bluuebunny/crossref_metadata_2025 huggingface dataset:
Constitutional Economics and the Law
Authors: Voigt Stefan
Published: May 2017

The economic analysis of constitutions, also known as ‘constitutional economics’ or ‘constitutional political economy’ is a young research program. Standard economics used to focus on the analysis of choices within rules, thus assuming rules to be exogenously given and fixed. Constitutional economics broadens this research program by analyzing the choice of rules, using the established method of economics, i.e. rational choice. This article discusses the two broad research avenues in constitutional economics: the normative branch, which is interested in legitimizing the state and its most basic rules by drawing solely on the self-interest of rational individuals; and the positive branch, which is interested in explaining, firstly, the (economic) effects of alternative constitutional rules and, secondly, the emergence and modification of constitutional rules.
The “Law” and Economics of Judicial Decision-Making
Authors: Tiller Emerson H.
Published: May 2017

Over the last three decades, the economics of judicial behaviour has revealed itself most prominently in the field now known as Law and Positive Political Theory (Law and PPT). Instead of the traditional focus of ‘law and economics’ on the normative efficiency of legal rules, Law and PPT identifies the role of competition among legal and political institutions for policy outcomes, with these outcomes usually taking the form of legislative enactments, executive action, judicial opinions, or administrative agency pronouncements (regulations). This article illustrates the ‘law’ features of Law and PPT, while keeping the economics of judicial decision-making — especially the efficiency-driven, game-theoretic, utility maximization features — at the forefront of the analysis. It begins by summarizing basic elements of Law and PPT as relevant to judicial decision-making. It then discusses context-specific applications of Law and PPT where the craft of law is revealed as strategy.
Contractarian Perspectives in Law and Economics
Authors: Vanberg Georg , Vanberg Viktor
Published: May 2017

This article sketches the distinct perspective that a contractarian approach can bring to law and economics. It focuses on a particularly important strand of the contractarian tradition: the constitutional political economy (CPE) research program (also known as constitutional economics), developed most fully in the work of Nobel laureate James Buchanan. Like law and economics, the CPE paradigm is primarily concerned with the comparative analysis of social, economic, and political institutions. But its foundational assumptions offer a distinct contrast to the mainstream neoclassical paradigm that has dominated law and economics as a field. The article first provides a brief overview of contractarian approaches. It then describes the central features of the CPE paradigm. It contrasts the foundations of the CPE approach with those of neo-classical economics; explores the implications of these differences for the research foci at the heart of these two traditions; and discusses how mainstream and constitutional economics approaches may be reconciled.
Austrian Perspectives in Law and Economics
Authors: Rajagopalan Shruti , Rizzo Mario J.
Published: May 2017

This article describes and analyzes the Austrian approach to law and economics within the context of the law and economics discipline. The important and distinctive feature of the Austrian approach is the emphasis on economic and legal processes. The article focuses on four themes within the Austrian approach to law and economics: the spontaneous origin of legal institutions; the analysis of implications of ignorance, decentralization of knowledge, and static and dynamic uncertainty; the interaction between the changes in legal institutions and the market process and coordination; and entrepreneurship in market and non-market settings.
Cost–Benefit Analysis in Legal Decision-Making
Authors: Zerbe Richard O.
Published: May 2017

Benefit-cost analysis (BCA), or cost-benefit analysis, is important in policy and law. This article introduces the nature and history of BCA to provide an understanding of the development of the benefit-cost concepts, objections to the concepts, and their actual use in legal and economic practice. The term ‘benefit-cost’ is used to differentiate from the term ‘cost-benefit’ used by engineers whose approach is more mechanical than terms of efficiency used in law and economics. BCA is seen as a useful tool with some positive predictive ability in determining judge's decisions. It also appears to contribute to greater efficiency in government investment spending.
Well-Being and Public Policy
Authors: Bronsteen John , Buccafusco Christopher , Masur Jonathan
Published: May 2017

Governments rely on certain basic metrics and tools to analyze prospective laws and policies and to monitor how well their countries are doing. In the United States, cost-benefit analysis (CBA) is the primary tool for analyzing prospective policies, especially with respect to administrative regulations. Similarly, Gross Domestic Product (GDP) is perhaps the most prominent metric for monitoring a country's progress. In recent years, one of the most important developments in social science has been the emergence of psychological research measuring subjective well-being (SWB) or ‘happiness’. This article first explains the way in which SWB is measured and how those measurements have been validated. It then discusses well-being analysis (WBA), which uses happiness data to analyze prospective policies more accurately than does CBA. Next, it covers the ways in which SWB data have been used to generate prices that can be used by traditional economic analysis. This is followed by a discussion of attempts to revise CBA to deal with the limitations stemming from the fact that it uses wealth to assess the effects of policy on quality of life. Finally, the article lays out the progress made towards creating an SWB-based alternative to GDP.
Mechanism Design and the Law
Authors: Güth Werner
Published: May 2017

Mechanism design is the game theoretic jargon for institutional design and the even older tradition (in German) of ‘Ordnungspolitik’ (institutional design policy). When implementing institutions or mechanisms (or simply rules of conduct) such regulation should usually be codified by complementing the law appropriately. This article first derives and discusses legal rules as traditionally justified and implemented legally. This is then confronted with game theoretic mechanism design, relying on Dominance Solvability or the Revelation Principle. It is argued that the Revelation Principle is very useful for welfaristic or, more generally, consequentialistic explorations of what is attainable but offers no practical basis for legal mechanism design due to its unrealistic common knowledge restrictions.
Carrots vs. Sticks
Authors: Dari-Mattiacci Giuseppe , DeGeest Gerrit
Published: May 2017

This article draws a general picture of the differences between the metaphors of carrots and sticks. It discusses incentive effects (in principle, a $100 carrot creates the same incentives as a $100 stick, but there are exceptions); transaction costs (carrots are paid upon compliance, sticks upon violation, therefore sticks have lower transaction costs if the majority complies); risks (probabilistic carrots create risks for compliers, probabilistic sticks for violators); wealth and budget constraints (the maximum carrot depends on the principal's wealth, the maximum stick on the agent's wealth, but sticks can have a multiplication effect); distributive effects (carrots may overcompensate, sticks may undercompensate; individualizing sanctions changes the distributive effect of carrots but not of sticks); activity level effects caused by these distributive effects; the principal's incentives to behave opportunistically; and the agent's incentives to self-report. The article also discusses special types (precompensated, annullable, combined, intra-group financed, reversible, strict liability carrots and sticks) and two extensions (political risks, behavioural effects).
From Earlier to Later Hominins
Authors: El Zaatari Sireen , Ungar Peter S.
Published: May 2017

More than fifty years ago researchers recognised that microscopic patterns of wear on tooth enamel surfaces record information about ingestive behaviours and diets. Various methods of analysis have since been developed and applied to detect subtle dietary differences amongst extant and extinct species, and to differentiate short-term and seasonal variations in diet. This chapter provides a historical overview of methods of dental microwear analysis and their applications to non-human primates and fossil hominins. We consider in detail microwear texture analysis, wherein scanning confocal profilometry and scale-sensitive fractal analysis are used as tools for 3D characterization of microwear features. Studies employing this technique on a broad range of taxa, including hominins, attest to its efficacy, and provide insights into diets of extinct forms. We also for the first time compare microwear textures of Plio-Pleistocene species with those of Neanderthals to consider variation in diet between earlier and more recent fossil hominins.
Sport and Social Theory
Authors: Hartmann Douglas
Published: May 2017

This chapter provides an overview of how major social theories, both classical and contemporary, can help organize and enrich the historical study of sport. Classical frameworks discussed include the functionalism associated with Émile Durkheim, Max Weber’s rationalization, and the economic and capitalist critiques that originated with Karl Marx. More contemporary bodies of work include symbolic interactionism, dramaturgical and semiotic approaches, feminist and critical race theories, and the grand syntheses of Pierre Bourdieu. Throughout, it is argued that these theoretical resources reveal the socially constructed and historically contingent nature of modern sporting forms, establish the importance of situating sport in its broader social contexts, and highlight the role and significance of sport in contemporary life. The chapter concludes by suggesting that closer theoretical engagement not only improves the quality of sport history but can help bring the study of sport more to the center of all social research and cultural critique.
Sport and Political Doctrine in a Post-Ideological Age
Authors: Hoberman John
Published: May 2017

Is the familiar left–right bipolar model of the ideological spectrum still relevant to political interpretations of national sports policies in the post-Communist age? This chapter describes what some may regard as a “post-ideological,” namely, post–Cold War, political world in which governments around the world offer political rationales for the instrumental use of sport. This chapter argues that there is a political doctrine governing the professed or actual use of sport by national governments that is so widespread and fundamental that it persists independently of traditional left–right political ideologies. These policies and their goals are quite uniform across the globe. There is a modern sports-functional orthodoxy that government officials everywhere feel they must adhere to that promises elite success plus public benefits. This functionalist discourse of sport is a state-sanctioned ideology that promotes the value of sport as a resource for implementing various forms of social engineering.
Industrialization and Sport
Authors: Vamplew Wray
Published: May 2017

This chapter considers three main aspects of sport and industrialization. First, it challenges the conventional wisdom that the British Industrial Revolution was the catalyst for the development of modern sport in Britain and that subsequently Britain’s industrialization led to the cultural export of sport to the rest of the world. In doing so it critiques Guttmann’s theory of modernization in sport; unravels the various influences of industrialization, urbanization, and commercialization; and notes several different models of sport development that emerged around the world. Second, it examines the economic history of sport becoming an industry itself, looking at equipment manufacture, gate-money spectator sport, the role of the professional player, and the various objectives of the entrepreneurs involved. Finally, it considers sport in the industrial workplace, particularly the motives of employers who provided sports facilities for their workers. It emphasizes that sport was often offered to both male and female employees.
Diffusion and Empire
Authors: Dubois Laurent
Published: May 2017

This chapter seeks to grapple with the contradictory ways in which sport and empire have intersected in various historical and geographical contexts, taking as its central examples the parallel of the contrasting histories of cricket, football, and baseball, which allow for exploration both of the well-trodden story of sport in the British empire and of the story of French and US empires. The focus is on the period from 1880 to 1940, though some of the broader implications and trajectories of sport and empire are also considered. The aim is ultimately to reflect on the complex and contradictory dynamics of diffusion, paying attention both to forms of hegemony exercised by colonial powers and to the agency and visions of the colonized who decided, in a striking array of places and societies, to begin playing a small number of global sports.
Sport in China
Authors: Brownell Susan
Published: May 2017

Due to the Orientalist bias in sport history in the West, starting in the late nineteenth century, “Far Eastern civilization” was defined in terms of its lack relative to “Western civilization,” which (it was said) valued sports and created the Olympic Games. This chapter begins by outlining some of the similarities between classical Greece and China and proceeds to trace the course of China’s encounter with the West through sports up to the present. Western sports were introduced into East Asia by the YMCA, but China turned them to its own goals during Ping Pong Diplomacy. The pursuit of Olympic medals made the position of wushu (traditional martial arts) ambiguous. Inside China, hosting the 2008 Olympic Games in Beijing was called the fulfillment of a “one hundred-year dream,” symbolizing that China had finally been written into world history and was no longer defined by its sporting deficiency relative to the West.
Sport in West and North Europe
Authors: Young Christopher
Published: May 2017

This chapter examines the development of sport in one of the most significant regions in its history. It explains the institutional reasons why a truly comparative history of the continent is still lacking and presents and critiques fruitful new avenues that might lead to a more integrated picture. Its principle plaidoyer is for greater recognition of sports of non-British origin, as well as the polygenetic spread of British sports, especially in English-language scholarship. It also urges a cautious reconsideration of political and ideological narratives (of the Fascist era in particular), which have tended to reduce complex historical reality to moral truths. While the chapter places a special emphasis on the first half of the twentieth century, it outlines the three key areas of sport’s development after 1945: affluence in the West, the Cold War, and European integration. Here, too, the chapter calls on future accounts to strive for greater complexity.
Contemporary Globalization and Recent Olympic Leadership
Authors: Wenn Stephen R. , Barney Robert K.
Published: May 2017

Through the lens of contemporary globalization, this chapter examines the presidential leadership of Juan Antonio Samaranch and Jacques Rogge. Deane Neubauer’s thoughts on contemporary globalization offer a frame for examining the International Olympic Committee’s (IOC) full embrace of commercial revenue through the sale of television rights and the genesis of the Olympic Program (now Olympic Partners). Samaranch’s vision with respect to revenue generation, necessitated in large measure due to the IOC’s compromised financial circumstances in the late 1970s, transformed the organization. Globalization and its pervasive effects on the world’s economy and industry of sport were central considerations for both Samaranch and Rogge. No longer an institution that avoids commercial links for fear of their influence on the Olympic message, as was the case under the likes of Avery Brundage (1952–1972), the IOC today is staffed by skilled professionals whose focus is nurturing the Olympic brand and courting corporate executives.
WADA and Doping in World Sport
Authors: Hunt Thomas M.
Published: May 2017

Performance enhancement in sport has a long and controversial history. Although several organizations enacted prohibitions on the subject of doping prior to the Second World War, public scrutiny on the issue remained relatively light until the second half of the twentieth century. Beginning in the 1960s, officials passed a number of regulatory measures with the twin goals of protecting the health of athletes and ensuring the fairness of competitions. Due partially to the effects of Cold War political rivalries, the use of drugs by athletes nevertheless remained widespread in the world of sport. This policy situation changed dramatically with the end of the superpower conflict in 1991, however. The following decade was marked by increasingly vociferous calls for reform from outside the international governance structure for sport. In February of 1999, regulatory powers over the subject were centralized in a new organization called the World Anti-Doping Agency (WADA).
Sport and National Identity
Authors: Porter Dilwyn
Published: May 2017

This chapter explores the role of sport in the construction of national identity. It focuses initially on sport as a cultural practice possessing the demonstrable capacity to generate events and experiences through which imagined communities are made real. The governments of nation-states or other political agencies might intervene directly in this process, using sport as a form of propaganda to achieve this effect. More often, however, the relationship between sport and national identity is reproduced in everyday life, flagged daily by the mass media as an expression of banal nationalism. Particular attention is given to the role of sports that are indigenous to particular nations and also to sports engaged in competitively between nations. These have contributed in different ways to the making of national identities.
History of Sport and Religion in the United States and Britain
Authors: Koehlinger Amy
Published: May 2017

This chapter surveys scholarly writing about the intersection of religion and sport in the United States and Britain. It reviews the dominant historiography of works on religion and athletics, arguing that historians have focused primarily on clergy within Protestant traditions and the question of whether specific sports were considered licit or illicit in different places and times. This perspective occludes consideration of Catholic and other religions, the historical importance of bloodsport, and the informal nature of the interrelationship of religion and sport in daily life. The chapter also examines approaches to sport in scholarship from religious studies, highlighting the ways that scholars of religion have imagined sport as a form of religion (or “natural religion,” civil religion), often taking the perspective of the spectator and fan. The chapter concludes by exploring newer modes of analysis that explore the body as a site where religion and sport intersect.
Sport in Southern Europe
Authors: McFarland Andrew
Published: May 2017

This chapter explores how sport became intertwined with identity, politics, consumerism, and culture in Southern Europe to the extent that it is difficult to imagine modern Spain, Italy, Portugal, or Greece without it. The region houses some of the world’s most legendary football clubs and leagues, which have deep-rooted connections to the political, economic, and social histories of their cities, regions, and nations. Sports groups forged this audience within the region’s well-established cultures by connecting the activity to national, regional, and civic identities, often with the support of (or in opposition to) dictatorial or Fascist regimes. The region also boasts consistent involvement in international competitions, such as hosting six Olympic Games, highlighted by Greece’s Olympic heritage. Southern Europe’s sporting world continued to change in the last third of the twentieth century with the rise of Spanish sport and the growth of basketball throughout the region.
The Global Spread of Football
Authors: Taylor Matthew
Published: May 2017

This chapter offers new ways of conceptualizing the spread of association football across the world from the late nineteenth century. It rejects “diffusion,” a term that implies a unidirectional and uncomplicated journey and disregards the bumps and barriers that football faced and the twisted routes it actually took. Drawing instead on notions of cultural transfer, exchange, and circulation and using examples from Europe, Latin America, Africa, Asia, and Australasia, it argues that the spread of the game was frequently the result of a range of cross-cultural influences. Critiquing the assumed primacy of the British in existing accounts, this chapter also stresses the role of mobile individuals and groups and members of migrant or transnational communities in spreading the game. It suggests that the numerous and contorted paths along which the game traveled complicates the linear explanations of diffusion that have dominated nation-based histories.
Marriage Rights and Religious Exemptions in the United States
Authors: Griffin Leslie
Published: May 2017

After providing background on the law of marriage in the United States, this article examines the numerous religious exemptions—solemnization exemptions, religious-organization exemptions, commercial exemptions, Religious Freedom Restoration Act exemptions, the ministerial-exception exemption, and tax exemptions—that are currently in effect or proposed for American marriage laws. Although these exemptions are usually proposed in the name of religious liberty, over the long run their number, scope, and breadth threaten the religious neutrality that the First Amendment of the U.S. Constitution requires. Solemnization exemptions control which clergy and which government officials are allowed by states to perform marriages. Religious organization exemptions free some institutions from holding marriages they find exceptionable. Commercial exemptions threaten many limits to same-sex marriages. RFRA, ministerial exception, and tax exemptions also pose risks to equal celebration of same and opposite sex marriages.
Rehabilitation Research at the National Institutes of Health:
Authors: Frontera Walter R. , Bean Jonathan F. , Damiano Diane , Ehrlich-Jones Linda , Fried-Oken Melanie , Jette Alan , Jung Ranu , Lieber Rick L. , Malec James F. , Mueller Michael J. , Ottenbacher Kenneth J. , Tansey Keith E. , Thompson Aiko
Published: May 2017

Approximately 53 million Americans live with a disability. For decades, the National Institutes of Health (NIH) has been conducting and supporting research to discover new ways to minimize disability and enhance the quality of life of people with disabilities. After the passage of the American With Disabilities Act, the NIH established the National Center for Medical Rehabilitation Research with the goal of developing and implementing a rehabilitation research agenda. Currently, a total of 17 institutes and centers at NIH invest more than $500 million per year in rehabilitation research. Recently, the director of NIH, Dr Francis Collins, appointed a Blue Ribbon Panel to evaluate the status of rehabilitation research across institutes and centers. As a follow-up to the work of that panel, NIH recently organized a conference under the title “Rehabilitation Research at NIH: Moving the Field Forward.” This report is a summary of the discussions and proposals that will help guide rehabilitation research at NIH in the near future.

This article is being published almost simultaneously in the following six journals: American Journal of Occupational Therapy, American Journal of Physical Medicine and Rehabilitation, Archives of Physical Medicine and Rehabilitation, Neurorehabilitation and Neural Repair, Physical Therapy, and Rehabilitation Psychology. Citation information is as follows: Frontera WR, Bean JF, Damiano D, et al. Am J Phys Med Rehabil. 2017;97(4):393–403.
Anticoagulation Control in Patients With Ventricular Assist Devices
Authors: Boehme Amelia K. , Pamboukian Salpy V. , George James F. , Beasley T. Mark , Kirklin James K. , Tallaj Jose , Dillon Chrisly , Levitan Emily B. , Griffin Russell , McGwin Gerald , Hillegass William B. , Limdi Nita A.
Published: May 2017

Anticoagulation control has been associated with risk of thromboembolism and hemorrhage. Herein, we explore the relationship between anticoagulation control achieved in left ventricular assist device (LVAD) patients and evaluate the association with risk of thromboembolism and hemorrhage. Patients (19 years old or older) with a continuous flow LVAD placed from 2006 to 2012. Percent time spent in target range (PTTR) for international normalized ratio (INR) was estimated with target range of 2.0–3.0. Proportion of time spent in target range was categorized into PTTR > 60%, PTTR ≥ 50 < 60%, and PTTR < 50%. The relationship between PTTR and thromboembolism and hemorrhage was assessed. One hundred fifteen participants contributed 624.5 months of follow-up time. Only 20% of patients achieved anticoagulation control (PTTR > 60% for INR range of 2–3). After adjusting for chronic kidney disease, history of diabetes, history of atrial fibrillation, and age at implant, compared with patients with PTTR < 50%, the relative risk of thromboembolism in patients with PTTR ≥ 60% (hazard ratio [HR]: 0.37; 95% confidence interval [CI]: 0.14–0.96; p = 0.042) was significantly lower, but not for patients with a PTTR of ≥ 50 < 60% (HR: 0.21; 95% CI: 0.02–1.82; p = 0.16). The relative risk for hemorrhage was also significantly lower among patients with a PTTR ≥ 60% (HR: 0.45; 95% CI: 0.21–0.98; p = 0.045), but not among those with PTTR of ≥ 50 < 60% (HR: 0.47; 95% CI: 0.14–1.56; p = 0.22). This current study demonstrates that LVAD patients remain in the INR target range an average of 42.9% of the time. To our knowledge, this is the first report with regard to anticoagulation control as assessed by PTTR and its association with thromboembolism, hemorrhage, or death among patients with ventricular assist devices (VADs).
Overuse of Health Care Services in the Management of Cancer
Authors: Baxi Shrujal S. , Kale Minal , Keyhani Salomeh , Roman Benjamin R. , Yang Annie , Derosa Antonio P. , Korenstein Deborah
Published: May 2017

Background:

Overuse, the provision of health services for which harms outweigh the benefits, results in suboptimal patient care and may contribute to the rising costs of cancer care. We performed a systematic review of the evidence on overuse in oncology.

Methods:

We searched Medline, EMBASE, the Cochrane Library, Web of Science, SCOPUS databases, and 2 grey literature sources, for articles published between December 1, 2011 and March 10, 2017. We included publications from December 2011 to evaluate the literature since the inception of the ABIM Foundation’s Choosing Wisely initiative in 2012. We included original research articles quantifying overuse of any medical service in patients with a cancer diagnosis when utilizing an acceptable standard to define care appropriateness, excluding studies of cancer screening. One of 4 investigator reviewed titles and abstracts and 2 of 4 reviewed each full-text article and extracted data. Methodology used PRISMA guidelines.

Results:

We identified 59 articles measuring overuse of 154 services related to imaging, procedures, and therapeutics in cancer management. The majority of studies addressed adult or geriatric patients (98%) and focused on US populations (76%); the most studied services were diagnostic imaging in low-risk prostate and breast cancer. Few studies evaluated active cancer therapeutics or interventions aimed at reducing overuse. Rates of overuse varied widely among services and among studies of the same service.

Conclusions:

Despite recent attention to overuse in cancer, evidence identifying areas of overuse remains limited. Broader investigation, including assessment of active cancer treatment, is critical for identifying improvement targets to optimize value in cancer care.
Renal Function Follow-Up and Renal Recovery After Acute Kidney Injury in Critically Ill Children*
Authors: Hessey Erin , Ali Rami , Dorais Marc , Morissette Geneviève , Pizzi Michael , Rink Nikki , Jouvet Philippe , Lacroix Jacques , Phan Véronique , Zappitelli Michael
Published: May 2017

Objectives:

To evaluate factors associated with renal recovery from acute kidney injury in critically ill children and the extent to which serum creatinine is measured before discharge.

Design:

Retrospective cohort study.

Setting:

Two PICUs at tertiary centers in Montreal, QC, Canada.

Patients:

Children (< 18 yr old) admitted to the PICU between 2003 and 2005. Patients with end-stage renal disease, no healthcare number, died during admission, or admitted postcardiac surgery were excluded.

Interventions:

None.

Measurements and Main Results:

Acute kidney injury was defined using internationally accepted criteria (Kidney Disease: Improving Global Outcomes). Two renal recovery outcomes commonly used in the literature were evaluated: hospital discharge serum creatinine less than 1.5 and less than 1.15 times baseline. Proportions of patients with 1) serum creatinine measurements between PICU and hospital discharge and 2) renal recovery were calculated. Univariate and multivariate analyses were performed to determine factors associated with serum creatinine monitoring and nonrecovery after acute kidney injury. Of 2,033 patients included, 829 (40.8%) had serum creatinine measurements between PICU and hospital discharge. The odds of having a discharge serum creatinine measurement increased with acute kidney injury severity (stages 1, 2, 3 adjusted odds ratio [95% CI]: 1.49 [1.03–2.15], 2.52 [1.40–4.54], 7.87 [3.16–19.60], respectively). Acute kidney injury recovery was 92.5% when defined as serum creatinine less than 1.5 times baseline versus 75.9% when defined as less than 1.15 times baseline (p < 0.001). Stage 3 acute kidney injury was associated with having a discharge serum creatinine greater than or equal to 1.5 times baseline (adjusted odds ratio = 3.51 [1.33–9.19]).

Conclusions:

Less than half the PICU population had serum creatinine measured before hospital discharge. More severe acute kidney injury was associated with higher likelihood of serum creatinine monitoring and lower probability of acute kidney injury recovery. Future research should address knowledge translation on post-PICU acute kidney injury follow-up before hospital discharge.
Making Psychotherapy Great Again?
Authors: PLAKUN ERIC M.
Published: May 2017

Psychotherapy never stopped being as “great” as other treatments. This column explores the evidence base for both psychotherapy and medications, using depression as a specific example. The limitations are comparable for psychotherapy and medication, with much of the evidence based on small degrees of “statistically significant” rather than “clinically meaningful” change. Our field’s biomedical emphasis leads to a false assumption that most patients present with single disorders, when comorbidity is the rule rather than the exception. This false assumption contributes to limitations in the evidence base and in our ability to treat patients optimally.
Overcoming Barriers to Initiating Medication-assisted Treatment for Heroin Use Disorder in a General Medical Hospital: A Case Report and Narrative Literature Review
Authors: HASSAMAL SAMEER , GOLDENBERG MATTHEW , ISHAK WAGUIH , HAGLUND MARGARET , MIOTTO KAREN , DANOVITCH ITAI
Published: May 2017

Deaths due to heroin overdoses are increasing and are the leading cause of death among intravenous heroin users. Although medication-assisted treatment (MAT) improves morbidity and mortality in patients with opioid use disorders, it is underutilized. Most efforts to expand access to MAT have focused on outpatient settings. Although the inpatient medical setting presents a critical opportunity to initiate treatment, general hospitals are often unfamiliar with MAT, creating a number of barriers to its use. In this report, we describe the case of a woman with heroin use disorder who was initiated on buprenorphine maintenance treatment while hospitalized for cardiac disease related to her intravenous heroin use. Barriers to initiating buprenorphine in this case included patient, practitioner, and organizational factors, and, ultimately, shared misperceptions about the feasibility of administering buprenorphine in a general medical hospital. These barriers were addressed, buprenorphine was initiated, and the patient demonstrated reduced craving, improved postoperative pain control, improved overall well-being, increased engagement in discharge planning, and acceptance of referral for addiction specialty aftercare. Our experience with this patient suggests that it is feasible to initiate buprenorphine in acute medical settings and that such treatment can improve patient outcomes. Our review of the literature reveals emerging evidence supporting the value of this practice.
Transient thresholding: a mechanism enabling non-cooperative transcriptional circuitry to form a switch
Authors: Aull K. H. , Tanner E. , Thomson M. , Weinberger L. S.
Published: May 2017

Threshold generation in fate-selection circuits is often achieved through deterministic bistability, which requires cooperativity (i.e., nonlinear activation) and associated hysteresis. However, the Tat positive-feedback loop that controls HIV’s fate decision between replication and proviral latency lacks self-cooperativity and deterministic bistability. Absent cooperativity, it is unclear how HIV can temporarily remain in an off state long enough for the kinetically slower epigenetic silencing mechanisms to act— expression fluctuations should rapidly trigger active positive feedback and replication, precluding establishment of latency. Here, using flow cytometry and single-cell imaging, we find that the Tat circuit exhibits a transient activation threshold. This threshold largely disappears after ∼40 hours—accounting for the lack of deterministic bistability—and promoter activation shortens the lifetime of this transient threshold. Continuous differential equation models do not recapitulate this phenomenon. However, chemical reaction (master equation) models where the transcriptional transactivator and promoter toggle between ‘inactive’ and ‘active’ states can recapitulate the phenomenon since they intrinsically create a single-molecule threshold transiently requiring excess molecules in the ‘inactive’ state to achieve at least one molecule (rather than a continuous fractional value) in the ‘active’ state. Given the widespread nature of promoter toggling and transcription factor modifications, transient thresholds may be a general feature of inducible promoters.
African nonhuman primates are infected with the yaws bacteriumTreponema pallidumsubsp.pertenue
Authors: Knauf Sascha , Gogarten Jan F. , Schuenemann Verena J. , De Nys Hélène M. , Düx Ariane , Strouhal Michal , Mikalová Lenka , Bos Kirsten I. , Armstrong Roy , Batamuzi Emmanuel K. , Chuma Idrissa S. , Davoust Bernard , Diatta Georges , Fyumagwa Robert D. , Kazwala Reuben R. , Keyyu Julius D. , Lejora Inyasi A. V. , Levasseur Anthony , Liu Hsi , Mayhew Michael A. , Mediannikov Oleg , Raoult Didier , Wittig Roman M. , Roos Christian , Leendertz Fabian H. , Šmajs David , Nieselt Kay , Krause Johannes , Calvignac-Spencer Sébastien
Published: May 2017

Treponema pallidumsubsp.pertenue(TPE) is the causative agent of yaws. The disease was subject to global eradication efforts in the mid 20thcentury but reemerged in West Africa, Southern Asia, and the Pacific region. Despite its importance for eradication, detailed data on possible nonhuman disease reservoirs are missing. A number of African nonhuman primates (NHPs) have been reported to show skin ulcerations suggestive of treponemal infection in humans. Furthermore antibodies againstTreponema pallidum(TP) have been repeatedly detected in wild NHP populations. While genetic studies confirmed that NHPs are infected withTPstrains, subspecies identification was only possible once for a strain isolated in 1966, pinpointing the involvement ofTPE. We therefore collected a number of recently isolated simianTPstrains and determined eight whole genome sequences using hybridization capture or long-range PCR combined with next-generation sequencing. These new genomes were compared with those of known humanTPisolates. Our results show that naturally occurring simianTPstrains circulating in three African NHP species all cluster with humanTPEstrains and show the same genomic structure as humanTPEstrains. These data indicate that humans are not the exclusive host for the yaws bacterium and that a One Health approach is required to achieve sustainable eradication of human yaws.
PBxplore: a tool to analyze local protein structure and deformability with protein Blocks
Authors: Barnoud Jonathan , Santuz Hubert , Craveur Pierrick , Joseph Agnel Praveen , Jallu Vincent , de Brevern Alexandre G. , Poulain Pierre
Published: May 2017

Proteins are highly dynamic macromolecules. A classical way to analyze their inner flexibility is to perform molecular dynamics simulations. In this context, we present the advantage to use small structural prototypes, namely the Protein Blocks (PBs). PBs give a good approximation of the local structure of the protein backbone. More importantly, by reducing the conformational complexity of protein structures, they allow analyzes of local protein deformability which cannot be done with other methods and had been used efficiently in different applications. PBxplore is a suite of tools to analyze the dynamics and deformability of protein structures using PBs. It is able to process large amount of data such as those produced by molecular dynamics simulations. It produces various outputs with text and graphics, such as frequencies, entropy and information logo. PBxplore is available athttps://github.com/pierrepo/PBxploreand is released under the open-source MIT license.
Recreational Sporting Activity Vehicle‐Related Deaths
Authors: Prahlow Samuel P. , Renner Andrew , Grande Abigail J. , deJong Joyce , Prahlow Joseph A.
Published: May 2017

Deaths occurring in the setting of nonprofessional, vehicle‐related, recreational sporting activities occurring on land or in water during warm or winter months represent a diverse group of cases. These deaths tend to involve scenarios where the participants are purposefully attempting to enjoy themselves prior to experiencing sudden, catastrophic accidents resulting in lethal outcomes. Ultimately, many of the deaths are related to the high speed at which these vehicle‐related activities normally occur. Three broad categories of factors may play contributory roles in death: human factors, vehicle factors, and environmental factors. A series of selected cases are presented, representing examples of varying activity types, involving motorized and nonmotorized vehicles, land and water activities, and warm weather and cold weather environments. For each case, the various human, vehicle and environmental factors believed to be contributory to the accident are considered, and strategies for prevention of these and similar deaths involving recreational sporting vehicles are presented.
Why Do People Choose Emergency and Urgent Care Services? A Rapid Review Utilizing a Systematic Literature Search and Narrative Synthesis
Authors: Coster Joanne E. , Turner Janette K. , Bradbury Daniel , Cantrell Anna
Published: May 2017

Objectives

Rising demand for emergency and urgent care services is well documented, as are the consequences, for example, emergency department (ED) crowding, increased costs, pressure on services, and waiting times. Multiple factors have been suggested to explain why demand is increasing, including an aging population, rising number of people with multiple chronic conditions, and behavioral changes relating to how people choose to access health services. The aim of this systematic mapping review was to bring together published research from urgent and emergency care settings to identify drivers that underpin patient decisions to access urgent and emergency care.

Methods

Systematic searches were conducted across Medline (via Ovid SP), EMBASE (via Ovid), The Cochrane Library (via Wiley Online Library), Web of Science (via the Web of Knowledge), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; via EBSCOhost). Peer‐reviewed studies written in English that reported reasons for accessing or choosing emergency or urgent care services and were published between 1995 and 2016 were included. Data were extracted and reasons for choosing emergency and urgent care were identified and mapped. Thematic analysis was used to identify themes and findings were reported qualitatively using framework‐based narrative synthesis.

Results

Thirty‐eight studies were identified that met the inclusion criteria. Most studies were set in the United Kingdom (39.4%) or the United States (34.2%) and reported results relating to ED (68.4%). Thirty‐nine percent of studies utilized qualitative or mixed research designs. Our thematic analysis identified six broad themes that summarized reasons why patients chose to access ED or urgent care. These were access to and confidence in primary care; perceived urgency, anxiety, and the value of reassurance from emergency‐based services; views of family, friends, or healthcare professionals; convenience (location, not having to make appointment, and opening hours); individual patient factors (e.g., cost); and perceived need for emergency medical services or hospital care, treatment, or investigations.

Conclusions

We identified six distinct reasons explaining why patients choose to access emergency and urgent care services: limited access to or confidence in primary care; patient perceived urgency; convenience; views of family, friends, or other health professionals; and a belief that their condition required the resources and facilities offered by a particular healthcare provider. There is a need to examine demand from a whole system perspective to gain better understanding of demand for different parts of the emergency and urgent care system and the characteristics of patients within each sector.
Association of Anticipated and Laboratory‐Derived Alcohol Stimulation, Sedation, and Reward
Authors: Fridberg Daniel J. , Rueger Sandra Y. , Smith Patrick , King Andrea C.
Published: May 2017

Background

Laboratory alcohol challenges are the “gold standard” for obtaining accurate measurements of subjective alcohol stimulation, sedation, and reward. However, these approaches are time and resource intensive. This study examined the extent to which self‐reported anticipated alcohol stimulation, sedation, and reward corresponded with those same responses measured with the Biphasic Alcohol Effects Scale (BAES), Brief‐BAES (B‐BAES), and Drug Effects Questionnaire (DEQ) during a controlled laboratory alcohol challenge.

Methods

Participants were 106 light‐to‐heavy social drinkers (58.5% male; mean ± SD age = 35.8 ± 3.2 years) who completed the Anticipated BAES and DEQ, as well as laboratory‐derived versions of these scales 30 and 60 minutes after consuming placebo and 0.8 g/kg alcohol on separate days as part of laboratory sessions in the Chicago Social Drinking Project.

Results

Anticipated BAES/B‐BAES and Anticipated DEQ alcohol effects were strong predictors of their corresponding laboratory‐derived responses during both the rising limb and at peak breath alcohol concentrations. Effects were significant even when accounting for age, sex, past‐month heavy drinking frequency, and laboratory session order (placebo or alcohol first).

Conclusions

This study provides strong preliminary support for measuring anticipated alcohol effects with the Anticipated BAES/B‐BAES and Anticipated DEQ as a proxy of subjective responses experienced during a controlled laboratory alcohol challenge. The findings lend support for these measures as viable alternatives to other anticipatory scales when laboratory‐derived alcohol response measurement is not feasible.
Aripiprazole Suppression of Drinking in a Clinical Laboratory Paradigm: Influence of Impulsivity and Self‐Control
Authors: Anton Raymond F. , Schacht Joseph P. , Voronin Konstantin E. , Randall Patrick K.
Published: May 2017

Background

Aspects of impulsivity have been implicated in the development, or maintenance, of alcohol use disorder (AUD). The brain dopamine system is implicated in both reward processing/memory (typically subcortical) and in brain inhibitory control mechanisms (typically cortical). Using a validated clinical laboratory paradigm, the dopamine/serotonin “stabilizing” drug, aripiprazole was evaluated in non‐treatment‐seeking AUD individuals based on their level of impulsivity/self‐control.

Methods

Ninety‐nine individuals (77% male; mean age 27; 7.5 drinks per day; 83% heavy drinking days) meeting DSM‐IV criteria for alcohol dependence were randomized to aripiprazole (N = 47 evaluable) or placebo (N = 48 evaluable) based on their Barratt Impulsiveness Scale (BIS‐11) score (above or below 68). Aripiprazole, or similar placebo, was titrated to 15 mg over 8 days. Drinking was recorded over 6 days under natural conditions. On Day 8, after 1 day of required abstinence, individuals participated in a bar laboratory paradigm that included a priming drink (breath alcohol concentration [BAC] target 0.02 to 0.03 g/dl) and free‐choice consumption of up to 8 drinks (max BAC 0.1 g/dl) in exchange for a “bar credit” of $2 per drink (max $16). End points were drinks per day under natural conditions and drinks consumed in the bar laboratory after the priming drink.

Results

There was no significant main effect of aripiprazole or interaction with BIS‐11 score during the natural drinking period. However, there was a main effect of aripiprazole on bar laboratory drinking (p = 0.04) and aripiprazole reduced the total number of drinks consumed more among individuals with low self‐control (p = 0.034) and increased latency to consume those drinks (p = 0.045) more among those with high impulsivity. Relative to placebo, aripiprazole caused more side effects and increased alcohol‐induced sedation, but neither significantly influenced its interaction with impulsivity/self‐control scores on drinking.

Conclusions

This paradigm forced a choice between immediate drinking reward and delayed monetary reward. In those with high impulsivity and/or low self‐control, aripiprazole shifts the balance away from immediate drinking toward a later reward. Medications targeting cortical dopamine/serotonin balance might show clinical benefit of reduced drinking, among individuals with impulsivity/low self‐control.