bluuebunny/crossref_metadata_2025 huggingface dataset:
Sleep and stroke
Authors: Dyken Mark Eric , Im Kyoung Bin , Richerson George B. , Lin-Dyken Deborah C.
Published: June 2017

The study of stroke and sleep is in its infancy, as exemplified by the fact that polysomnography (PSG) has only recently been used to help confirm that obstructive sleep apnea (OSA) is a stroke risk factor. There is a strong association between stroke and sleep problems, as stroke can cause, and also may result from, some sleep disorders. Symptoms of OSA, the most frequent and dangerous sleep problem associated with stroke, often suggest other primary sleep disorders. OSA should be the first concern, and, if diagnosed, positive airway pressure (PAP) and positional therapies are first-line treatments. If OSA is ruled out, good sleep hygiene through cognitive–behavioral techniques (cognitive, sleep restriction, stimulus control, and progressive relaxation therapies) are often recommended, as stroke patients are prone to the adverse effects of medications routinely used for sleep problems.
National Databases for Neurosurgical Outcomes Research: Options, Strengths, and Limitations
Authors: Karhade Aditya V , Larsen Alexandra M G , Cote David J , Dubois Heloise M , Smith Timothy R
Published: June 2017

BACKGROUND

Quality improvement, value-based care delivery, and personalized patient care depend on robust clinical, financial, and demographic data streams of neurosurgical outcomes. The neurosurgical literature lacks a comprehensive review of large national databases.

OBJECTIVE

To assess the strengths and limitations of various resources for outcomes research in neurosurgery.

METHODS

A review of the literature was conducted to identify surgical outcomes studies using national data sets. The databases were assessed for the availability of patient demographics and clinical variables, longitudinal follow-up of patients, strengths, and limitations.

RESULTS

The number of unique patients contained within each data set ranged from thousands (Quality Outcomes Database [QOD]) to hundreds of millions (MarketScan). Databases with both clinical and financial data included PearlDiver, Premier Healthcare Database, Vizient Clinical Data Base and Resource Manager, and the National Inpatient Sample. Outcomes collected by databases included patient-reported outcomes (QOD); 30-day morbidity, readmissions, and reoperations (National Surgical Quality Improvement Program); and disease incidence and disease-specific survival (Surveillance, Epidemiology, and End Results-Medicare). The strengths of large databases included large numbers of rare pathologies and multi-institutional nationally representative sampling; the limitations of these databases included variable data veracity, variable data completeness, and missing disease-specific variables.

CONCLUSION

The improvement of existing large national databases and the establishment of new registries will be crucial to the future of neurosurgical outcomes research.
The Nature of a Buddhist Path
Authors: Finnigan Bronwyn
Published: June 2017

Is there a “common element” in Buddhist ethical thought from which one might rationally reconstruct a Buddhist normative ethical theory? Many construe this as the question Which contemporary normative theory does Buddhist ethics best approximate: consequentialism or virtue ethics? This essay argues that two distinct evaluative relations underlie these positions: an instrumental and a constitutive analysis. This chapter raises some difficulties for linking these distinct analyses to particular normative ethical theories but gives reasons to think that both may be justified as meta-ethical grounds for rationally reconstructing Buddhist thought as an ethical theory. It closes with some reflections on the complexity involved in trying to establish a single and homogeneous position on the nature of Buddhist ethics.
WINGO Politics
Authors: Olcott Jocelyn
Published: June 2017

This chapter examines the organizational and geopolitical rivalries that gave rise to IWY. It considers how long-simmering ideological tensions between the International Council of Women (ICW) and the Women’s International Democratic Federation (WIDF)—dubbed WINGOs (women’s international non-governmental organizations)—fostered competing visions for IWY. While the WIDF and its allies saw IWY as linking women’s issues with human rights, their Cold War rivals linked IWY humanitarian concerns and development strategies. Australia provides a case study of the growing rift in civil society between WINGOs and feminists and the tensions between those working within the rules of the game to those who wanted to change the game entirely. The chapter examines the Australian case to demonstrate the ways that IWY highlighted generational differences, particularly between younger women’s liberationists and older, more establishmentarian activists.
Opening Acts
Authors: Olcott Jocelyn
Published: June 2017

This chapter focuses on two events that preceded the IWY intergovernmental conference and NGO tribune: a “journalists’ encounter” and a seminar on women in development. The journalists’ encounter was organized by the UN’s information agency, which sponsored Third World media fellows and invited scores of other journalists to discuss media coverage of women, an issue of considerable interest among feminist activists and IWY planners. The development seminar was sponsored by the US Agency for International Development (USAID) via the American Association for the Advancement of Science and focused on crafting development strategies that would improve rather than diminish women’s status. Discussions included women’s access to credit, recognition of women’s uncommodified subsistence labors, and greater attention to local priorities and solutions. The chapter explores how these two issues intersected as Third World intellectuals protested against Western domination of media representations, echoing feminist concerns about male-dominated mass communications media.
“This Is an Illegitimate Delegation”
Authors: Olcott Jocelyn
Published: June 2017

This chapter focuses on a protest at the US embassy in which women of color, particularly Wynta Boynes of the Congress of Racial Equality (CORE) and Esther Urista of La Raza Unida, protested that the US delegation to the intergovernmental conference was insufficiently representative of US women. The episode signals the ways in which, in the wake of the US civil rights movement, race had emerged as the principal gauge of representation and identification. US delegation leaders claimed the confrontation as a victory, indicating that it demonstrated a “free and uninhibited exchange” and offered “an impressive and persuasive example of U.S. participatory democracy at work.
The First Rule of Fight Club
Authors: Olcott Jocelyn
Published: June 2017

Although the NGO tribune had been fashioned as the free-wheeling counterpart to the more protocol-bound intergovernmental conference, it did have one rule: no one was authorized to represent the tribune. However, by the conference’s mid-point, many tribune-goers, particularly those who had joined the Feminist Caucus, grew frustrated that they did not have a say in the government proceedings. The Feminist Caucus renamed itself United Women of the Tribune and sent a delegation led by Betty Friedan to submit proposed amendments to the IWY World Plan of Action. Other groups emerged to challenge the United Women’s authority to represent the tribune to the conference.
Coming Out Party
Authors: Olcott Jocelyn
Published: June 2017

This chapter centers on one of the few moments when sexuality emerged as a particular topic of discussion, after an Australian tribune participant, Laurie Bebbington, identified herself as a lesbian feminist. Her intervention inspired lesbian participants at the NGO tribune to hold a series of forums on the importance of sexual recognition. Critics insisted on a zero-sum game in which a host of rights loosely related to sexuality—especially for lesbians, sex workers, and those seeking reproductive autonomy—were seen as coming at the expense of human rights and economic justice in the Third World. Some observers saw IWY as a Trojan horse that smuggled in unacceptable sexual freedoms.
Graded Modality
Authors: Lassiter Daniel
Published: June 2017

This book explores graded expressions of modality, a rich and underexplored source of insight into modal semantics. Studies on modal language to date have largely focussed on a small and non-representative subset of expressions, namely modal auxiliaries such as must, might, and ought. Here, Daniel Lassiter argues that we should expand the conversation to include gradable modals such as more likely than, quite possible, and very good. He provides an introduction to qualitative and degree semantics for graded meaning, using the Representational Theory of Measurement to expose the complementarity between these apparently opposed perspectives on gradation. The volume explores and expands the typology of scales among English adjectives and uses the result to shed light on the meanings of a variety of epistemic and deontic modals. It also demonstrates that modality is deeply intertwined with probability and expected value, connecting modal semantics with the cognitive science of uncertainty and choice.
The meaning of kinship terms
Authors: Wierzbicka Anna
Published: June 2017

This chapter seeks to portray the meanings of some basic kin terms in English and some other European languages in a new way, holding on to two principles: that all the meanings one posits have to be open to intuitive verification by ordinary native speakers, and that the meanings posited for individual kin words should ‘add up’ to a coherent overall picture. To achieve this, the chapter aims at an account which could make sense in a developmental as well as cross-linguistic perspective: there must be some imaginable developmental progression from the meanings of children’s kin words such as mummy and daddy to the meanings of kin terms hypothesized as operating in adult speech. The chapter shows that semantic components phrased in the Natural Semantic Metalanguage (NSM) allow us to ‘reconstruct’ such a progression in a way which is both rigorous and testable and which makes sense to ordinary speakers, including language learners.
Pausanias’ Arcadia between Conservatism and Innovation
Authors: Baleriaux Julie
Published: June 2017

The vivid survival of traditional features in Arcadian religion under the early Roman Empire is striking. Despite the brutal conquest of Rome and the intrusiveness of its administration, cities were able to keep their most peculiar religious characteristics alive. This chapter investigates this seemingly uninterrupted religious continuity despite remarkable political change. In line with the studies of Alcock and more recently Spawforth, it aims to show that the attitude of Rome towards Hellenism, and in particular the antiquarian attitude to religion it promoted, triggered a cascade of changes in the human, social, economic, political, and religious landscape of Greece. The apparent conservatism of Arcadian religion during that period was not principally ‘resistance’—in the sense of asserting a distinct Greek identity through religion—but was rather largely promoted by the Romans themselves.
Scandalous Maps in Aeschylean Tragedy
Authors: Suksi Aara
Published: June 2017

In Homeric epic, describing a map of the world, like epic song itself, is a privilege granted by the divine Muses and figured in Hephaestus’ shield-making. In two examples from Aeschylean tragedy, a defiant hero appropriates the map-making prerogative of the gods established in Homeric epic. In each case, in a bid to restructure the existing order, the hero lays claim to the divine ability to map the space of the world without invoking the Muses. In Prometheus Bound, Prometheus’ gift of a map to mortal Io is not just an altruistic favour. It is also a part of his strategy for controlling and directing the future in a way that will ultimately lead to his own liberation. In Agamemnon, Clytemnestra uses Hephaestus’ fire to map space instantaneously. Her control of the god’s technology is aligned with her scandalous power over every other aspect of the action of the play.
Spectral continuity, amplitude changes, and perception of length contrasts
Authors: Kawahara Shigeto , Pangilinan Melanie
Published: June 2017

Japanese displays a singleton/geminate contrast in obstruents and nasals, but not in glides. Patterns of emphatic gemination show that Japanese avoids creating new nasal geminates. This chapter tests hypotheses about why Japanese shows these preferences. Concerning the distinction between obstruent geminates and sonorant geminates, dispreference of sonorant geminates may exist because these geminates are easily confused with corresponding singletons. This confusability problem arises because sonorants are spectrally continuous with flanking vowels, and consequently perception of their constriction durations is difficult. Two non-speech perception experiments show that length distinctions of consonant intervals that are spectrally continuous with surrounding segments are difficult to perceive. Concerning the difference between nasal geminates and glide geminates, two further non-speech experiments show that amplitude changes facilitate discrimination and categorization of short/long contrasts. Overall, the results of the four perception experiments reported here accord well with the cross-linguistic phonological patterning of geminates.
Thinking Historically/Thinking Analytically
Authors: Garber Daniel
Published: June 2017

This chapter contrasts the treatment of the passions in certain historical figures (Descartes, Spinoza, Malebranche) with their treatment in contemporary analytic philosophy. When introduced into analytic philosophy in the twentieth century, the theory of the passions was taken to be a coherent and self-contained philosophical domain, with its own problems and its own theories. This is contrasted with the historical figures treated, where the passions are subordinated to larger philosophical programmes. And so Descartes’ account is intended to be a theory of the passions (and a morality) for a specifically Cartesian man, the unity of a mind and a mechanical body; for Spinoza and Malebranche, the theory of the passions is closely connected with the project of attaining Beatitude (Spinoza) or reuniting with God (Malebranche).
The Relevance of the Logical Method for Hegel’s Practical Philosophy
Authors: Nuzzo Angelica
Published: June 2017

This chapter examines the relevance of the “absolute method” developed in Hegel’s Science of Logic for his practical philosophy or philosophy of objective spirit. It argues, first, that the fruitfulness and vitality of Hegel’s practical philosophy as a whole depends in a fundamental way on two conditions, namely, (i) on its being conceived as part of a system of philosophy, and (ii) on its being based on the logic as the first part of the system. It argues, second, that the “absolute method” with which Hegel concludes the Logic presents the structure of a “logic of action.” It follows that since the Science of Logic itself is developed on the basis of the method, the logic is the foundational part of Hegel’s practical philosophy. Ultimately, the chapter contends that this is Hegel’s transformation and radicalization of Kant’s claim of the primacy of practical reason.
Hegel on Crime and Punishment
Authors: Brooks Thom
Published: June 2017

This chapter offers a systematic reading of Hegel’s comments about punishment in his philosophical system with careful attention to his Philosophy of Right. It argues that the conventional reading, which claims his theory of punishment is mostly confined to the section Abstract Right, raises interpretive difficulties. One problem is the inadequacy of punishment as described in Abstract Right to be a complete theory of punishment. A second problem is accounting for apparent inconsistencies between what Hegel says in Abstract Right versus comments stated elsewhere in the Philosophy of Right and larger system. The chapter argues that later sections like Ethical Life matter for our understanding Hegel’s penal theory and a systematic reading of his texts can help make best sense of this and the unified theory of punishment he defends. It concludes by reflecting on the implications this reading has for our understanding Hegel’s philosophy and its contemporary appeal.
Dutch and German R-pronouns and P-stranding
Authors: Noonan Máire
Published: June 2017

This chapter explores the fine structure of R-pronouns, spatial PPs, and P-stranding constructions. The guiding hypothesis and theoretical backdrop is that an extended clausal structure is generalized to all categories, including adpositions, (P). The empirical evidence comes from a comparison of the morphosyntactic distribution of the ‘r’ in German and Dutch so-called R-pronouns (locative pronouns) and P-stranding constructions, and from complex spatial PPs in Colloquial German. The chapter argues that a comparative approach to these closely related Germanic languages warrants the decomposition of function words into parts not traditionally recognized as morphemes. The morphemes making up locative pronouns (e.g. Dutch daar ‘there’) and place adpositions (e.g. German auf ‘on’) are shown to pronounce different parts of the clausal structure. A ramification of the analysis is that P-stranding in Dutch and German is in fact the stranding of a remnant phrase that contains the R-pronoun by a projection containing the preposition.
Introduction
Authors: Eaglestone Robert
Published: June 2017

‘Which writer today is not a writer of the Holocaust?’ asked Imre Kertész, Hungarian survivor and novelist, in his Nobel acceptance lecture. He continued: one ‘does not have to choose the Holocaust as one’s subject to detect the broken voice that has dominated modern European art for decades’....
Evil
Authors: Eaglestone Robert
Published: June 2017

Evil—the Nobel laureate William Golding wrote that anyone who lived through the years of the Second World War ‘without understanding that man produces evil as a bee produces honey, must have been blind or wrong in the head’. Why, then, do accounts by Holocaust perpetrators and fictions that focus on perpetrators and which appear to teach us about evil fail to do so, swerve from the issue, and seem shallow and unproductive? By working through Hannah Arendt’s changing view of evil, this chapter develops a way to answer this question and examine the significance of evil, first in relation to texts by perpetrators (often, like Speer with Sereny, by or with proxies) then in relation to fiction about perpetrators, concluding with the most significant work of Holocaust fiction in recent years, Jonathan Littell’s The Kindly Ones.
Disorientalism Today
Authors: Eaglestone Robert
Published: June 2017

While Chapter 4 explored the benefits of using ideas from Holocaust studies to analyse a novella about a colonial genocide, this chapter analyses the risks involved in such a process. Looking at a range of texts from the 1990s to the 2010s about genocide and atrocity in Africa, and drawing on postcolonial scholarship, it suggests that there are ambiguous limitations in using the ideas taken from our readings of the literature of the Holocaust, widely defined, to understand accounts of the Rwandan genocide and other atrocities in Africa and begins to advance some concepts for reading these other accounts of genocide. The authors evaluated include, amongst others, Ishmael Beah, Gil Courtemanche, David Eggers, Uzodinma Iweala, and Paul Rusesabagina.
Conclusion
Authors: Eaglestone Robert
Published: June 2017

What good is literature? ‘Perhaps’, wrote Sebald, ‘only to help us to remember, and teach us to understand that some strange connections cannot be explained by causal logic.’1 This book has followed Kertész’s suggestion that the ‘broken voice’ of the Holocaust will remain through culture: it has also explored the role of literature in memory and analysed some of the strange links between the past and the present which shape the meaning of both. Some themes have recurred....
Reforming Democracy
Authors: Bedock Camille
Published: June 2017

When, why, and how are democratic institutions reformed? This is the broad question guiding this research, rooted in a context of declining political support in Western Europe. This book deals with the context, the motives, and the mechanisms explaining the incidence of institutional engineering in consolidated Western European democracies between 1990 and 2015. It is centred on the choice of elites to use—or not to use—institutional engineering as a response to the challenges they face. The book answers two key questions about institutional change. First, how much change to the core democratic rules can be observed over the course of the last twenty-five years, where did change take place, and at what point in time? Second, why are some reform attempts successful while others are not? The use of a wide comparison of Western European democracies over time is the central contribution of the book in tackling these two issues. This enables a development of the concept of bundles of reforms, a key analytical tool to understand institutional change in a longitudinal and comparative perspective.
The Anarchical Society and Indigenous Peoples
Authors: Keal Paul
Published: June 2017

This essay focuses on Bull’s conception of world order and its relevance to indigenous peoples. Realizing world order needs to include the specific goal of just relations between indigenous and non-indigenous peoples, which would require both mutually agreed settlements of historical injustices and engagement with indigenous notions of sovereignty that challenge traditional conceptions of it. Bull thought the ultimate units of world society are individual human beings and that the outlook for a just world order is bound up with the extension of cosmopolitan culture and moral awareness. This could have led him to defend the group rights essential to indigenous peoples. The liberal individualism in his thought prevented him from doing so and the strand of individualism in cosmopolitanism may be incompatible with indigenous aims. In practice a cosmopolitan world order might result in the further erosion of distinctive indigenous identities and cultures.
A Century of Fiscal Squeeze Politics
Authors: Hood Christopher , Himaz Rozana
Published: June 2017

Contributing to the literature on austerity, this book identifies and compares episodes of ‘fiscal squeeze’ (that is, substantial efforts to cut public spending and/or raise taxes) in the UK over a century from 1900 to 2015. It looks at how different the politics of fiscal squeeze and austerity is today from what it was a century ago, ways in which fiscal squeeze can reshape the state, leading to new ways of organizing government or providing services, and at how political credit and blame play out in the aftermath of fiscal squeeze. The analysis is both quantitative and qualitative, starting with reported financial outcomes and then looking at the political choices and processes that lie behind those outcomes to identify patterns and puzzles that have not been recognized or explained adequately so far in received theory. Thus the book identifies a long-term shift from deep but short-lived episodes of spending restraint or tax increases in the earlier part of the century towards episodes in which the pain is spread out over a longer period during the latter part of the century. It also identifies a marked reduction of revenue-led squeezes in the last part of the century. Analysing fiscal squeeze both in terms of reported outcomes and a qualitative analysis of loss imposition, political cost to incumbents and state, helps to solve a puzzle in the literature about the electoral effects of austerity and apparently erratic voter ‘punishment’ of governments that impose austerity policies.
The Leadership Capital of Italian Presidents
Authors: Grimaldi Selena
Published: June 2017

Recently, Italian presidents have become pivotal figures, deeply affecting the direction of the Italian political system, exercising influence far beyond their previous role as constitutional guardians. The aim of this chapter is to understand how Oscar Luigi Scalfaro, Carlo Azeglio Ciampi, and Giorgio Napolitano have gained and spent ever greater amounts of power. The analysis is based on the LCI approach; however, the indicators used by Bennister et al. (2015) have been adapted both to the Italian context and to ‘institutionally’ constrained leaders. The LCI allows the traceability of power over time, revealing how each president has built on others’ strengths but all have encountered similar limits: while Italian presidents can spend their capital in focused areas, too overt attempts to act politically can erode their capital by damaging their perceived neutrality and moral probity.
Religious Establishment and Public Justification
Authors: Vallier Kevin
Published: June 2017

This chapter develops a principle that determines when governmental activity constitutes an objectionable form of establishment, either religious or secular. Situated within the theory of public reason liberalism, the principle holds that non-coercive forms of establishment, such as the use of religious symbols in government, are governed by a publicly justified purpose requirement. To be permissible, the relevant governmental act must have a purpose that can be publicly justified to multiple qualified points of view. Given that few acts of establishment, religious or secular, have that purpose, this chapter concludes that public reason liberalism is generally unfriendly to non-coercive establishment.
Data and Methodology
Authors: Cruces Guillermo , Fields Gary S. , Jaume David , Viollaz Mariana
Published: June 2017

This study is based on microeconomic data from more than 150 household surveys, five million households, and eighteen million persons contained in the SEDLAC—Socio-Economic Database for Latin America and the Caribbean. These data cover the following sixteen Latin American countries: Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, El Salvador, Honduras, Mexico, Panama, Paraguay, Peru, Uruguay, and Venezuela. Based on these household surveys and the SEDLAC harmonization methodology, the study constructs comparable time series for a wide range of labour market, poverty, and income inequality indicators. It also employs aggregate macroeconomic indicators from two sources: the World Bank’s World Development Indicators and the United Nations Economic Commission for Latin America and the Caribbean’s database on social expenditure.
Conclusions from the Cross-Country Analysis
Authors: Cruces Guillermo , Fields Gary S. , Jaume David , Viollaz Mariana
Published: June 2017

In the great majority of Latin American countries in the 2000s, economic growth took place and brought about improvements in almost all labour market indicators and consequent reductions in poverty rates. Across these countries, economic growth was not all that mattered; external factors were particularly important for changes in labour market conditions, while reductions in poverty were strongly related to improvements in earnings and employment indicators. Although the 2008 crisis affected some countries differently from others, nearly all labour market indicators were at least as high or higher by 2012 than immediately before the crisis in all countries but one.
Ecuador
Authors: Cruces Guillermo , Fields Gary S. , Jaume David , Viollaz Mariana
Published: June 2017

Ecuador experienced moderate economic growth during the 2000s. The economy suffered a mild recession during the international crisis of 2008, but returned to pre-recession GDP per capita level in 2010. Most labour market indicators improved over the period. The only indicator that worsened was the employment structure by occupational position. Most labour market indicators were affected negatively by the international crisis but recovered their pre-crisis levels by 2012. The only exception was labour earnings for some employment categories. With the onset of the crisis of 2008, the poverty rate stopped falling, but it regained its downward trend from 2011 onwards.
El Salvador
Authors: Cruces Guillermo , Fields Gary S. , Jaume David , Viollaz Mariana
Published: June 2017

During the 2000s, El Salvador experienced slow economic growth for Latin American standards. The country underwent a recession during the international crisis of 2008, but returned to pre-recession output level in 2011. Changes in labour market conditions were mixed. The unemployment rate fell, and the mix of employment by occupations, economic sector, and education improved slightly. However, the employment mix by occupational position deteriorated, and the share of registered workers and earnings decreased. Most labour indicators were affected adversely by the crisis, and some have yet to return to pre-crisis levels. Most poverty and inequality indicators fell over the period.
Honduras
Authors: Cruces Guillermo , Fields Gary S. , Jaume David , Viollaz Mariana
Published: June 2017

During the 2000s Honduras grew less than the average Latin American country and labour market indicators moved, in general, in a worsening direction. The only exceptions were the reduction in the unemployment rate and the improvements in the mix of employment by occupational group and educational level. The country underwent a recession as a consequence of the international crisis of 2008, from which it had not fully recovered by 2012. Most labour market indicators were affected negatively by the crisis, and the majority of them had not recovered their pre-crisis levels by 2012. Poverty has been rising steadily since 2008.
Mexico
Authors: Cruces Guillermo , Fields Gary S. , Jaume David , Viollaz Mariana
Published: June 2017

During the 2000s Mexico grew less than the average for Latin America. Labour market indicators exhibited mixed changes, with improvements over the period for some of them and deterioration for others. While the composition of employment improved and poverty decreased, labour earnings fell and informality increased. The country was severely hurt by the international crisis of 2008, which affected in one way or another all population groups, but Mexico surpassed its pre-crisis output levels by 2012. Most labour market indicators were affected negatively by the crisis, and labour earnings and poverty indicators had not recovered their pre-crisis levels by 2012.
Peru
Authors: Cruces Guillermo , Fields Gary S. , Jaume David , Viollaz Mariana
Published: June 2017

The Peruvian economy performed exceptionally well between 2000 and 2012, with a growth performance that placed the country well above the regional average and an improvement in all labour market indicators. The chapter shows that the economy suffered a slowdown as a consequence of the international crisis of 2008, but Peru sustained positive GDP growth rates during that episode and had only a small reduction in gross domestic product per capita. The only labour market indicators impacted by the international crisis were the employment structure by educational level and the percentage of registered workers who suffered a slowdown in their improving trends.
Performance of a Modern Glucose Meter in ICU and General Hospital Inpatients: 3 Years of Real-World Paired Meter and Central Laboratory Results
Authors: Zhang Ray , Isakow Warren , Kollef Marin H. , Scott Mitchell G.
Published: June 2017

Objective:

Due to accuracy concerns, the Food and Drug Administration issued guidances to manufacturers that resulted in Center for Medicare and Medicaid Services stating that the use of meters in critically ill patients is “off-label” and constitutes “high complexity” testing. This is causing significant workflow problems in ICUs nationally. We wished to determine whether real-world accuracy of modern glucose meters is worse in ICU patients compared with non-ICU inpatients.

Design:

We reviewed glucose results over the preceding 3 years, comparing results from paired glucose meter and central laboratory tests performed within 60 minutes of each other in ICU versus non-ICU settings.

Setting:

Seven ICU and 30 non-ICU wards at a 1,300-bed academic hospital in the United States.

Subjects:

A total of 14,763 general medicine/surgery inpatients and 20,970 ICU inpatients.

Interventions:

None.

Measurements and Main Results:

Compared meter results with near simultaneously performed laboratory results from the same patient by applying the 2016 U.S. Food and Drug Administration accuracy criteria, determining mean absolute relative difference and examining where paired results fell within the Parkes consensus error grid zones. A higher percentage of glucose meter results from ICUs than from non-ICUs passed 2016 Food and Drug Administration accuracy criteria (p < 10–10) when comparing meter results with laboratory results. At 1 minute, no meter result from ICUs posed dangerous or significant risk by error grid analysis, whereas at 10 minutes, less than 0.1% of ICU meter results did, which was not statistically different from non-ICU results.

Conclusions:

Real-world accuracy of modern glucose meters is at least as accurate in the ICU setting as in the non-ICU setting at our institution.
Effect of the Learning Curve on Visual and Refractive Outcomes of Small-Incision Lenticule Extraction
Authors: Chan Tommy C. Y. , Ng Alex L. K. , Cheng George P. M. , Woo Victor C. P. , Zhang Jiamei , Wang Yan , Jhanji Vishal
Published: June 2017

Purpose:

To investigate the effect of the learning curve for small-incision lenticule extraction during the first 2 years of experience.

Methods:

Small-incision lenticule extraction was performed using the 500-kHz VisuMax femtosecond laser (Carl Zeiss Meditec) by the same surgeon. The initial 100 patients since the surgeon started operating independently were considered as group 1; the recent 100 patients were considered as group 2. The same laser settings and technique were used. The visual and refractive outcomes were compared between groups at postoperative 1 week and 6 months. Vector analysis was performed for eyes with astigmatic correction.

Results:

Two hundred right eyes of 200 patients were included. Age, preoperative corrected visual acuity, manifest refraction, and central corneal thickness were similar between groups (P ≤ 0.154). Postoperatively, the efficacy index at 1 week was better in group 2 (group 1: 0.85 ± 0.16 vs. group 2: 0.91 ± 0.10, P = 0.019) but was similar between groups at 6 months (group 1: 0.91 ± 0.14 vs. group 2: 0.94 ± 0.08, P = 0.181). The safety index was higher in group 2 at 1 week (group 1: 0.93 ± 0.10 vs. group 2: 0.95 ± 0.08, P = 0.045) and 6 months postoperatively (group 1: 0.97 ± 0.07 vs. group 2: 0.99 ± 0.03, P = 0.011). Vector analysis showed that postoperative residual astigmatism and misalignment of astigmatic correction were lower in group 2 than in group 1 (P ≤ 0.039) at 1 week and 6 months. The duration of docking and that of lenticule extraction was shorter in group 2 (P ≤ 0.034).

Conclusions:

Our study showed that faster visual recovery, better safety profile, and more accurate astigmatic correction could be attained with increasing surgical experience.
Corneal Stiffening by a Bacteriochlorophyll Derivative With Dextran and Near-Infrared Light: Effect of Shortening Irradiation Time up to 1 Minute
Authors: Brekelmans Jurriaan , Goz Alexandra , Dickman Mor M. , Brandis Alexander , Sui Xiaomeng , Wagner H. Daniel , Nuijts Rudy M. M. A. , Scherz Avigdor , Marcovich Arie L.
Published: June 2017

Purpose:

The aim of this study is to determine the effect of variation of the exposure time of near-infrared irradiation on corneal stiffening after a bacteriochlorophyll derivative (WST11) with dextran (WST-D) application.

Methods:

One hundred four paired eyes of 3-month-old New Zealand White rabbits were included in this study. Fifty-two eyes (ex vivo n = 34, in vivo n = 18) were mechanically deepithelialized, treated topically with WST-D, and irradiated at 10 mW/cm2 using a diode laser at 755 nm for 1, 5, or 30 minutes. Untreated fellow eyes served as controls. Corneoscleral rings were removed immediately after treatment (ex vivo), or 1 month after treatment (in vivo). Corneal strips were cut and underwent biomechanical stress–strain measurements.

Results:

Ex vivo, the mean tangent elastic modulus was significantly higher in the treatment groups than in the control groups for 1, 5, and 30 minutes of irradiation, respectively, 6.06 MPa, 95% confidence interval (CI, 4.5–7.6) versus 14.02 MPa, 95% CI (10.2–17.8), n = 11, 4.8 MPa, 95% CI (3.9–5.7) versus 15.03 MPa, 95% CI (12–18.1), n = 11, and 7.8 MPa, 95% CI (5.6–10.02) versus 16.2 MPa, 95% CI (13.6–18.9), n = 11; P < 0.001 for all comparisons. In vivo, the mean elastic moduli in the treatment groups were significantly higher for 5 and 30 minutes of irradiation but not for 1 minute of irradiation, respectively, 11.4 MPa, 95% CI (8.5–14.2), versus 17.1 MPa, 95% CI (14.5–19.7), n = 5; P < 0.001, and 9.4 MPa, 95% CI (5.1–13.8) versus 16 MPa, 95% CI (13.1–19), n = 5; P < 0.01, and 11.3 MPa, 95% CI (6–16.6) versus 12.2 MPa, 95% CI (7.5–16.8), n = 5; P = 0.7.

Conclusions:

WST-D/near-infrared treatment using shortened irradiation time (1 minute ex vivo and 5 minutes in vivo) results in significant corneal stiffening, and this might provide an alternative to the currently applied riboflavin/ultraviolet A cross-linking.
The Use of 5-Aminosalicylic Acid in Children and Adolescents With Inflammatory Bowel Disease
Authors: Sokollik Christiane , Fournier Nicolas , Rizzuti David , Braegger Christian P. , Nydegger Andreas , Schibli Susanne , Spalinger Johannes
Published: June 2017

Background:

In ulcerative colitis (UC) 5-aminosalicylic acid (5-ASA) is recommended as primary therapy for mild to moderate disease. Topical 5-ASA has been proven especially effective. In Crohn’s disease (CD) the evidence for a beneficial role of 5-ASA is weak. We investigated the use of topical and systemic 5-ASA therapy in children and adolescents with inflammatory bowel disease.

Materials and Methods:

Data of patients younger than 18 years, registered between April 2008 and December 2015 in the Swiss Inflammatory Bowel Disease Cohort, were analyzed.

Results:

Three hundred twenty pediatric inflammatory bowel disease patients were included; 189 with CD and 131 with UC. Over one third of UC patients [51 (39%)] received topical 5-ASA therapy and 43 (33%) received combination therapy during their disease course. UC patients with left-sided colitis or proctitis were more likely to receive topical or combination therapy as compared with patients with pancolitis (P<0.001 and <0.001, respectively). An increase in the use of topical 5-ASA therapy in UC patients was noted over time from 5% to 38%. Forty-seven percent of CD patients were treated with oral 5-ASA during their disease course. The usage was stable over time at approximately 15% to 20%.

Conclusions:

In recent years a very positive trend showing an increase in topical 5-ASA therapy in children and adolescents with UC has been observed. However topical therapy is still used with relative low frequency, especially in patients with a more extensive disease. Conversely, despite weak evidence supporting 5-ASA use in CD patients it has been frequently prescribed. Physicians should continue to encourage their UC patients to use topical therapy.
Predictors of Mortality in Cirrhosis Inpatients With Clostridium difficile Infection
Authors: Smith Elliot Z. , Northup Patrick G. , Argo Curtis K.
Published: June 2017

Background:

Clostridium difficile is a bacterial pathogen associated with significant morbidity and mortality in patients with cirrhosis.

Goals:

Our primary aim is to identify variables that are predictive of poor outcomes in cirrhosis patients with C. difficile infection (CDI). We also aim to further characterize the risk factors for developing CDI and risk of mortality in this patient population.

Study:

A total of 200 subjects with a diagnosis of cirrhosis and CDI were matched to 200 cirrhosis inpatients without CDI. The groups were compared to evaluate variables associated with decreased survival for cirrhosis inpatients with CDI as well as risk factors for developing CDI.

Results:

Cirrhosis patients with CDI were more frequently prescribed antibiotics during their hospitalization (P=0.002) and cared for in an intensive care unit (ICU) (P<0.001). Preadmission proton pump inhibitor and spontaneous bacterial peritonitis (SBP) prophylactic antibiotic use were not significantly different between the 2 cohorts. CDI subjects had an increased 30-day mortality (44% vs. 28.5%, P=0.034), however overall mortality was not significantly different (P=0.2). The multivariable logistic regression model demonstrated an increased 30-day and overall mortality in the CDI population was independently associated with albumin <3 g/dL and ICU admission.

Conclusions:

C. difficile infections are associated with a significant increase in 30-day mortality, but not overall mortality. Risk factors of ICU admission and antibiotic exposure were associated with the diagnosis of CDI in cirrhosis patients. Hypoalbuminemia and ICU admission were found to be strong predictors of increased mortality in cirrhosis patients with CDI.
Early Infections and the Risk of Irritable Bowel Syndrome
Authors: Krajicek Edward J. , Almazar Ann E. , Larson Joseph J. , Atkinson Elizabeth J. , Talley Nicholas J. , Saito Yuri A.
Published: June 2017

Goals:

The goal of this study is to evaluate the association between early life infections and subsequent adult onset irritable bowel syndrome (IBS).

Background:

Infections during adulthood are a known risk factor for adult-onset IBS. This investigation examined the role of childhood infections and infection risk factors in the development of IBS symptoms.

Study:

In total, 1010 subjects (509 outpatients with IBS, 501 matched controls) were mailed questionnaires regarding early-life infections during infancy (0 to 12 mo), toddler years (1 to 3 y), and child years (4 to 18 y). Comparisons between cases and controls were performed using logistic regression adjusting for age, gender, and somatization score.

Results:

Around 648 (64.2%) subjects responded. The median age was 51.3 years (range, 18.0 to 70.7 y) and 535 (83%) were female. Childhood (below 18 y) infections were common in cases and controls (98% vs. 98%; P=0.465), with no differences between cases and controls during infant, toddler, and child-age periods. For gastrointestinal infections experienced below 18 years, no differences were observed by infection type (bacterial, viral, or parasitic) or age group. Cases were more likely to report bronchitis by age 18 [43% vs. 25%; P=0.003; odds ratio, 1.73 (1.20-2.51)], but not other common infections. Regular antibiotic exposure was greater amongst cases (43%) than controls (30%) [P=0.09; odds ratio, 1.37 (0.96-1.96)]. The association between bronchitis and IBS case status remained significant after adjusting for antibiotic use (P=0.01).

Conclusions:

Greater early childhood gastrointestinal infections rates were not observed in adult individuals with IBS compared with adult controls. The study does not support a statistically significant link between early life infections and IBS aside from bronchitis.
Management of Eosinophilic Esophagitis Based on Pathophysiological Evidence
Authors: van Rhijn Bram D. , Bredenoord Albert J.
Published: June 2017

Over the past decades eosinophilic esophagitis (EoE) has been increasingly diagnosed, and significant progress has been made in our understanding of its pathophysiology. As EoE cannot be cured yet, treatment goals are suppression of disease activity and symptoms as well as the prevention of progression to a more severe disease phenotype. Disease-modifying treatment options can be divided into dietary therapy and immunosuppressive medications, of which topical steroids have been most investigated, yet are still prescribed off-label. In this review, we will summarize recent advances in our understanding of EoE and discuss the mechanisms of action of current treatment options, with emphasis on the role of the esophageal epithelial barrier and the effects of proton-pump inhibitors in the management of patients with EoE.
Incidental Hippocampal Hyperintensity on Diffusion-weighted MRI
Authors: Jeong Moonyoung , Jin Jaehyun , Kim Jeong Hee , Moon Yeonsil , Choi Jin Woo , Kim Hahn Young
Published: June 2017

Objectives:

Dot-like hippocampal hyperintensities (HHs) on diffusion-weighted MRI (DWI) have been reported as an interesting imaging finding of transient global amnesia (TGA) that is characterized by typical anterograde amnesia. However, we found that these dot-like HHs are occasionally seen in some patients without clinical symptoms of TGA.

Methods:

We identified 8 patients who did not show clinical symptoms of TGA, despite the presence of hippocampal lesions on DWI (No-TGA group, n=8). For the comparison group, 16 age-matched and sex-matched patients were selected from among patients who had been diagnosed with TGA (TGA group, n=16).

Results:

No significant difference was found in vascular risk factors, years of education, or underlying cognitive function between the 2 groups. More than half of the patients in each group performed preceding Valsalva-associated activities. Multiple hippocampal lesions or concomitant lesions in the cingulate gyrus were found only in the TGA group.

Conclusions:

Dot-like HHs on DWI can be observed without the typical symptoms of TGA. Valsalva maneuver–associated activities could produce asymptomatic hippocampal lesions. The symptoms of TGA may be presented on a spectrum, from no symptoms to mild vegetative symptoms or to the typical symptoms of TGA, depending on individual susceptibility.
Spectrum of Autonomic Nervous System Impairment in Sjögren Syndrome
Authors: Goodman Brent P. , Crepeau Amy , Dhawan Priya S. , Khoury Julie A. , Harris Lucinda A.
Published: June 2017

Objective:

To describe the spectrum of autonomic dysfunction in a uniformly evaluated cohort of patients with Sjögren syndrome.

Methods:

A series of 13 patients underwent a comprehensive evaluation for suspected autonomic impairment, including a neurological examination, autonomic testing, and laboratory studies. A diagnosis of Sjögren syndrome was established as the cause of autonomic dysfunction in all. Clinical features, findings on autonomic testing, and laboratory results are described.

Results:

All patients in this series reported postural lightheadedness and syncope or near-syncope. Autonomic testing confirmed the presence of orthostatic hypotension on tilt-table testing in 5 patients and an excessive postural tachycardia and/or hypertensive response in 8 patients. Only 2 of the patients with orthostatic hypotension had a significant sensory neuropathy. Symptoms suggestive of gastrointestinal and genitourinary impairment were seen in nearly all patients, with abnormal motility testing (most frequently esophageal dysmotility) in 5 of 6 patients who underwent formal testing. Patients in this series treated with immune-modulating therapy experienced significant improvement.

Conclusions:

A diagnosis of Sjögren syndrome should be aggressively pursued in patients with signs and symptoms suggestive of autonomic nervous system impairment. Although the spectrum of adrenergic failure is variable, ranging from orthostatic hypotension to an excessive postural tachycardia, most patients do have symptoms of more generalized autonomic failure. Patients who were treated with immune-modulating therapy did improve.