bluuebunny/crossref_metadata_2025 huggingface dataset:
The Court and the Charter
Authors: Delfino Massimiliano
Published: March 2017

Starting from the judgment of the Court of Justice of the European Union, Association de médiation sociale, of January 2014, this contribution deals with some important issues, such as the distinction between rights and principles protected by the Charter of Fundamental Rights, and, above all, their field of application. With reference to the latter issue, a broad interpretation of Article 51, paragraph 1, of the Charter is suggested, according to which its provisions ‘are addressed to the institutions, bodies, offices and agencies of the Union… and to the Member States only when they are implementing Union law’. Under this interpretation, the rights and principles are applicable in the formation of European Union law, regardless of the field covered by secondary legislation. With reference to the national systems, even the connection with EU law has to be understood in a broad sense, so that the rights and principles shall be respected or observed when Member States are implementing all the secondary sources of the Union and not only those relating to the legal subject to which the right or principle specifically refers.
Young and Old: Age Discrimination in Italian Case Law
Authors: Guaglianone Luciana , Ravelli Fabio
Published: March 2017

This article examines the first judgments issued by Italian courts on age-related discrimination, both against the young and the elderly. The two judgments must be welcomed insofar as they rectify the delay in Italian jurists approaching this issue, in spite of the clear signals received from the EU. While the line of reasoning may still be weak and unsatisfactory in some respects, such mistakes should be considered as unavoidable setbacks, which do not in any way diminish the importance of these decisions in the Italian context.
The Dark Side of Fundamental Rights Adjudication?
Authors: Papa Veronica
Published: March 2017

The aim of the article is to deal with the case law of the European Court of Justice in the field of fundamental social rights, with particular regard to the application of the Charter of fundamental rights.

The analysis starts from an evaluation – in the first part – of the judgment delivered by the CJEU in the case Association de médiation sociale (AMS). Then, the second part of the article explores the legal reasoning of the CJEU in other paradigmatic cases, from which is possible to infer the asymmetric interpretation of the Charter of fundamental rights, mentioned in the title. Finally, some brief reflections on the role of the CJEU in the social architecture of the European Union are proposed.
Service Provision Changes – Lessons for the Continent?
Authors: Titze Julian
Published: March 2017

In light of recent legislative reforms in the United Kingdom, this article discusses the application of the Transfer of Undertakings Regulation (TUPE) to outsourcing, re-tendering and insourcing under and beyond the Acquired Rights Directive 2001/23. The reflective British experience of creating and retaining a distinct notion of a ‘Service Provision Change’ is highly relevant for other EU Member States. Therefore, Service Provision Changes under TUPE Reg 3(1)(b) are contrasted with the notion of a ‘Directive Transfer’. An evaluation of the UK case law concludes that the notion of a Service Provision Change is not merely an extension of the Directive Transfer. Its statutory structure limits evasion conceivable under the Directive. When applied in a purposive manner, the concept of Service Provision Changes is good regulation beyond an EU Directive in that it improves legal certainty for all stakeholders and provides additional protection for employees working in labour-intensive services. Any Member State reconsidering its transfer regulation should take a close look at the British experience.
Crisis and Labour Law
Authors: Ribeiro Ana Teresa
Published: March 2017

The present study exposes the main features of the recent changes introduced in Portuguese labour law, following the severe crisis the country went through and the external financial aid it required. It addresses separately the alterations implemented in individual labour law and collective labour law, pinpointing the main developments verified in these areas and the driving forces behind them.

Aside from an explanatory perspective (that covers the previous and the currents traits of the labour regime), this article also provides a critical point of view, regarding the consequences of these changes and the reactions they provoked amongst Portuguese society and its social partners.
Can the EU Seasonal Workers' Directive Alleviate the Pending Crisis of Climate-Induced Displacement
Authors: Gromilova Mariya
Published: March 2017

Due to growing unrest on the African continent, the migration crisis in the EU is escalating. Numbers of global refugees and displaced persons are continuously increasing. Climate change is predicted to cause about 50 and 350 million additional people to move by 2050, with at least half coming from Sub-Saharan Africa.1 At the same time, due to the decline and ageing of the EU population, the EU needs migrants to fill gaps in the labour market. This article demonstrates that migration from Africa can be used as a mutually beneficial strategy. The EU can strengthen its economy and welfare systems. African states can increase their resilience to climate change, boost development and adaptation. Ultimately, it can reduce the need for relocation. In particular, this article investigates the potential of the recent EU Seasonal Workers' Directive – which refers to the importance of promoting the development of third states – to serve this ambition. Since the Directive still has to be implemented into Member States' national laws, this article suggests learning some lessons from schemes already adopted and functioning outside of the EU. Namely it analyses the seasonal labour migration schemes of Australia and New Zealand that give migration opportunities to Pacific Islanders and analyses their experiences in promoting development in the Pacific region. This analysis highlights crucial aspects that should be taken into account during the implementation of the EU Directive.
Employment and Security in the Netherlands
Authors: Gundt Nicola
Published: March 2017

This paper deals with the changes that were introduced in Dutch labour law in 2015. The Act on Employment and Security aims at lessening the divide between outsiders with precarious employment relations and well protected insiders, enjoying dismissal protection and good employment conditions. In order to do so, the Act changes the rules concerning flexible employment as well as the rules concerning dismissal. It is regarded as most far-reaching change of Dutch dismissal law since the Second World War. This contribution first describes the aim and purpose of the act, then discusses the changes made to the law, and finally, though it is still early days, tries to critically assess the act.
Different Ways to Fight against Unfair Dismissal on the Grounds of HIV/AIDS Status
Authors: Pärli Kurt
Published: March 2017

Stigma and discrimination against HIV-positive employees – caused by irrational fears of getting infected – is widespread in the world of work. This paper deals with three dismissal cases on the ground of the HIV status – all debated in 2013 in Switzerland, Germany and Greece – where courts at different levels on the basis of a different legal framework came the same conclusion that the dismissal was not legal. Common to all cases is the fact that the relevant HIV-positive employees haven't had any restrictions regarding their ability to work. In all cases, not scientifically proven prejudices regarding the transmission risk of the HIV status have caused irrational behaviour by different stake holders. The three judgments discussed in this article indicate the right way to deal with these issues, but, there are different roads to Rome – and nothing can be said against a variety of approaches.
Extending Working Life
Authors: Kullmann Miriam
Published: March 2017

Ageing has been a concern for several years now. Member States introduced higher pensionable ages to increase labour market participation and facilitate the active participation of older workers in the labour market, and also those who are beyond pensionable age. This contribution uses the Netherlands as a case study for analysing the introduced changes made to facilitate the employment of pensionable workers. Besides increasing pensionable age, obstacles in labour law were also removed. A ‘labour law light’ regime has been created for this group of workers, making hiring pensionable workers more flexible by loosening dismissal law protection, introducing an extended possibility of using fixed-term employment contracts, and diminishing the employer's obligation to continue paying the worker's wage during sickness. This paper critically analyses the merits of the government's response by statutorily facilitating the possibility of employing workers beyond their pensionable age. The regime's aim has significant limitations with regard to actually stimulating employees to continue working beyond the pensionable age, having in mind a more sustainable approach towards active ageing.
The Impact of Atypical Work in Italy and Russia
Authors: Rymkevich Olga
Published: March 2017

The paper aims to analyse the impact of precarious employment in Italy and Russia. Although these two countries differ significantly in a number of respects such as size, economic structure, political and legal systems and culture, there are some similarities which make a comparison possible. Both belong to the continental legal system, both are characterised by formally rigid labour legislation, a large informal sector of the economy, profound regional differences, and a weakened role of trade unions. In recent decades both countries have undertaken a set of reforms in a neoliberal spirit leading to the proliferation of precarious employment. The paper aims to provide a comparison between Italy and Russia from the point of view of the impact of atypical employment on their legal and economic systems, with a particular focus on the different perceptions of atypical work, precariousness and employment security and different regulatory approaches as well as different legal and non-legal mechanisms to adapt to changes perceived as negative shocks. Another question the paper addresses is whether and to what extent flexible work can serve as a stepping stone to permanent high quality employment in these countries. However, considering the ongoing character of the reforms, the impact of many of the legal measures discussed in the paper is still unclear.
The Flexicurity System in Ireland
Authors: Keane Eddie
Published: March 2017

This article discusses the implementation of the flexicurity system in Ireland. As the percentage of dependent employees in temporary employment in Ireland grew from 5.3% in 2002 to 10.2% in 2012, it is clear that flexible working relationships are on the increase. This development in flexibility should be balanced by the creation of modern forms of security for workers. Therefore the paper examines the provisions for developing employment security, i.e. active labour market policies and income security in Ireland. In highlighting the deficiencies of the Irish provisions, the paper exposes some of the difficulties of achieving worker security under the flexicurity system
Individual Dismissal Law and the Financial Crisis: An Evaluation of Recent Developments
Authors: Kovács Erika
Published: March 2017

This article offers an evaluation of recent developments in the individual dismissal laws of certain Southern European states (Greece, Italy, Portugal, and Spain), with special regard to the reforms adopted in response to the economic crisis. The paper first highlights the influence of the European Commission on national dismissal laws. It then focuses on four selected major changes in national individual dismissal laws, which have been suggested by the Troika. The reforms of dismissal law are assessed – within the limited scope of the present article – from both an economic and a fundamental rights perspective. Finally, in the summary the general findings of the paper are presented.
Trade Unions and the Challenges of EU Enlargement: ‘The Kind of Laws the Unions Ought to Want’
Authors: Zahn Rebecca
Published: March 2017

The recent EU enlargements in 2004 and 2007 have thrown up changed regulatory and opportunity structures for European trade unions, primarily as a consequence of an increase in the free movement of workers, services and establishment. In addition, the European enlargements came at a time when Member State governments were attempting to ‘modernise’ their labour and social security systems in order to combat the effects of an enlarged Europe within a globalised world economy. As a result, trade unions find themselves in a vulnerable position within their domestic legal systems and are required to reassess the type of functions that they can adopt at a national and European level in order to effectively respond to European enlargement. Against this background, this article considers the kind of laws the unions ought to want in order to effectively respond to the challenges facing them following the enlargements.
Unused Potential? The Risk of Unemployed ‘Older’ Workers
Authors: Kullmann Miriam
Published: March 2017

Using Sen's capability approach as an analytical framework, this paper attempts to assess and evaluate the Dutch measures for facilitating transitions from unemployment to (gainful) employment. This method is particularly useful in the context of the EU's economically informed flexicurity approach to evaluate the institutional preconditions for effective participation in the labour market. It will be argued that the existing legal measures alone are insufficient to address the difficulties of reintegrating older (long-term) unemployed persons in the labour market. Measures taken to reactivate older unemployed workers merely build upon economic considerations, such as guaranteeing the sustainability of the pensions and social security schemes. Other (non-economic) considerations are often overlooked. This ignores the actual risks: not actually having access to the labour market entails a variety of risks, not only in terms of job, and thus (a partial) income, loss for the employee concerned, but also for the Member States who are obliged to do everything necessary to achieve the EU's goals.
Reconfiguring the Employment-Pension Connection in Times of Austerity
Authors: Colàs-Neila Eusebi
Published: March 2017

The EU's response to the current economic crisis has been a new, stronger emphasis on economic governance and the spread of austerity policies in many Member States. Both sets of measures have impacted on pension systems, which have undergone various reforms to reduce public expenditure. The EU has played an influential role in this field, insisting, despite a lack of competence, on the promotion of complementary private retirement savings to ensure adequate incomes. Consequently, the protection levels of public social security systems are being eroded. This paper discusses these pension reforms in times of austerity by taking the Spanish case as an example. As an alternative to austerity, social policies should focus on increasing budget revenues instead of reducing public spending and should consider changes in employment when reforming pension regulations. A rights-based approach that effectively guarantees an adequate public pension is needed in the light of international regulations and some notable case law.
Job Security or Employment Security: What's in a Name?
Authors: Zekic Nuna
Published: March 2017

The main aim of the article is to survey and conceptualise the place of employment security in labour law, and to explore a number of important legal questions relating to this concept. After scrutinising the notion of employment security, the author endorses the view that job security that exists on the basis of dismissal law is more complex than reform proposals usually suggest. In addition, the author argues that dismissal protection serves other goals and interests than job security alone and that these aspects of dismissal protection legislation cannot be replaced by (an increased) employment security (coupled with income security). A further development of true employment security can, however, certainly complement job security and benefit workers, since they have never had absolute job security and this job security seems to be eroding.
Temporary Agency Workers Work ‘Temporarily’
Authors: Krüger Laura
Published: March 2017

Articles 1(1) and 3(1 b)-e)) of Directive 2008/104/EC state that temporary agency workers work temporarily under the supervision and direction of the user undertaking. Section 1(1) 2 AUG, introduced in order to transpose Articles 1(1) and 3(1 b)-e)) of the Directive, states that temporary agency workers are temporarily assigned to user undertakings (‘Die Uberlassung von Arbeitnehmern an Entleiher erfolgt vorübergehend’). As there exists no definition of the notion ‘temporarily’, this article deals with the European and German interpretation of this notion.
Religious Freedom and Labour Relationships in Portugal
Authors: Machado Susana Sousa
Published: March 2017

The present study addresses the conflicts between the fundamental right to religious freedom analysed in the view of the legal-juridical perspective in Portugal. To this end, the Portuguese legislation and case law will be considered. Within this context, questions relating to religious festivities and working hours within the working context are thus pertinent. Therefore, it has become relevant to present and comment on the solutions brought forward by the case law, namely in Portugal, drawing conclusions on the essential effects of this issue on the labour relationship.
“There are days I wish it wasn’t there, and there’s days I realize I’m lucky”: A qualitative study of psychological sequelae to the implantable cardioverter defibrillator as a treatment for the prevention of sudden cardiac death in arrhythmogenic right ventricular cardiomyopathy
Authors: Etchegary Holly , Pullman Daryl , Connors Sean P , Simmonds Charlene , Young Terry-Lynn , Hodgkinson Kathy A
Published: March 2017

Objectives

Arrhythmogenic right ventricular cardiomyopathy caused by a TMEM43 p.S358L mutation is a fully penetrant autosomal dominant cause of sudden cardiac death where prophylactic implantable cardioverter defibrillator therapy significantly reduces mortality by returning lethal cardiac rhythms to normal. This qualitative study assessed the psychological ramifications of the implantable cardioverter defibrillator on recipients, their spouses and their mutation negative siblings.

Design

Qualitative interview study.

Participants

Twenty-one individuals (nine mutation positive, eight mutation negative and four spouses) from 15 families completed semi-structured interviews.

Results

No theoretical assumptions about the data were made: inductive sub-coding was accomplished with the constant comparison method and cohesive themes across all respondent interviews were determined. All interviewees had a family history of sudden cardiac death and appropriate implantable cardioverter defibrillator therapy in themselves or family members. Average length of time with an implantable cardioverter defibrillator was 10 years. Major themes included: (1) acceptance and gratitude, (2) grudging acceptance, (3) psychological effects (on emotional and psychological well-being; functioning of the broader family unit; and relationships), and (4) practical concerns (on clothes, travel, loss of driving licence and the effects of an implantable cardioverter defibrillator discharge). These affected all family members, regardless of mutation status.

Conclusions

Despite the survival advantage of implantable cardioverter defibrillator therapy, the intervention carries psychological and practical burdens for family members from kindreds manifesting p.S358L TMEM43 ARVC that does not appear to dissipate with time. A move towards integrating psychology services with the cardiac genetics clinic for the extended family may provide benefit.
Prescription patterns of long-acting somatostatin analogues
Authors: Machado-Alba Jorge Enrique , Machado-Duque Manuel Enrique
Published: March 2017

Background:

Acromegaly and endocrine tumors are uncommon morbidities that are currently treated with different drugs.

Objective:

To determine the prescription patterns of somatostatin analogues in patients affiliated with the Health System of Colombia.

Methods:

Retrospective cohort study of patients of any age and sex treated with octreotide or lanreotide between January 2011 and August 2015. Socio-demographic, clinical (indications) and pharmacological (comedications) variables were considered. Multivariate analysis was performed with SPSS 23.0.

Results:

We identified 289 patients, with a mean age of 56.6 ± 14.0 years and female predominance (59.5%), who underwent treatment during the 56 months of monitoring. Octreotide was used in 56.1% of cases, followed by lanreotide (43.9%), both at approved doses. We found that 4.5% of subjects changed from one drug to another over the course of therapy, which was associated with being diabetic and receiving insulin (odds ratio: 4.27; 95% confidence interval: 1.23–14.84; p = 0.014). The most common indications were acromegaly (52.2% of cases) followed by neuroendocrine tumors (15.9%). The most common comorbidities were hypertension (39.4% of cases), depression (27.3%), dyslipidemia (23.3%), diabetes mellitus (23.5%) and hypothyroidism (23.5%). Being male (odds ratio: 0.57; 95% confidence interval: 0.35–0.94; p = 0.029) and belonging to the age group between 45 and 65 years (odds ratio: 0.44; 95% confidence interval: 0.21–0.90; p = 0.024) were significantly associated with a lower risk of receiving comedications.

Conclusion:

Somatostatin analogues are being used at recommended doses, especially in patients with acromegaly and neuroendocrine tumors. Variables associated with change in therapy were identified.
Experiences of supportive care when waiting for a lung re-transplantation
Authors: Ivarsson Bodil , Ingemansson Richard , Sjöberg Trygve
Published: March 2017

Objectives:

Lung transplant patients and their next of kin share the experiences of illness but little is known in the face of a lung re-transplantation. To describe patients’ and next of kin’s experiences of supportive care while awaiting lung re-transplantation and the objective was to highlight a small group with special circumstances and needs.

Methods:

Using qualitative content analysis, seven adult patients and seven next of kin were consecutively selected from a regional lung transplantation centre and individually interviewed shortly after decision about lung re-transplantation.

Results:

The experiences of supportive care were captured in one main category: ‘once again haunted by death’ and three sub-categories: ‘when life turns and death once again snorts down your neck’, ‘the importance of information’, and ‘perceptions of support’. A complex interaction between the experience of waiting, and communication patterns, emotional states, and social support was shown.

Conclusion:

This study provides insights into the complex interaction between the experience of waiting for a second lung transplant and communication patterns, emotional states, social support and social roles between patients, next of kin, healthcare professionals, and the health and social welfare system. There is a need for developing supportive care programme to achieve the best possible care.
An Investigation of Perspectives of Respite Admission Among People Living With Amyotrophic Lateral Sclerosis and the Hospitals That Support Them
Authors: Nakai Michiko , Narita Yugo , Tomimoto Hidekazu
Published: March 2017

Background: Amyotrophic lateral sclerosis is a progressive disease with rapid degeneration. Respite care is an essential service for improving the well-being of both patients with this disease and their family caregivers, but accessibility of respite services is limited. This study investigates perspectives on respite admission among people living with amyotrophic lateral sclerosis and the hospitals supporting them. Method: We conducted semistructured interviews among 3 patients with amyotrophic lateral sclerosis and 12 family members, exploring demographic information and their awareness and experience of respite admission. We also interviewed 16 representatives from hospitals about awareness of and preparation for respite admission for patients with this disease, the role of regional networks for intractable diseases, and knowledge about communication support schemes. Results: We found significant differences in the revised Amyotrophic Lateral Sclerosis Functional Rating Scale between patients who had and had not received respite admission. Qualitative analysis of the data indicated that respite admission was a contributory factor in continuing and stabilizing home care. Limited provision of social services and hospital care quality were barriers to respite admission. Conclusion: Respite admission was essential to continued home care for patients with amyotrophic lateral sclerosis. Severe-stage patients were eligible for respite admission. Its accessibility, however, was limited, especially for patients living in rural areas. Supporting hospitals had limited capacity to respond to patients’ needs. Individualized care and communication were internal barriers to respite admission.
Workplace Violence Training Programs for Health Care Workers: An Analysis of Program Elements
Authors: Arbury Sheila , Zankowski Donna , Lipscomb Jane , Hodgson Michael
Published: March 2017

Commercial workplace violence (WPV) prevention training programs differ in their approach to violence prevention and the content they present. This study reviews 12 such programs using criteria developed from training topics in the Occupational Safety and Health Administration’s (OSHA) Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers and a review of the WPV literature. None of the training programs addressed all the review criteria. The most significant gap in content was the lack of attention to facility-specific risk assessment and policies. To fill this gap, health care facilities should supplement purchased training programs with specific training in organizational policies and procedures, emergency action plans, communication, facility risk assessment, and employee post-incident debriefing and monitoring. Critical to success is a dedicated program manager who understands risk assessment, facility clinical operations, and program management and evaluation.
How Comprehensive and Efficient Are Patient-Reported Outcomes for Rotator Cuff Tears?
Authors: Makhni Eric C. , Hamamoto Jason T. , Higgins John D. , Patterson Taylor , Griffin Justin W. , Romeo Anthony A. , Verma Nikhil N.
Published: March 2017

Background:

Increasing emphasis is placed on patient-reported outcomes (PROs) after common orthopaedic procedures as a measure of quality. When considering PRO utilization in patients with rotator cuff tears, several different PROs exist with varying levels of accuracy and utilization.

Hypothesis/Purpose:

Understanding which disease-specific PRO may be most efficiently administered in patients after rotator cuff repair may assist in promoting increased patient and physician adoption of these useful scores. Using a novel assessment criterion, this study assessed all commonly used rotator cuff PROs. We hypothesize that surveys with fewer numbers of questions may remain comparable (with regard to comprehensiveness) to longer surveys.

Study Design:

Systematic review.

Methods:

Commonly utilized rotator cuff PROs were analyzed with regard to number of survey components, comprehensiveness, and efficiency. Comprehensiveness (maximum score, 11) was scored as the total number of pain (at rest/baseline, night/sleep, activities of daily living [ADLs], sport, and work) and functional (strength, motion/stiffness, and ability to perform ADLs, sport, and work) metrics included, along with inclusion of quality of life/satisfaction metrics. Efficiency was calculated as comprehensiveness divided by the number of survey components.

Results:

Sixteen different PROs were studied. Number of components ranged from 5 (University of California at Los Angeles score [UCLA]) to 36 (Short Form–36 [SF-36], Japanese Orthopaedic Association score [JOA]). The Quality of Life Outcome Measure for Rotator Cuff Disease (RC-QoL) included all 5 pain components, while 7 PROs contained all 5 functional components. Ten PROs included a quality of life/satisfaction component. The most comprehensive scores were the RC-QoL (score, 11) and Penn (score, 10), and the least comprehensive score was the Marx (score, 3). The most efficient PROs were the UCLA, the Quick Disabilities of the Arm, Shoulder, and Hand score (QuickDASH), and Constant scores. The least efficient scores were the JOA and SF-36 scores.

Conclusion:

Many commonly utilized PROs for rotator cuff tears are lacking in comprehensiveness and efficiency. Continued critical assessment of PRO quality may help practitioners identify the most comprehensive and efficient PRO to incorporate into daily clinical practice.
Selections From the ABC 2016 Annual Conference, Albuquerque, New Mexico: Bright as Stars in the Albuquerque Desert Sky: Classroom-Tested Business Communication Assignments
Authors: Whalen D. Joel
Published: March 2017

This article, the first of a two-part series, presents 13 teaching innovations debuted at the 2016 Association for Business Communication’s annual conference. The second edition of My Favorite Assignment will be published in the fall 2017 Business and Professional Communication Quarterly. Assignments include international collaborative projects, students’ professional development, fast skill-building exercises, data interpretation, event planning, and more. Additional assignment support materials—instructions to students, stimulus materials, slides, grading rubrics, frequently asked questions, and sample student projects—are posted on these websites: http://www.businesscommunication.org/page/assignments and http://salesleadershipcenter.com/research .
Eliciting the Functional Processes of Apologizing for Errors in Health Care
Authors: Prothero Marie M. , Morse Janice M.
Published: March 2017

This article has been awarded GQNR’s Best Paper Award for the 2017 Volume

The purpose of this article was to analyze the concept development of apology in the context of errors in health care, the administrative response, policy and format/process of the subsequent apology. Using pragmatic utility and a systematic review of the literature, 29 articles and one book provided attributes involved in apologizing. Analytic questions were developed to guide the data synthesis and types of apologies used in different circumstances identified. The antecedents of apologizing, and the attributes and outcomes were identified. A model was constructed illustrating the components of a complete apology, other types of apologies, and ramifications/outcomes of each. Clinical implications of developing formal policies for correcting medical errors through apologies are recommended. Defining the essential elements of apology is the first step in establishing a just culture in health care. Respect for patient-centered care reduces the retaliate consequences following an error, and may even restore the physician patient relationship.
How I manage the toxicities of myeloma drugs
Authors: Delforge Michel , Ludwig Heinz
Published: March 2017

The treatment of multiple myeloma is considered a continuously evolving paradigm as a result of the growing availability of new and highly effective drugs, including first- and second-generation proteasome inhibitors, immunomodulatory agents, and monoclonal antibodies. Clinical trials advocate long-term rather than short-term treatment schedules with combinations of these new anti–myeloma drug classes. Although the overall toxicity profile of the recommended regimens can be considered favorable, their increasing complexity and prolonged use warrant a heightened vigilance for early and late side effects, a priori because real-life patients can be more frail or present with 1 or more comorbidities. The treatment decision process, at diagnosis and at relapse, therefore requires myeloma physicians to carefully balance efficacy and toxicity profiles for each individual patient. Early and/or unnecessary tapering or treatment discontinuation for drug-related adverse events may not only reduce patients’ quality of life, but also negatively impact their outcome. Accurate knowledge in recognizing and managing the potential side effects of present-day treatment regimens is therefore a cornerstone in myeloma care. Using 5 case vignettes, we discuss how to prevent and manage the most common nonhematological adverse events of anti–myeloma treatment regimens containing proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies.
Human bronchial epithelium orchestrates dendritic cell activation in severe asthma
Authors: Gras Delphine , Martinez-Anton Asuncion , Bourdin Arnaud , Garulli Celine , de Senneville Laure , Vachier Isabelle , Vitte Joana , Chanez Pascal
Published: March 2017

The innate immune response is impaired in asthma, with increased epithelial release of C-X-C motif chemokine ligand (CXCL)8, interleukin (IL)-33 and thymic stromal lymphopoietin (TSLP). We hypothesised that dendritic cells might modulate the hyperresponsive epithelium in severe asthma.

For this purpose, we investigated epithelial–dendritic crosstalk in normal and diseased conditions, and because ultrafine particulate matter may affect asthmatic airways, we investigated its impact on this crosstalk. Air–liquid interface cultures of human bronchial epithelial cells (HBEC) of control subjects (cHBEC) or severe asthma patients (saHBEC) were co-cultured with monocyte-derived dendritic cells (moDC).

Increased release of CXCL8, TSLP and IL-33 from saHBEC contrasted with cHBEC producing CXCL10 and CCL2. Regarding moDC activation, saHBEC co-cultures induced only upregulation of CD86 expression, while cHBEC yielded full moDC maturation with HLA-DR, CD80, CD86 and CD40 upregulation. Particulate matter stimulation of HBEC had no effect on cHBEC but stimulated CXCL8 and IL-33 release in saHBEC. Particulate matter impaired epithelium signalling (TSLP, IL-33 and CXCL8) in saHBEC co-cultures despite C-C chemokine ligand 2 induction.

Crosstalk between HBEC and moDC can be establishedin vitro, driving a T1-type response with cHBEC and a T2-type response with saHBEC. Normal or asthmatic status of HBEC differentially shapes the epithelial–dendritic responses. We conclude that control moDC cannot rescue the hyperresponsive airway epithelium of severe asthmatics.
Isobolographic Analysis of Drug Combinations With Intrathecal BRL52537 (κ-Opioid Agonist), Pregabalin (Calcium Channel Modulator), AF 353 (P2X3 Receptor Antagonist), and A804598 (P2X7 Receptor Antagonist) in Neuropathic Rats
Authors: Jung Young-Hwan , Kim Yeo Ok , Han Jung Hyun , Kim Yong-Chul , Yoon Myung Ha
Published: March 2017

BACKGROUND:

Neuropathic pain should be treated with drug combinations exhibiting multiple analgesic mechanisms of action because the mechanism of neuropathic pain involves multiple physiological causes and is mediated by multiple pathways. In this study, we defined the pharmacological interaction of BRL52537 (κ-opioid agonist), pregabalin (calcium channel modulator), AF 353 (P2X3 receptor antagonist), and A804598 (P2X7 receptor antagonist).

METHODS:

Animal models of neuropathic pain were established by spinal nerve ligation (SNL) in male Sprague-Dawley rats, and responses to the mechanical stimulation using von Frey filaments were measured. Drugs were administered by intrathecal route and were examined for antiallodynic effects, and drug interactions were evaluated using isobolographic analysis. The mRNA expression levels of pain-related receptors in each spinal cord or dorsal root ganglion of naïve, SNL, and drug-treated SNL rats were evaluated using real-time polymerase chain reaction.

RESULTS:

Intrathecal BRL52537, pregabalin, AF 353, and A804598 produced antiallodynic effects in SNL rats. In the drug combination studies, intrathecal coadministration of BRL52537 with pregabalin or A804598 exhibited synergistic interactions, and other drugs combinations showed additivity. The rank order of potency was observed as follows: BRL52537 + pregabalin > BRL52537 + A804598 > pregabalin + AF 353 > A804598 + pregabalin > BRL52537 + AF 353 > AF 353 + A804598. Real-time polymerase chain reaction indicated that alterations of P2X3 receptor and calcium channel mRNA expression levels were observed, while P2X7 receptor and κ-opioid receptor expression levels were not altered.

CONCLUSIONS:

These results demonstrated that intrathecal combination of BRL52537, pregabalin, AF 353, and A804598 synergistically or additively attenuated allodynia evoked by SNL, which suggests the possibility to improve the efficacy of single-drug administration.
Utilizing Forced Vital Capacity to Predict Low Lung Compliance and Select Intraoperative Tidal Volume During Thoracic Surgery
Authors: Hoftman Nir , Eikermann Eric , Shin John , Buckley Jack , Navab Kaveh , Abtin Fereidoun , Grogan Tristan , Cannesson Maxime , Mahajan Aman
Published: March 2017

BACKGROUND:

Tidal volume selection during mechanical ventilation utilizes dogmatic formulas that only consider a patient’s predicted body weight (PBW). In this study, we investigate whether forced vital capacity (FVC) (1) correlates better to total lung capacity (TLC) than PBW, (2) predicts low pulmonary compliance, and (3) provides an alternative method for tidal volume selection.

METHODS:

One hundred thirty thoracic surgery patients had their preoperative TLC calculated via 2 methods: (1) pulmonary function test (PFT; TLCPFT) and (2) computed tomography 3D reconstruction (TLCCT). We compared the correlation between TLC and PBW with the correlation between TLC and FVC to determine which was stronger. Dynamic pulmonary compliance was then calculated from intraoperative ventilator data and logistic regression models constructed to determine which clinical measure best predicted low compliance. Ratios of tidal volume/FVC plotted against peak inspiratory pressure were utilized to construct a new model for tidal volume selection. Calculated tidal volumes generated by this model were then compared with those generated by the standard lung-protective formula Vt = 7 cc/kg.

RESULTS:

The correlation between FVC and TLC (0.82 for TLCPFTand 0.76 for TLCCT) was stronger than the correlation between PBW and TLC (0.65 for TLCPFTand 0.58 for TLCCT). Patients with very low compliance had significantly smaller lung volumes (forced expiratory volume at 1 second, FVC, TLC) and lower diffusion capacity of the lungs for carbon monoxide when compared with patients with normal compliance. An FVC cutoff of 3470 cc was 100% sensitive and 51% specific for predicting low compliance. The proposed equation Vt = FVC/8 significantly reduced calculated tidal volume by a mean of 22.5% in patients with low pulmonary compliance without affecting the mean tidal volume in patients with normal compliance (mean difference 0.9%).

CONCLUSIONS:

FVC is more strongly correlated to TLC than PBW and a cutoff of about 3.5 L can be utilized to predict low pulmonary compliance. The equation Vt = FVC/8 reduced mean calculated tidal volume in patients with low pulmonary compliance and/or small lungs.
The Pathway of Injectate Spread With the Transmuscular Quadratus Lumborum Block: A Cadaver Study
Authors: Dam Mette , Moriggl Bernhard , Hansen Christian K. , Hoermann Romed , Bendtsen Thomas F. , Børglum Jens
Published: March 2017

BACKGROUND:

The spread of injectate resulting from a transmuscular quadratus lumborum (TQL) block and a transverse oblique paramedian (TOP) TQL block has never been examined. The aim of this cadaveric study was to investigate by which pathway the injectate spreads cephalad into the thoracic paravertebral space and which nerves were dyed by the injectate cephalad and caudad to the diaphragm when performing a TQL and a TOP TQL block. We also aimed to investigate whether the thoracic and lumbar sympathetic trunks as well as the lumbar plexus were covered by the injectate.

METHODS:

Ultrasound-guided bilateral TQL and TOP TQL injections were administered in 8 cadavers. A total of 16 injections were performed. With the TQL injection, the curvilinear transducer was oriented in the transverse plane above the iliac crest at the posterior axillary line to identify the Shamrock sign. With the TOP TQL injection, the same transducer was placed with a TOP orientation 3 cm lateral to the L2 spinous process to identify the L2 transverse process and the adjoining quadratus lumborum muscle. For both techniques, the needle was advanced in-plane to the transducer, with the end point in the interfascial plane between the quadratus lumborum and psoas major muscles. Thirty milliliters of dye solution was injected bilaterally for each technique. The spread of the dye was evaluated by subsequent dissection.

RESULTS:

In all successful injections, the dye was seen to spread into the thoracic paravertebral space and the intercostal spaces to surround the somatic nerves and the thoracic sympathetic trunk. The main pathway of spread of injectate was posterior to the medial and lateral arcuate ligaments. Caudad to the diaphragm, the injected dye surrounded the subcostal, iliohypogastric, and ilioinguinal nerves in all cases, whereas the genitofemoral and lateral femoral cutaneous nerves were dyed in a varying degree. No dye was seen to surround the lumbar plexus, femoral nerve, or lumbar sympathetic trunk. The pattern of spread was similar with the TQL and TOP TQL injections.

CONCLUSIONS:

The spread of injectate with the TQL and TOP TQL approaches is cephalad from the lumbar point of administration between the quadratus lumborum and psoas major muscles, predominantly via a pathway posterior to the arcuate ligaments and into the thoracic paravertebral space to reach the somatic nerves and the thoracic sympathetic trunk in the intercostal and paravertebral spaces. The lumbar plexus and lumbar sympathetic trunk are not affected.
Lactate Elevation During and After Major Cardiac Surgery in Adults: A Review of Etiology, Prognostic Value, and Management
Authors: Andersen Lars W.
Published: March 2017

Elevated lactate is a common occurrence after cardiac surgery. This review summarizes the literature on the complex etiology of lactate elevation during and after cardiac surgery, including considerations of oxygen delivery, oxygen utilization, increased metabolism, lactate clearance, medications and fluids, and postoperative complications. Second, the association between lactate and a variety of outcomes are described, and the prognostic role of lactate is critically assessed. Despite the fact that elevated lactate is strongly associated with many important outcomes, including postoperative complications, length of stay, and mortality, little is known about the optimal management of postoperative patients with lactate elevations. This review ends with an assessment of the limited literature on this subject.
Restitution as Diagnosis: Political Aspects of the “Trophy Art” Problem and Russian-German Relations
Authors: Akinsha Konstantin
Published: March 2017

During World War II the Soviet Union did not join the Allied restitution effort. Instead, more than two and a half million objects (not counting millions of books) were transported to the Soviet Union from its zone of occupation in Germany and from other European countries occupied by the Red Army. During the 1950s the Khrushchev government restituted collections from East Germany and western Poland. However, millions of artworks and books were kept in secret depositories until the beginning of perestroika. The problem of so-called cultural trophies provoked heated discussions in the Russian Federation and in many senses became a mirror reflecting Russian policy changes and predicting the transformation of the failed liberal democracy into an authoritarian state.
The Crisis of Kinship
Authors: Heintz Lauren
Published: March 2017

“The Crisis of Kinship: Queer Affiliations in the Sexual Economy of Slavery” reexamines the discourse of queer kinship in order to take up Sharon Holland's call that queer studies has yet to reckon with the institution of slavery. I consider how the crisis of the oedipal drama—namely, unknown parentage and incest—is foundational to the sexual economy of slavery. Rather than a taboo that finds heterosexual resolution, incest is a sexual construct of slavery that paradoxically enables the emergence of queer sexual and kinship affiliations. I ground my reading in the nineteenth-century short story “Le Mulâtre,” by the African American author Victor Séjour. “Le Mulâtre” takes me to unwieldy genealogies of kinship, incest, and same-sex desire. Here, I look to the sexual epistemologies of Vodou religious practices in Haiti; I engage pre-Freudian theories of Oedipus by Johann Jakob Bachofen, who situates Oedipus in the sexually promiscuous space of the swamp. In all, an examination of incest and miscegenation in slavery reveals a repressed racialization of the Oedipus complex.
Epithelial and non-epithelial Ptch1 play opposing roles to regulate proliferation and morphogenesis of the mouse mammary gland
Authors: Monkkonen Teresa , Landua John D. , Visbal Adriana P. , Lewis Michael T.
Published: March 2017

Patched 1 (Ptch1) has epithelial, stromal and systemic roles in murine mammary gland organogenesis, yet specific functions remain undefined. Cre-recombinase-mediated Ptch1 ablation in mammary epithelium increased proliferation and branching, but did not phenocopy transgenic expression of activated smoothened (SmoM2). The epithelium showed no evidence of canonical hedgehog signaling, and hyperproliferation was not blocked by smoothened (SMO) inhibition, suggesting a non-canonical function of PTCH1. Consistent with this possibility, nuclear localization of cyclin B1 was increased. In non-epithelial cells, heterozygous Fsp-Cre-mediated Ptch1 ablation increased proliferation and branching, with dysplastic terminal end buds (TEB) and ducts. By contrast, homozygous Ptch1 ablation decreased proliferation and branching, producing stunted ducts filled with luminal cells showing altered ovarian hormone receptor expression. Whole-gland transplantation into wild-type hosts or estrogen/progesterone treatment rescued outgrowth and hormone receptor expression, but not the histological changes. Bone marrow transplantation failed to rescue outgrowth. Ducts of Fsp-Cre;Ptch1fl/fl mice were similar to Fsp-Cre;SmoM2 ducts, but Fsp-Cre;SmoM2 outgrowths were not stunted, suggesting that the histology might be mediated by Smo in the local stroma, with systemic Ptch1 required for ductal outgrowth and proper hormone receptor expression in the mammary epithelium.