by carrying for their child. Within the larger population of CHSCN, young people with cerebral palsy (CP) have more unmet needs due to the complexity and potential severity of the disability. The purpose of this study was to identify factors associated with differences in insurance coverage and impact on the family of children with CP and other CHSCN.

Methods

The data were taken from the National Survey of Children with Special Health Care Needs, which was designed to examine state‐ and national‐level estimates of CSHCN. Three variables examined differences in insurance coverage between those children diagnosed with CP versus all other CSHCN: insurance coverage for the previous year, current insurance coverage, and adequacy of insurance coverage. Four variables representing different indicators of family impact were used to assess differences between children with CP versus all other CSHCN: out‐of‐pocket expenses for healthcare, family financial burden, hours per week that family members spent caring for the child, and impact on family work life.

Results

The results of this study showed significant differences between households with a child with CP and a child with another health special need in terms of insurance coverage, indicating a tendency of children with CP to be insured the entire year. As for the impact on the family in households with children with CP versus other CSHCN, there were significant differences in all four variables that were analysed.

Conclusions

There is limited evidence highlighting differences between the impact of caring for a child with CP and caring for other CSHCN. Caring for a child with CP has a significant impact on the family, despite insurance coverage.
Soluble ST2 in end‐stage heart failure, before and after support with a left ventricular assist device
Authors: Tseng Cheyenne C. S. , Huibers Manon M. H. , Gaykema Lonneke H. , Siera‐de Koning Erica , Ramjankhan Faiz Z. , Maisel Alan S. , de Jonge Nicolaas
Published: January 2018

Background

The interleukin‐33 (IL‐33)/suppressor of tumorigenicity 2 (ST2) pathway is suggested to play an important role in fibrosis, remodelling and the progression of heart failure (HF). Increased soluble (sST2) levels are associated with adverse outcome in the average HF population. Less is known about sST2 levels in end‐stage HF. Therefore, we studied sST2 levels in end‐stage HF and the effect of unloading by left ventricular assist device (LVAD) support on sST2 levels.

Method and results

Serial plasma measurements of sST2 were performed pre‐implantation and 1, 3 and 6 months after (LVAD) implantation in 38 patients. sST2 levels were elevated in end‐stage HF just prior to LVAD implantation (74.2 ng/mL [IQR 54.7‐116.9]; normal <35 ng/mL) and decreased substantially during LVAD support, to 29.5 ng/mL [IQR 24.7‐46.6](P< .001). Patients with INTERMACS profile I had significantly higher sST2 levels compared to patients in profile II and profile III. A moderate correlation was found between sST2 and C‐reactive protein (r= .580,P< .010).

Conclusion

Levels of sST2 are elevated in end‐stage HF patients with variability that suggests multiple inputs to a pro‐inflammatory and pro‐fibrotic pathway. Cardiogenic shock and increased C‐reactive protein levels are associated with higher sST2 levels. LVAD support results in a significant drop in sST2 levels with normalization within 3 months postimplantation. This suggests that LVAD support leads to lessening of fibrosis and inflammation, which might eventually be used to target medical policy: explantation of the LVAD versus permanent use or cardiac transplantation.
Transcriptional patterns associated with BDCA3 expression on BDCA1+ myeloid dendritic cells
Authors: van der Aa Evelyn , Biesta Paula J , Woltman Andrea M , Buschow Sonja I
Published: January 2018

Myeloid dendritic cells, including BDCA3hi DCs and BDCA1+ DCs (hereafter dubbed DC1 and DC2 for clarity), play a pivotal role in the induction and regulation of immune responses. Interestingly, a fraction of DC2 also express low to intermediate levels of BDCA3. It is unknown whether BDCA3+ DC2 also share other traits with DC1 that are absent in BDCA3− DC2 and/or whether BDCA3 expression renders DC2 functionally distinct from their BDCA3‐lacking counterparts. Here, we used expression analysis on a predefined set of immunology‐related genes to determine divergence between BDCA3‐positive and BDCA3‐negative DC2 and their relation to bona fide BDCA3hi DC1. Results showed that mRNA fingerprints of BDCA3+ DC2 and BDCA3− DC2 are very similar, and clearly distinct from that of DC1. Differences in mRNA expression, however, were observed between BDCA3+ DC2 and BDCA3− DC2 that pointed toward a more activated status of BDCA3+ DC2. In line with this, higher steady state maturation marker expression and TLR‐induced maturation marker expression and inflammatory cytokine production by BDCA3+ DC2 were observed. This dataset provides insight into the relationship between myeloid DC populations and contributes to further understanding of DC immunobiology.
Functional differences in airway dendritic cells determine susceptibility to IgE‐sensitization
Authors: Leffler Jonatan , Mincham Kyle T , Mok Danny , Blank Fabian , Holt Patrick G , Stumbles Philip A , Strickland Deborah H
Published: January 2018

Respiratory IgE‐sensitization to innocuous antigens increases the risk for developing diseases such as allergic asthma. Dendritic cells (DC) residing in the airways orchestrate the immune response following antigen exposure and their ability to sample and present antigens to naïve T cells in airway draining lymph nodes contributes to allergen‐specific IgE‐sensitization. In order to characterize inhaled antigen capture and presentation by DC subtypes in vivo, we used an adjuvant‐free respiratory sensitization model using two genetically distinct rat strains, one of which is naturally resistant and the other naturally susceptible to allergic sensitization. Upon multiple exposures to ovalbumin (OVA), the susceptible strain developed OVA‐specific IgE and airway inflammation, whereas the resistant strain did not. Using fluorescently tagged OVA and flow cytometry, we demonstrated significant differences in antigen uptake efficiency and presentation associated with either IgE‐sensitization or resistance to allergen exposures in respective strains. We further identified CD4+ conventional DC (cDC) as the subset involved in airway antigen sampling in both strains, however, CD4+ cDC in the susceptible strain were less efficient in OVA sampling and displayed increased MHC‐II expression compared with the resistant strain. This was associated with generation of an exaggerated Th2 response and a deficiency of airway regulatory T cells in the susceptible strain. These data suggest that subsets of cDC are able to induce either sensitization or resistance to inhaled antigens as determined by genetic background, which may provide an underlying basis for genetically determined susceptibility to respiratory allergic sensitization and IgE production in susceptible individuals.
Adult consequences of prenatal drug exposure
Authors: Oei Ju Lee
Published: January 2018

Maternal drug use is not new but over the last few decades, the number of mothers using drugs of addiction has escalated to epidemic levels. These drugs are both legal (e.g. prescription medication) and illegal (e.g. heroin) and all will cross the placental barrier into the developing infant. The most immediate and obvious consequence of intra‐uterine drug exposure is newborn withdrawal or the Neonatal Abstinence Syndrome (NAS) which is now, with prompt recognition and treatment, an uncommon cause of neonatal death. Thousands (if not millions) of adults most likely would have had a history of passive drug exposure during gestation and the outcomes of these people are unknown. Most are physically healthy and do not need extra medical attention but the effects of prenatal drug exposure may be subtle and extensive. Drug‐use disorders are accompanied by a myriad of other adverse problems, including poverty, mental and physical health problems and inadequate parenting ability that may compound the negative effects of drugs. Emerging data suggest that vulnerability to health and neurocognitive issues are pervasive and long‐lasting as are lifestyle issues. This review will address current evidence in this area and highlight the knowledge gaps that must be addressed in order to optimise the outcomes for this vulnerable and marginalised but rapidly expanding population of adults.
Neutrophil infiltration to the brain is platelet‐dependent, and is reversed by blockade of platelet GPIbα
Authors: Giles James A. , Greenhalgh Andrew D. , Denes Adam , Nieswandt Bernhard , Coutts Graham , McColl Barry W. , Allan Stuart M.
Published: January 2018

Neutrophils are key components of the innate immune response, providing host defence against infection and being recruited to non‐microbial injury sites. Platelets act as a trigger for neutrophil extravasation to inflammatory sites but mechanisms and tissue‐specific aspects of these interactions are currently unclear. Here, we use bacterial endotoxin in mice to trigger an innate inflammatory response in different tissues and measure neutrophil invasion with or without platelet reduction. We show that platelets are essential for neutrophil infiltration to the brain, peritoneum and skin. Neutrophil numbers do not rise above basal levels in the peritoneum and skin and are decreased (~60%) in the brain when platelet numbers are reduced. In contrast neutrophil infiltration in the lung is unaffected by platelet reduction, up‐regulation of CXCL‐1 (2·4‐fold) and CCL5 (1·4‐fold) acting as a compensatory mechanism in platelet‐reduced mice during lung inflammation. In brain inflammation targeting platelet receptor GPIbα results in a significant decrease (44%) in platelet‐mediated neutrophil invasion, while maintaining platelet numbers in the circulation. These results suggest that therapeutic blockade of platelet GPIbα could limit the harmful effects of excessive inflammation while minimizing haemorrhagic complications of platelet reduction in the brain. The data also demonstrate the ability to target damaging brain inflammation in stroke and related disorders without compromising lung immunity and hence risk of pneumonia, a major complication post stroke. In summary, our data reveal an important role for platelets in neutrophil infiltration to various tissues, including the brain, and so implicate platelets as a key, targetable component of cerebrovascular inflammatory disease or injury.
Failure to confirm high blood pressures in pediatric care—quantifying the risks of misclassification
Authors: Koebnick Corinna , Mohan Yasmina , Li Xia , Porter Amy H. , Daley Matthew F. , Luo Gang , Kuizon Beatriz D.
Published: January 2018

Pediatric practice guidelines call for repeating an elevated office blood pressure (BP) at the same visit, but there are few data available to support this recommendation. We compared the visit results in children aged 3 to 17 years with aBPreading ≥95th percentile (n = 186 732) based on the initialBPand the mean of twoBPreadings, using electronic medical records from 2012–2015. Failure to repeat an initialBPreading ≥95th percentile would lead to a false “hypertensive” visit result in 54.1% of children who would require follow‐up visits. After an initial visit result indicating hypertension, hypertension stage I or stageIIwas sustained in 2.3% and 11.3% of youth during their next visits, respectively. In conclusion, only approximately half of the pediatric patients would be correctly classified based on their initialBP. The recommendation to repeat highBPduring the same visit needs to be emphasized because it saves unnecessary follow‐up visits.
Mental disorder: Are we moving away from distress and disability?
Authors: Telles‐Correia Diogo
Published: January 2018

The first time that formally a definition of mental disorder was presented was in DSM‐III. This resulted from a complex conceptual analysis carried out by Spitzer, chair of the committee on nomenclature and statistics.

The criteria of harm (distress‐disability) arise as main defining characteristics for mental illness, being added that “there is an inference” that there is a dysfunction.

The distress‐disability model was later developed by Wakefield. This author argued that in a medical or psychiatric disorder there had to be a dysfunctional component (value free) and another one of harm (value laden).

In this article, we intend to review the emergence and evolution of the definition of mental disorder and the importance that the criteria of distress and disability always had in this definition. This happened until the advent of DSM‐5 when these criteria came to play a secondary role.
Revolution from below in Panguipulli: Agrarian reform and political conflict under the Popular Unity in Chile
Authors: Robles‐Ortiz Claudio
Published: January 2018

This article examines the political conflict in rural society during the Popular Unity Government (1970–73) by focusing on the mobilization of forestry workers in Panguipulli, a district in southern Chile. Adopting land invasions as their main strategy in the struggle for land and power, Panguipulli workers experienced a radical politicization by aligning themselves with the Peasant Revolutionary Movement, the “peasant front” of the Revolutionary Left Movement. Because of its relation with this emerging “new left,” rural mobilization was a significant expression of the “revolution from below”, which challenged the Popular Unity's “Chilean road to socialism.” Moreover, because rural mobilization also took place in other areas throughout Chile where the Revolutionary Left Movement was influential, it gave rise to a grassroots project for radicalizing the government's agrarian reform. As a result, the rural “revolution from below” strongly influenced the content and trajectory of political conflict under the Popular Unity Government.
Effect of gut stress induced by oxidized wheat gluten on the growth performance, gut morphology and oxidative states of broilers
Authors: Liao R. B. , Yan H. J. , Liu G. H. , Zhang S. , Chang W. H. , Liu W. , Lin C. H. , Huang X. Y. , Cai H. Y.
Published: January 2018

This study was to investigate the effect of oxidized wheat gluten (OG) on growth performance, gut morphology and its oxidative states of broilers. One hundred and eighty‐day‐old male broilers (10 chicks/pen) were randomly allocated into three dietary treatments: control diet (CON), diet with 8% wheat gluten (WG) and diet with 8% OG with six pens/treatment. Body weight (BW) (21 and 35 days) and average daily gain (ADG) (1–21 days and 22–35 days) decreased (p < .05) and feed conversion ratio (FCR) (1–21 days and 22–35 days) increased (p < .05) in OG treatment. Feed intake (FI) decreased (p < .05) in WG and OG treatments during 22–35 days. However, FI was not influenced by dietary treatments during 1–21 days (p > .05). The OG‐fed broilers had a lower faecal pH value (p < .05) and higher faecal moisture content (p < 05) at 14, 21, 28 and 35 days. Villus height, crypt depth and V/C value were not different (p > .05) among treatments at 21 and 35 days. Lipid peroxidation (LPO) (21 and 35 days) and malondialdehyde (MDA) (35 days) content in crop of OG treatment increased (p < .05). Oxidized glutathione (GSSG) (21 days), LPO (21 and 35 days) and MDA (21 and 35 days) content in ileum of OG treatment increased (p < .05). The reduced glutathione/oxidized glutathione (GSH/GSSG) (21 days) and (GSH) (35 days) in ileum of OG treatment decreased (p < .05). The present findings indicate that OG might be a stressor for broiler gut, which could induce oxidative stress both in crop and in ileum, and the diarrhoea as well. The growth performance of broiler was consequently depressed.
Conflict between heterozygote advantage and hybrid incompatibility in haplodiploids (and sex chromosomes)
Authors: Ghenu Ana‐Hermina , Blanckaert Alexandre , Butlin Roger K. , Kulmuni Jonna , Bank Claudia
Published: January 2018

In many diploid species, the sex chromosomes play a special role in mediating reproductive isolation. In haplodiploids, where females are diploid and males haploid, the whole genome behaves similarly to the X/Z chromosomes of diploids. Therefore, haplodiploid systems can serve as a model for the role of sex chromosomes in speciation and hybridization. A previously described population of FinnishFormicawood ants displays genome‐wide signs of ploidally and sexually antagonistic selection resulting from hybridization. Here, hybrid females have increased survivorship but hybrid males are inviable. To understand how the unusual hybrid population may be maintained, we developed a mathematical model with hybrid incompatibility, female heterozygote advantage, recombination and assortative mating. The rugged fitness landscape resulting from the co‐occurrence of heterozygote advantage and hybrid incompatibility results in a sexual conflict in haplodiploids, which is caused by the ploidy difference. Thus, whereas heterozygote advantage always promotes long‐term polymorphism in diploids, we find various outcomes in haplodiploids in which the population stabilizes either in favour of males, females or via maximizing the number of introgressed individuals. We discuss these outcomes with respect to the potential long‐term fate of the Finnish wood ant population and provide approximations for the extension of the model to multiple incompatibilities. Moreover, we highlight the general implications of our results for speciation and hybridization in haplodiploids versus diploids and how the described fitness relationships could contribute to the outstanding role of sex chromosomes as hotspots of sexual antagonism and genes involved in speciation.