bluuebunny/crossref_metadata_2025 huggingface dataset:
Accountability in Global Environmental Governance: A Meaningful Tool for Action?
Authors: Kramarz Teresa , Park Susan
Published: March 2016

Global environmental governance (GEG) is characterized by fragmentation, duplication, dispersed authority, and weak regulations. The gap between the need for action and existing responses has led to demands for accountability. This has created a paradox: accountability mechanisms to improve GEG have proliferated while the environment deteriorates. We offer a two-tier explanation for this paradox. First, actors establishing GEG are not held to account for the design of their environmental interventions. Biases in public, private, voluntary, and hybrid institutions, which shape goals and determine what to account for and to whom, remain unexamined. Second, efforts to establish accountability focus on functional requirements like monitoring and compliance, leading accountability to be viewed as an end in itself. Thus, complying with accountability may not mitigate negative environmental impacts. The utility of accountability hinges on improving governance at both tiers. Turning the accountability lens to the goals of those designing environmental institutions can overcome the focus of justifying institutions over environmental problems.
Художественная Избыточность Романого Творчества Достоевского И «Вечный Муж» [Poetic Excess in Dostoevsky’s Novelistic Technique and the Novella “The Eternal Husband”]
Authors: Власкин А.П.
Published: March 2016

«Вечный муж» Достоевского – достаточно странное произведение, осо- бенно если учесть его место в ряду романов писателя. Может ли равнять- ся с ними «Вечный муж»? Равняться по художественным достоинствам или по любым другим параметрам? Ответ на этот вопрос дается в докладе на основе анализа «избитка».

Достоевский образы некоторых своих героев воображал себе гораздо более богатыми по смысловым возможностям, чем то, как они вырази- лись в конкретном произведении. Раскольников, Соня, Свидригайлов – в них слишком многое остается как будто «за кадром», а точнее – за сюжетом. Иными словами, в подобных образах (преимущественно в концептуально значимых) потенциально содержится нечто такое, что не укладывалось в прокрустово ложе единичной судьбы и в логику кон- кретного сюжета. Нашему восприятию это художественное явление ока- зывается доступно через наблюдаемые реминисценции и в более упро- щенном виде – через типологию.Явление это можно называть художест- венной избыточностью воображения писателя.

[Dostoevsky’s The Eternal Husband is a curious work especially in comparison with the rest of Dostoevsky’s opus. How can The Eternal Husband be ranked in that opus? Does one apply artistic merit or other parameters? The answer to this question is given in the article on the basis of an analysis of “excess.”

Dostoevsky conceived some of his literary characters as much more substantial in their sense radius than they actually turned out to have in their expression in the concrete work. Raskolnikov, Sonia, Svidrigailov – they are all hidden behind the screen, as it were, or more precisely, behind the sujet. In other words, in such conceptually important characters there is something which potentially transcends the procrastination of individual destiny and the logic of a concrete sujet. We perceive these artistic phenomena by means of reminiscences and in a simplified form by means of a typology. This phenomenon can be called the excess of artistic imagination of the writer.]
Kant with Sade with Dostoevsky: The Voice, the Object and the Limits of Representing in Bobok
Authors: Ascroft Edward
Published: March 2016

This paper explores the dialectic of a subject constructed through these ‘gazes’. The gaze in this psychoanalytic re-reading of Dostoevsky’s story Bobok is reinterpreted through the function of what we will term the ‘aural gaze,’ which is elaborated as the invocatory function of the psychic apparatus or voice. By means of these psychic functions, which come to expression in the plot and structure of Dostoevsky’s novella, a world is constructed in which the subject not only ‘looks’ or is ‘looked-at’ but is listened to and made to speak.
Two new species of Curuapira Martins & Galileo, 1998 (Coleoptera, Cerambycidae, Lamiinae, Desmiphorini)
Authors: SANTOS-SILVA ANTONIO C. , BEZARK LARRY G. , GALILEO MARIA HELENA M.
Published: March 2016

Two new species of Curuapira Martins & Galileo, 1998 are described: C. hovorei sp. nov. from Ecuador and C. armandi sp. nov. from Panama. A key to species of the genus is provided.
Mesoscale and Synoptic Environment in Three Orographically Enhanced Rain Events on the Coast of Santa Catarina (Brazil)
Authors: Guimarães Rodrigues M. Laura , Ynoue Rita Yuri
Published: March 2016

In this study three cases of extreme rainfall events are analyzed in Florianopolis, Santa Catarina (SC), on Brazil’s coast, lying between the mountains and the South Atlantic Ocean in southeastern South America. The largest rainfall totals, 200–300 mm in 12–24 h, resulted in flash floods. ECMWF 6-hourly 1.5° × 1.5° data were used to determine the synoptic fields and quasigeostrophic forcing, along with observational data from local networks, for subsynoptic analyses. In case C1, during May 2010, there was a frontal passage. In C2 and C3 (January 2008 and February 1979, respectively) the coastline separated a ridge over the continent from a trough over the sea at the surface, with an atmosphere of low baroclinicity predominating at 500 hPa. All three events were characterized by postfrontal conditions; the presence of an anticyclone over the sea, centered at 35°–40°S; and slow-moving or quasi-stationary midlevel cyclones over the continent, at 27 °S. The circulation generated in the cyclone resulted in strong (10 m s−1) and persistent low-level east-northeast winds along the coast of SC, favoring the influx of heat and humidity on days with heavy rain. The upward motion at 850 hPa was concentrated over the affected areas and stronger than that at 500 hPa. Even so, the moist air that reached the mountain in a conditionally unstable environment rose only to middle levels. The features presented were similar to those observed for orographic rain events in Europe and the United States.
Using the Qur’ān to Empower Arab Women? Theory and Experimental Evidence From Egypt
Authors: Masoud Tarek , Jamal Amaney , Nugent Elizabeth
Published: March 2016

A growing body of scholarship on the political and economic subordination of women in the Muslim world has argued that widespread patriarchal attitudes toward women’s roles in public life can be ameliorated by offering progressive reinterpretations of Islamic scriptures. In this article, we explore this hypothesis with a large-scale survey experiment conducted among adult Egyptians in late 2013. In the study, a subset of respondents were exposed to an argument in favor of women’s political equality that was grounded in the Qur’ān, Islam’s holiest text. We found that this group was significantly more willing to express approval of female political leadership than those exposed to a non-religious argument in favor of women’s eligibility for political leadership. A further analysis of conditional treatment effects suggests that the religious justification for female political leadership was more likely to elicit agreement among less educated and less pious respondents, and when delivered by women and targeted at men. Our findings suggest that Islamic discourse, so often used to justify the political exclusion of women, can also be used to help empower them.
Enhancing Scholarship Focused on Trans People and Issues
Authors: Tebbe Elliot A. , Moradi Bonnie , Budge Stephanie L.
Published: March 2016

Scholarship about lesbian, gay, bisexual, and transgender (LGBT) people and issues has been growing. However, trans issues are often overlooked or addressed only nominally in this literature, leading to calls for further focused attention to trans people and issues. In a series of articles, this Major Contribution addresses such calls by (a) providing a content analysis of scholarship about trans people and issues, (b) discussing methodological considerations and strategies for conducting research with trans populations, and (c) presenting an empirical study that addresses how intersecting identities (e.g., ethnicity/race, sexual orientation, socioeconomic status) combine in relation to trans people’s mental health. This article provides a context for the Major Contribution and offers an overview of each of the component articles.
Social Change and Psychological Change in Rural Mali
Authors: Schooler Carmi , Caplan Leslie J , Mounkoro Pakuy Pierre , Diakité Chiaka
Published: March 2016

We examine the effects of socio-environmental change on personality in Mali in three ways, using data from a longitudinal two-wave (1994, 2004) survey conducted in rural Mali. Firstly, we compare the between-wave personality stability of Anxiety, Self-confidence, Mastery/Fatalism, and Authoritarianism with that in USA, Japan, Poland, and Ukraine. Secondly, we examine socio-economic hardship and political instability in pre-industrial Mali. Thirdly, we examine patterns of psychological reaction to political and social change during the study period. Our findings have implications for comparisons and generalizations across times and cultures about the contribution of socio-environmental conditions to over-time change in personality.
Modeling and experimentation of multi-layered nanostructured graphene-epoxy nanocomposites for enhanced thermal and mechanical properties
Authors: Atif Rasheed , Shyha Islam , Inam Fawad
Published: March 2016

The influence of multi-layered nanostructured graphene as reinforcement on thermal and mechanical properties of epoxy-based nanocomposites has been studied. The maximum improvement in mechanical properties was observed at 0.1 wt%. The Young’s and flexural moduli increased from 610 MPa to 766 MPa (26% increase) and 598.3 MPa to 732.8 MPa (23% increase), respectively. The tensile and flexural strengths increased from 46 MPa to 65 MPa (43% increase) and 74 MPa to 111 MPa (49% increase), respectively. The mode-1 fracture toughness (K1C) and critical strain energy release rate (G1C) increased from 0.85 MPa.m1/2 to 1.2 MPa.m1/2 (41% increase) and from 631 J/m2 to 685 J/m2 (9% increase), respectively. The increase in fracture toughness is attributed to the obstruction of cracks by graphene layers. The reinforcing effect of nanostructured graphene was also manifested in dynamic mechanical properties. The storage modulus and alpha-relaxation temperature values significantly increased indicating the fine integration of NSG in epoxy chains. The thermal properties of nanocomposites were simulated which showed that graphene is very efficient in significantly increasing the scattering and dissipation of thermal flux.
The Function of Commercial Streets in Montreal and Paris, 1853-1936
Authors: Lord Kathleen
Published: March 2016

Urban spaces and streets have been studied in a variety of ways in Montreal and Paris, but rarely have historians examined the specific relationship between the function of the street and social usage to reflect changes over time. The argument here is for an analytical approach to photographs combined with textual evidence to reveal the urban processes affecting the retail streets of rue Notre-Dame and rue Sainte-Catherine in Montreal, the through street of Boulevard de Sébastopol, and the pedestrian street of rue Mouffetard in Paris. Photographs reflect the success of modern urban transformations to rework the images of the city from various perspectives and for different purposes. They include the bourgeois female shopper on the late nineteenth-century retail and through streets, female retail and office workers interspersed among men on early twentieth-century rue Sainte-Catherine, and the agency of working-class women in the market transactions and peddler trades of rue Mouffetard.
Values Stability and Change in Adulthood
Authors: Milfont Taciano L. , Milojev Petar , Sibley Chris G.
Published: March 2016

Recent studies have examined whether values change across time. The present study investigates both rank-order stability and mean-level differences in core values—and whether age and sex moderate stability and change—over 3 years using a national probability sample (from 25 to 75 years; N = 3,962). Value priorities were highly stable, except for Conservation values among women, which peaked in stability at age 50 and decreased afterward. Older adults and women placed greater emphasis on values relating to the welfare of others and preservation of traditional practices and stability (Self-Transcendence and Conservation values). Younger individuals and men tended to more highly value the pursuit of status and power, and independent thought and behavior (Self-Enhancement and Openness to Change). The results are consistent with a life span perspective on values development and indicate values may change slowly throughout life as a reflection of biological and psychological maturation.
Quantifying the changes in oxygen extraction fraction and cerebral activity caused by caffeine and acetazolamide
Authors: Buch Sagar , Ye Yongquan , Haacke E Mark
Published: March 2016

A quantitative estimate of cerebral blood oxygen saturation is of critical importance in the investigation of cerebrovascular disease. We aimed to measure the change in venous oxygen saturation (Yv) before and after the intake of the vaso-dynamic agents caffeine and acetazolamide with high spatial resolution using susceptibility mapping. Caffeine and acetazolamide were administered on separate days to five healthy volunteers to measure the change in oxygen extraction fraction. The internal streaking artifacts in the susceptibility maps were reduced by giving an initial susceptibility value uniformly to the structure-of-interest, based on a priori information. Using this technique, Yv for normal physiological conditions, post-caffeine and post-acetazolamide was measured inside the internal cerebral veins as YNormal = 69.1 ± 3.3%, YCaffeine = 60.5 ± 2.8%, and YAcet = 79.1 ± 4.0%. This suggests that susceptibility mapping can serve as a sensitive biomarker for measuring reductions in cerebro-vascular reserve through abnormal vascular response. The percentage change in oxygen extraction fraction for caffeine and acetazolamide were found to be +27.0 ± 3.8% and −32.6 ± 2.1%, respectively. Similarly, the relative changes in cerebral blood flow in the presence of caffeine and acetazolamide were found to be −30.3% and + 31.5%, suggesting that the cerebral metabolic rate of oxygen remains stable between normal and challenged brain states for healthy subjects.
Computational design and analysis of aerostatic journal bearings with application to ultra-high speed spindles
Authors: Gao Siyu , Cheng Kai , Chen Shijin , Ding Hui , Fu Hongya
Published: March 2016

Aerostatic bearings are the critical parts of ultra-high speed spindles applied to precision milling, grinding, and other precision engineering applications. In this paper, the computational design and analysis of aerostatic journal bearings at ultra-high speed spindles are investigated particularly in light of the nonlinear compressible Reynolds equation and the associated computational analysis and algorithms using the finite element method-based Galerkin weighted residual method. The steady-state static and dynamic behaviors of aerostatic journal bearings are systematically studied, including pressure distributions, load capacity, stiffness, attitude angle, and volume flow rate under conditions of various operating speeds and eccentricity ratios. The coupling of the aerostatic and aerodynamic effects within ultra-high speed aerostatic journal bearings is further explored. The obtained results are formulated as design guidelines for aerostatic journal bearings applied to air-bearing spindles operating in high precision and ultra-high rotational speeds.
Predictors of Maternal Grief in the Year after a Newborn Death
Authors: Engler Arthur J. , Lasker Judith N.
Published: March 2016

Existing interventions to assist mothers following newborn death are implemented once manifestations of distress are present. Preventive measures could be instituted if predictors of grief were defined. The objective of this study was to investigate the value of perceived support, relationship satisfaction, emotion-focused coping, problem-focused coping, and mixed coping in predicting maternal grief in the year after a newborn death. The sample consisted of seventy-five bereaved mothers. Measures used included the Perinatal Grief Scale, Short Version; the Ways of Coping Scale, Revised; the Personal Resources Questionnaire 85, Part II; the Relationship Satisfaction Questionnaire; and the Demographic Data Sheet. Perceived support and emotion-focused coping accounted for a significant proportion of variance in total grief (43 percent), demonstrating that these two variables together can predict maternal grief. Programs to help bereaved mothers mobilize perceived support and use different ways of coping could be beneficial following the death of a newborn.
An Overview of Physician Attitudes toward Death and Dying: History, Factors, and Implications for Medical Education
Authors: Curtis Kayla K. , McGee Marsha G.
Published: March 2016

In recent years, much attention has been directed toward death-related topics, including the role of the physician in caring for terminally ill patients and communicating with patients and families about death and dying. During the past decade, researchers and critics have often described death in America as being problematic because of tension between heroic and humanistic medical care. This article presents an overview of the attitudes of physicians and medical students regarding end-of-life issues. Included are a discussion of the history of death in Western medicine, information about specific attitudes medical professionals hold regarding terminally ill patients and their families, and research findings about specific factors such as gender, specialty, and years of training and practice that contribute to these attitudes. A need for improved medical education about death and dying is emphasized, with recommendations about how to increase the knowledge of medical professionals and offer patients death with dignity.
Connecting with the Bereaved: Innovations in Group Counseling
Authors: Regan Sandra , Barnwell Alison
Published: March 2016

This article discusses the Teleconferencing Group Counseling service developed by the Australian Red Cross Blood Service–New South Wales as an extension of bereavement aftercare program (The Next Step Programme) for families involved in the organ donation process. It demonstrates that Teleconferencing Group Counseling (TGC) can be a very powerful and versatile tool. Coleaders with up to five group members travel on a bereavement journey, maintaining connection over eight one-hour weekly sessions. Combined with the TGC approach, the use of postcards as visual images to facilitate group process will be examined through two examples utilized in group sessions.
The Cycle of Loss, Grief, and Violence as Exhibited in the Lives of Inner-City Youth
Authors: Kelly Victor L.
Published: March 2016

Just as violence may occur in nature at any time, so too does it occur in institutions such as the school and the family, and on the most personal level, within the individual as well. This article explores the various forces that impact inner-city youth. Knowledge of these forces may provide a greater understanding of the way in which violence occurs in the lives of inner-city youth. The author also offers a hypothesis of the role they play in the grief processes of these same young people.
The Process of Acculturation in Israel among Elderly Immigrants from the Former Soviet Union
Authors: Ron Pnina
Published: March 2016

Between 1989 and 1995, more than a half million immigrants arrived in Israel from the former Soviet Union (FSU). Data show that elderly persons (65 and older) composed 14 percent of this immigration wave. The process of immigration from the FSU is a process of change extending to all areas of life, including environmental changes (climatic conditions, household arrangements); problems of language, culture, mentality, and social norms; and the personal and emotional changes accompanying such a process. Each of these transitions requires a process of personal adjustment to new situations of life that may negatively affect the immigrants' personal well-being, as individuals and as a group. Elderly immigrants are at risk as far as their capacity to adjust to changes. This study is an attempt to examine the main difficulties facing elderly immigrants from the FSU and the effect these problems have on their well-being during their acculturation in Israel.
Factors Associated With Frequent Emergency Department Use in the Medicare Population
Authors: Colligan Erin Murphy , Pines Jesse M. , Colantuoni Elizabeth , Wolff Jennifer L.
Published: March 2016

Frequent emergency department (ED) use is a public health and policy relevant concern but has not previously been examined in the Medicare population. We conducted a retrospective, claims-based analysis of a nationally representative 20% sample of fee-for-service Medicare beneficiaries in 2010 ( n = 5,778,038) to examine frequent ED use. We used multinomial logistic regression to study the relationship between frequent ED use and sociodemographic, outpatient care, and clinical characteristics. Factors that were most strongly associated with frequent ED use included being age 18 to 34 years compared with 65 to 74 years (relative risk ratio = 20.5, confidence interval [CI; 19.7, 21.3]) and mental illness (relative risk ratio = 6.8, CI [6.7, 6.9]). Low versus high continuity of care was associated with 24% (95% CI [1.21, 1.26]) greater risk of frequent compared with non-ED use. Although clinical and demographic characteristics are most strongly associated with frequent ED use, poor continuity of care is also a contributor.
Impact of surface elasticity for the contact problem on tangential triangle distribution force
Authors: Wang Liyuan , Wang Lijin
Published: March 2016

This paper proposes an application of surface elasticity theory in the analysis of the contact problem at nanoscale. The Fourier integral transform method is adopted to derive the fundamental solutions for the contact problem. As a special case, the deformation induced by a tangential triangle distribution force is discussed in detail. The results indicate some interesting characteristics in nano-contact mechanics, which are distinctly different from those in the macro-contact problem. This study is helpful to characterize and measure the mechanical properties of soft materials through nano-indentation.
Parental influence on the physical activity of Chinese children
Authors: Lijuan Wang , Jiancui Sun , Suzhe Zhao
Published: March 2016

This study aimed to examine the association among parental moderate-to-vigorous physical activity (MVPA), parental support, and the MVPA of children by gender. Participants comprised of 172 boys and 151 girls aged seven to 11 years old from three primary schools in Shanghai. Their parents were also included as research respondents. Accelerometers were utilized to measure MVPA duration among the children. Questionnaires that focused on parental support and MVPA were completed by the parents. Results indicated that only 4% of the children met the recommended MVPA duration of 60 minutes per day based on objective data. Parental support consisted of two constructs: logistic support and explicit modelling. Boys engaged in more MVPA than girls although no gender differences were noted in terms of the logistic support and explicit modelling of parents and their MVPA. A regression analysis revealed that 23.3% of the variance in MVPA for boys was explained by explicit modelling and MVPA of fathers. Moreover, 10.5% of the variance for girls was explained by the explicit modelling of mothers. Thus, parents should be highly encouraged to support the MVPA of their children by acting as role models. They can also enhance the MVPA of their children using different methods based on gender.
The effect of psychological capital between work–family conflict and job burnout in Chinese university teachers: Testing for mediation and moderation
Authors: Pu Jun , Hou Hanpo , Ma Ruiyang , Sang Jinyan
Published: March 2016

In this study, we investigated the relationship between work–family conflict and job burnout as well as the potential mediation/moderation effects of psychological capital. Participants were 357 university teachers who completed a questionnaire packet containing a work–family conflict scale, psychological capital questionnaire, and Maslach Burnout Inventory–General survey. According to the results, work–family conflict and psychological capital were both significantly correlated with job burnout. In addition, psychological capital cannot mediate—but can moderate—the relationship between work–family conflict and job burnout. Taken together, our findings shed light on the psychological capital underlying the association of work–family conflict and job burnout.
Environmental crisis, narcissism and the work of grief
Authors: Shaw Wendy S , Bonnett Alastair
Published: March 2016

This article explores the relationship between environmental crisis, narcissism and the work of grief. In the first section, we provide an overview of the way narcissism has re-emerged in recent scholarship within cultural geography and environmental psychology. Developing and in part challenging the normative focus on selfish, self-destructive consumption that we identify as a major strand in the literature, we draw out themes of daunting loss. In the second section, these themes and processes are explicitly framed in terms of grief and connected to recent conceptualisations of the ‘Anthropocene’. We argue that narcissistic responses can be usefully reframed in terms of a variety of grief responses. Hence, we address the work of grief as multifaceted and multi-directional – encompassing bewilderment, denial and also creative re-imaginings provoked by the experience of loss. This point is further developed in the third section using an example from an advocate of ‘re-wilding’.
Athena’s Way: The Jurisprudence of the Oresteia
Authors: Manderson Desmond
Published: March 2016

This article offers a substantial new interpretation of Aeschylus’ Oresteia, one of the most important literary texts to deal with the question of the rule of law, and one of Western jurisprudence’s founding documents. Perhaps in part because of it has fallen under the shadow of Antigone, the play has tended to suffer from a reductionist reading in which legal reason triumphs over the passions. The present article rereads the text drawing on recent scholarship on Aeschylus’ work. It argues that the central figure of the Furies has been misunderstood: they are not simply expressions of violence and passion; on the contrary, they are the most legalistic of all the figures in the play. The model of judgment introduced by Athena in the resolution of Oresteia does not pit law against emotion, or feud against process, but judgment against law. The trilogy begins by presenting the uncertainty of language as law’s curse, and the certain application of the law its cure; it concludes by radically reframing the question. Now the illusory certainty of law is the curse – and the uncertainty of language its cure. Athena’s way positions legal judgment as something more than the mere following of rules. The article then goes on to show that this approach not only casts a new light on orthodox jurisprudence. It is of profound relevance to the work of Giorgio Agamben and the theory of sovereignty he has famously expounded in Homo Sacer. What ultimately separates Athena’s rule of law from mere decisionism or Agamben’s executive and unlimited sovereignty are the external constraints to which she purposely submits herself. Athena demonstrates a vision of judgment as a participatory and transformative process. Above all, she insists on the essential role of public legal argument and public accountability in a discourse of legal legitimacy, which is not simply limited to judges or particular legal decisions. On the contrary, Athena connects the rule of law to a continuing discussion of legal values and judgments which is never finally settled, and in which all of us, as citizens of Athens, are participants.
A Curious Distal Tibiofibular Neuropathic Fracture
Authors: Brandao Roberto A. , Wukich Dane K.
Published: March 2016

Hindfoot and distal leg neuropathic fracture collapse secondary to normal pressure hydrocephalus is a very rare clinical pathology. The authors present a case of a 69-year-old woman who sustained a distal tibiofibular fracture that resulted in a recurvatum deformity with idiopathic neuropathy and gait instability on initial presentation. A subtalar and ankle joint arthrodesis was performed achieving rectus alignment of the lower extremity with no postoperative complications. Her neuropathic etiology was negative for common causative factors, including diabetes, infection, nutritional deficiencies, congenital neuropathy, and trauma. Approximately 6 months postoperatively, the patient had persistent bilateral lower extremity weakness with the sensation of her “feet sticking to the floor” on ambulation. A referral to neurology revealed a normal pressure hydrocephalus as a possible etiology for her gait abnormalities and neuropathy. She required a ventriculoperitoneal shunt, with resolved gait disturbance and associated weakness approximately 1.5 years postoperatively.

Levels of Evidence: Therapeutic, Level IV: Case report
Does increased femoral antetorsion predispose to cartilage lesions of the patellofemoral joint?
Authors: Oppermann Johannes , Dargel Jens , Eysel Peer , Bredow Jan
Published: March 2016

Aims and Objectives:

Anatomic variants, instability or incongruence of the patellofemoral joint have been shown to result in pathological patellofemoral stress-patterns and have been described to predispose to patellofemoral cartilage degeneration. Despite the fact that degeneration of the medial patellofemoral facet is seen more frequently when compared to the lateral facet, we need to be aware of patients with abnormal femoral antetorsion and subsequent femoral internal rotation, in whom we detect increased stress patterns and cartilage degeneration of the lateral facet of the patellofemoral joint. Although this entity is well studied in patients with internally rotated femoral components after total knee replacement, there is a lack of scientific evidence in native knees. The purpose of this study was to investigate if there was a relationship between femoral neck antetorsion and the presence and the pattern of osteoarthritis of the patellofemoral joint. It was hypothesized that an increased femoral neck antetorsion correlates with osteoarthritic changes of the lateral facet of the patellofemoral joint and correlates with an increased lateral trochlear height and a decreased sulcus angle.

Materials and Methods:

Seventy-eight formalin-embedded cadaveric lower extremities from thirty-four subjects with a median age of 74 years (range 60-88) were used. Surrounding soft tissues of the lower limb were removed. The femoral neck antetorsion was measured and referenced to the transepicondylar axis. The height of the medial and lateral facet of the trochlea and the sulcus angle were measured. The location and the degree of patellofemoral cartilage degeneration were recorded. Pearson’s correlation analysis was performed to correlate the femoral neck antetorsion with the measured knee parameters.

Results:

No significant correlation could be found between the femoral antetorsion and cartilage degeneration of the lateral patellofemoral joint (p = n.s.), the height of the lateral trochlea (p = n.s.), and the sulcus angle (p = n.s.).

Conclusion:

This study could not document that femoral neck antetorsion and subsequent internal rotation of the distal femur was correlated with the degree of degeneration of the lateral facet of the patellofemoral joint. Based on these findings, femoral internal rotation may only play a minor role in the development of lateral patellofemoral joint degeneration in native knees. In contrast, we are confronted with these cases in our daily clinical practice. To date, valid scientific reports and evidence of different treatment options are limited. Femoral derotational osteotomy could be one treatment option in these cases, but the indication should be considered thoroughly.
Influence of somatization dysfunction and depressive symptoms on the course of pain within the first year after uncomplicated total knee replacement (TKR), a prospective study
Authors: Bierke Sebastian , Petersen Wolf
Published: March 2016

Aims and Objectives:

The implantation of a bicondylar knee implant is one of the most common orthopedic surgeries performed in Germany. However, it has been shown that 10 to 25% of the patients are not satisfied with the result. Purpose of this study was to evaluate the effect of depressive symptoms and somatization on the outcome after total knee replacement (TKR).

Materials and Methods:

In 2012 and 2013 a total of 138 patients out of 150 were enrolled in this prospective study. Preoperatively depressive symptoms were assessed with the patient health questionnaire 9 (PHQ-9) and somatization was assessed with the PHQ-15. Primary outcome measure was the self-assessed knee function evaluated with the "knee osteoarthritis outcome score" (KOOS) and pain measured with a numerical rating scale (NRS). Secondary outcome measures were the KOOS subscales and the patient satisfaction. Group differences were tested by the independent t-test and the influence of other co-factors was checked with the univariate variance-analysis.

Results:

At 6 and 12 months postoperatively patients with a PHQ-9 of more than 10 points had significant higher pain score at rest and daily living activities. Somatization assessed with the PHQ-15 had a significant effect on pain at rest and pain at daily living activities at 6 and 12 months postoperatively. Both factors, PHQ-9 and PHQ-15 had also a significant effect on KOOS outcome and patient satisfaction.

Conclusion:

Psychopathological factors such as depressive symptoms and somatization have an impact on outcome after TKR. Preoperative screening for psychopathological conditions could help to improve patient selection for TKR.
Thick-osteochondral Flap Deepening Trochleoplasty for Patellar Instability
Authors: Donel Simon , Ali Khameinei , Smith Dr. Tobi , McNamara Iain
Published: March 2016

Aims and Objectives:

In patients with patellar instability and severe trochlear dysplasia, trochleoplasty has become increasingly used as part of the surgical management. The aim to report the mid-term results of this trochleoplasty including the sports and exercise activities of the cohort. Our hypothesis was that the operation would improve knee function and lead to an increase in sports participation in the patients.

Materials and Methods:

Between 1995 and 2010 the thick-flap deepening trochleoplasty was performed in 90 patients (107 knees) with severe trochlear dysplasia. Data was collected prospectively pre-operatively, at 6 weeks and 1-year follow-up. A standard pre-operative clinical assessment that included assessment of patellar apprehension , patellar tracking and patellofemoral crepitus. Post-operative outcome scores were performed by postal questionnaire and collected between June and December 2013, to determine the clinical and functional outcomes, including sports and exercise participation at a minimum of 2 years, with complete data available in 92%.

Results:

With a minimum follow-up of 2 years, average of 6 years (range 2 to 19 years). The Kujala score had a median and interquartile range (IQR) of 63 (47-75) pre-operatively rising to 79 (68-91) at 1 year follow-up and 84 (73-92) at final follow-up (p< 0.05). Seventy-two per cent were satisfied with their knee function at 1 year follow-up rising to 79% at final follow-up (p <0.0001). Sports and exercise participation increased from 36 patients (40%) pre-operatively to 60 (67%) at final follow-up. The numbers involved in competitions increased slightly from 10 (11%) to 11 (12%). Of those sports that involved twisting (e.g. soccer, cricket, badminton), participation increased from 16 (18%) to 22 (24%), whereas non-twisting sports (e.g. running, swimming, cycling) increased from 24 (27%) to 47 (52%) of whom 14 (16%) used walking as exercise.

Conclusion:

The thick-flap deepening trochleoplasty improves the clinical and functional outcomes for patients with symptomatic patellar instability with severe trochlear dysplasia. These results improve over time and beyond the 1 year clinical follow-up. However trochleoplasty does not lead to a significant improvement in sports participation at a competitive level. It does improve the sports and exercise patient participation, principally in non-twisting sports activities.
The transosseous ACL Refixation and biological Augmentation "TARBA". Preliminary Results of a new Operation Technique
Authors: Hinterwimmer Stefan , Achten Manfred , Bathish Einal
Published: March 2016

Aims and Objectives:

Differentiated gradings of anterior cruciate ligament (ACL) tear-types allow us to perform a more and more differentiated treatment of this injury. Especially in the tears close to the insertion ACL preserving techniques like "healing response" together with growth factors or synthetic augmentations of the original ACL like the "dynamic intraligamentous stabilization DIS" have increasing importance. Disadvantages of the mentioned techniques are the limited indications and the high need of material. That led us to the development of the "transosseous ACL refixation and biological augmentation TARBA", in which the original ACL is refixed to the femoral insertion and augmented with the patient’s doubled gracilis tendon. In the following we will present the first results with this technique.

Materials and Methods:

From 12/2013 to 02/2015 we used this technique in 56 patients (28x m, 28x f, age 30.7years). All patients had ACL tears in the proximal third close to the femoral insertion. The original ACL was fixed arthroscopically with 2 PDS fibres. Those were pulled out of the femur through a 5mm channel. The original-ACL was augmented with a doubled ipsilateral gracilis tendon. This tendon graft was pulled into the joint via another tibial 5mm channel and fixed at the femur with an endobutton and at the tibia with a cortical anchor screw. Both channels were placed exactly adjacent to the centre of the femoral and tibial anatomic insertion sites. The treatment result was controlled after 3, 6, 9 and 12 months with clinical examination and various scores (patient satisfaction, VAS, Lysholm, Tegner, Activity Rating Scale). After 6 months an instrumented stability test (Rolimeter) was performed. All patients were matched with 47 patients who had a complete ACL tear treated with 4-strand stemitendinosus tendon (control group).

Results:

Until now all patients with "TARBA" were satisfied with their operation. The range of motion was equal to the healthy side. Anterior-posterior stability in the Lachman test was equal to the healthy side. Rolimeter-test after 6 months showed an average side difference of less than 1mm. The Pivot-Shift test was 1x positiv in 3 patients. WE had to do 3 revisions (1x traumatic Re-tear, 1x traumatic meniscal tear, 1x limited range of extension). Compared with the control group with complete ACL replacements there was no sicnificant difference in the various scores.

Conclusion:

With "TARBA" the original ACL can be preserved. For augmentation only a rather thin tendon in small channels is "wasted". This new technique shows excellent subjective and objective results within the follow-up period we overlook. If we can prove these findings during the follow-up to come this technique to preserve the native ACL will enlarge the range of treatment options in ACL surgery significantly.
A Comparative Study of Estimation of lower Limb alignment by Physical Examination versus Lower Leg Radiography Measurements
Authors: Yilmaz Tayfun , Niemeyer Philipp , Südkamp Norbert P. , Mayer Sybille , Glaser Franziska
Published: March 2016

Aims and Objectives:

Alignment of the lower limb is a key parameter in the diagnostics and treatment concepts of osteoarthritis, in the treatment of cartilage defects and in ligamentous instabilities. The purpose of this study was to evaluate the relevance of the physical examination in direct comparison to radiographic examination in determination of the mechanical axis of the lower extremities.

Materials and Methods:

A total of 92 Patient with different pathologies of the knee joint have been included. (Male: n=60, Female: n=32; overall BMI 26,7 kg/m2). The physical Examination of the mechanical axis was determined by two independent examiners (orthopaedic surgeons) by clinical estimation using a goniometer. The radiographic measurement of the mechanical axis was performed on full weight-bearing whole Radiographs accordning to the recommendations given by Pauwels and Moreland. All variables failed test for normal distribution, so that Spearman’s ratio and for inter observer reliability Kendall’s tau was performed. For all statistical tests, SPSS was used for statistics. P-values < 0.05 were considered statistical significant.

Results:

The physical examination has a relevant variance to radiographic determination of the lower limb axis. In comparison to the control (radiographic evaluation), a misinterpretation of 3 degrees or more has been found in 30 % of the physical measurements in the overall study group, while in the subgroup of obese patients (BMI > 30kg/m2) the number of miscalculations increased to 44 %(p<0,05). In addition, a moderate correlation was found between the two independent investigators (r=0,61; p<0,001). Resulting in a low inter observer reliability. Higher degree of malalignment was found to correlate with inferior correlation factors between clinical and radiographic evaluation, while best correlation factors were found in the subgroup of patients without significant malalignment (Percentage of Misinterpretation 5 %). This percentage was significantly higher in valgus (40%) and varus (36%) deformities.

Conclusion:

In conclusion the physical examination has a large insecurity compared with the lower leg radiography. Reliability depends on BMI and failure probability increases in the subgroup of obese patients. With regard to the results of the present study and against the background of the great importance of lower limb alignment in the context of surgical treatments for cartilage defects, osteoarthritis and chronic ligamentous insufficiency, the indication for radiographic evaluation of alignment of the lower limb using full weight bearing AP radiographs should be made generously.
CNS Voltage-gated Calcium Channel Gene Variation And Prolonged Recovery Following Sport-related Concussion
Authors: McDevitt Jane
Published: March 2016

Objectives:

To examine the association between concussion duration and two calcium channel, voltage-dependent, R type, alpha 1E subunit (CACNA1E) single nucleotide polymorphisms (i.e., rs35737760 and rs704326). A secondary purpose was to examine the association between CACNA1E single nucleotide polymorphisms (SNPs) and three acute concussion severity scores (i.e., vestibule-ocular reflex test, balance error scoring scale, and Immediate Post-Concussion Assessment and Cognitive Testing).

Methods:

Forty athletes with a diagnosed concussion from a hospital concussion program completed a standardized initial evaluation. Concussion injury characteristics, acute signs and symptoms followed by an objective screening (i.e., vestibular ocular assessments, balance error scoring system test, and Immediate Post-Concussion Assessment and Cognitive Testing exam) were assessed. Enrolled participants provided salivary samples for isolation of DNA. Two exon SNPs rs35737760 and rs704326 within CACNA1E were genotyped.

Results:

There was a significant difference found between acute balance deficits and prolonged recovery group (X2 = 5.66, p = 0.017). There was an association found between the dominant model GG genotype (X2 = 5.41, p = 0.027) within the rs704326 SNP and prolonged recovery group. Significant differences were identified for the rs704326 SNP within the dominant model GG genotype (p = 0.030) for VOR scores by recovery. A significant difference was found between the rs704326 SNP codominant model AA (p = 0.042) and visual memory. There was an association between acute balance deficits and prolonged recovery (X2 = 5.66, p = 0.017) for the rs35737760 SNP. No significant associations between concussion severity and genotype for rs35737760 SNP.

Conclusion:

Athletes carrying the CACNA1E rs704326 homozygous genotype GG are at a greater risk of a prolonged recovery. Athletes that reported balance deficits at the time of injury were more likely to have prolonged recovery. These polymorphisms within CACNA1E could alter the CACNA1E protein and allow for an increase of calcium leading to deficits to the granule cells within the brain.
Safety and tolerability of BAN2401 - a clinical study in Alzheimer’s disease with a protofibril selective Aβ antibody
Authors: Logovinsky Veronika , Satlin Andrew , Lai Robert , Swanson Chad , Kaplow June , Osswald Gunilla , Basun Hans , Lannfelt Lars
Published: March 2016

Background

Several monoclonal antibodies for the treatment of Alzheimer’s disease (AD) have been in development over the last decade. BAN2401 is a monoclonal antibody that selectively binds soluble amyloid β (Aβ) protofibrils.

Methods

Here we describe the first clinical study with BAN2401. Safety and tolerability were investigated in mild to moderate AD. A study design was used with staggered parallel single and multiple ascending doses, from 0.1 mg/kg as a single dose to 10 mg/kg biweekly for four months. The presence of amyloid related imaging abnormalities (ARIA, E for edema, H for hemorrhage) was assessed with magnetic resonance imaging (MRI). Cerebrospinal fluid (CSF) and plasma samples were analyzed to investigate pharmacokinetics (PK) and effects on biomarkers.

Results

The incidence of ARIA-E/H on MRI was comparable to that of placebo. BAN2401 exposure was approximately dose proportional, with a serum terminal elimination half-life of ~7 days. Only a slight increase of plasma Aβ(1-40) was observed but there were no measurable effects of BAN2401 on CSF biomarkers. On the basis of these findings Phase 2b efficacy study has been initiated in early AD.

Conclusions

BAN2401 was well-tolerated across all doses. The PK profile has guided us for selecting dose and dose regimens in the ongoing phase 2b study. There was no clear guidance for an effective dose based on biomarkers.

Trial registration number

NCT01230853 ClinicalTrials.gov Registered October 27, 2010.
Selective use of percutaneous testis biopsy to optimize IVF-ICSI outcomes: a case series
Authors: Hayden Russell P. , Wright Diane L. , Toth Thomas L. , Tanrikut Cigdem
Published: March 2016

Background

Sperm quality may degrade during transit through the male reproductive tract in some individuals. In this setting surgically retrieved testicular sperm may outperform ejaculated samples for use with in vitro fertilization (IVF) and intracytoplasmic sperm injection (IVF-ICSI). We sought to describe one center’s experience with the use of fresh testicular sperm after prior failed IVF-ICSI with ejaculated samples.

Results

A retrospective review was conducted evaluating IVF-ICSI cycles performed at a tertiary IVF unit between 2009 and 2014. Couples who were managed with percutaneous testis biopsy to obtain sperm, despite availability of ejaculated sperm, were included. Four couples who underwent a total of 6 percutaneous testis biopsy/IVF-ICSI cycles were identified. Collectively, the couples had undergone 9 prior IVF-ICSI cycles using fresh ejaculated sperm without successful pregnancy. From the six cycles that used fresh testicular sperm four live births resulted (1 twin gestation, 3 singletons). Only 1 of the 4 couples remained childless.

Conclusions

For patients who have had prior failed IVF-ICSI attempts, this small case series demonstrates a possible therapeutic benefit when freshly procured testicular sperm are used in lieu of ejaculated samples.