bluuebunny/crossref_metadata_2025 huggingface dataset:
Passion's Fictions from Shakespeare to Richardson
Authors: Robinson Benedict S.
Published: May 2021

Passion’s Fictions traces the intimate links between literature and the sciences of soul and mind from the age of Shakespeare to the rise of the novel. It chronicles the emergence of new sciences of the passions between the sixteenth and eighteenth centuries out of and in some ways against a received “science of the soul,” and it argues that this history was shaped by rhetoric, which contained the most extensively particularized discourse on the passions, offering principles for moving and affecting the passions of others in concrete social scenes. This rhetoric of the passions centered on narrative as the instrument of a non-theoretical knowledge of the passions in their particularity, predicated on an account of passion as an intimate relation between an empassioned mind and an empassioning world: rhetoric offers a kind of externalist psychology, formalized in the relation of passion to action and underwriting an account of narrative as a means of both moving passion and knowing it. This book describes the psychology of the passions before the discipline of psychology, tracing the influence of rhetoric on theories of the passions from Francis Bacon to Adam Smith and using that history to read literary works by Shakespeare, Milton, Haywood, Richardson, and others. Narrative offers a means of knowing and moving the passions by tracing them to the events and objects that generate them; the history of narrative practices is thus a key part of the history of the psychology of the passions at a critical moment in its development.
Passion’s Intentions
Authors: Robinson Benedict S.
Published: May 2021

“Passion’s Intentions” provides a broad account of the concept of passion as the early modern period received it from various ancient and medieval sources. It starts with the rise of “treatises on the passions” in the seventeenth century, showing to what extent those books represent a new phenomenon but also anchoring their understanding of passion in a received “science of the soul”: a faculty psychology drawn largely from Aristotle, the Stoics, Augustine, and Aquinas. The chapter also connects that concept of passion to passages from the poetry of Edmund Spenser and John Donne and the plays of Shakespeare. But its primary aim is to emphasize the object-oriented, “intentional” nature of passion as the early modern period understood it: passion is directed at the world of things; it is intimately connected to the way those things appear to us, in what scholastic psychology called “intentions.” This also means that passion is not a purely internal state: while it is anchored in a structure of mental representations, it is also oriented to the world, shaped by situations, and must be understood with reference to those situations. As circumstanced encounters with qualitatively particular objects, the passions were seen to be infinite: knowledge of the passions comes from the outside in, through an immersive, open-ended, narrative understanding of particular lived situations. The chapter ends by briefly sketching how narrative, theorized by rhetoric as a mode of the knowledge of particulars, came to be seen as a crucial instrument of the knowledge of the passions.
The Springs of the Soul
Authors: Robinson Benedict S.
Published: May 2021

This chapter turns to the place of the passions in the “new philosophies” of the mid- to late-seventeenth century, which aimed to bring them into the purview of a true “certaine science.” In the process, they changed the concept of passion, turning it from a motion of the sensitive soul with associated but secondary effects in the body to a more centrally physiological movement: a motion of the spirits, themselves understood in increasingly materialist terms; or even a “spring” of the soul: a physical movement in the body that causes effects in the soul. The chapter demonstrates the impact of this shift in the concept of passion on late-seventeenth-century rhetoric. But it also argues that rhetoric continued to shape new forms of philosophical discourse on the passions, albeit in hidden or even disavowed ways. It traces the influence of rhetoric through major philosophical texts by Bacon, Hobbes, Descartes, Spinoza, Malebranche, and Locke. In its final pages it turns to two novels, Marie-Madeleine de Lafayette’s Princesse de Clèves and Eliza Haywood’s Love in Excess, to show how they fuse concepts of passion shaped by the new physiologies with an updated version of a circumstantial knowledge of the passions that had once belonged to rhetoric but that by the late seventeenth century was also guiding the production of new forms of long prose fiction.
English Landscapes and Identities
Authors: Gosden Chris , Green Chris , Cooper Anwen , Creswell Miranda , Donnelly Victoria , Franconi Tyler , Glyde Roger , Kamash Zena , Mallet Sarah , Morley Laura , Stansbie Daniel , ten Harkel Letty
Published: May 2021

The project on which the book was based synthesized all the major available sources of information on English archaeology for the period from 1500 BC to AD 1086, providing an overview of the history of the English landscape from the Bronze Age to the Norman invasion. The result is the first account of the English landscape over a crucial 2500-year period when people created many of the features still visible today. It also provides a celebration of many centuries of archaeological work, especially the intensive investigations that have taken place since the 1960s, when frequent large-scale work has transformed our understanding of England’s past.
Patterns in the Data across England
Authors: Harkel Letty ten , Cooper Anwen , Donnelly Victoria , Gosden Chris , Green Chris , Franconi Tyler , Morley Laura
Published: May 2021

We look at regional variability in the manner in which archaeologists have worked, regional differences in the types of evidence found, and how we can understand different ways of life across England in the past with some long-term continuities to these differences. Overall, we see a broad distinction between the south and east and the north and west, with fewer artefacts in the latter region and perhaps also more mobile ways of life in many periods. We also present a series of case studies, designed to give more detailed insights into a large number of contrasting areas across England, adding nuance to the broad distinctions identified above.
Movement
Authors: Franconi Tyler , Green Chris
Published: May 2021

This chapter presents means for modelling movement including information on the nature of the terrain, contrasting also movement by land and by water. We also used the densities and distribution of archaeological evidence as a proxy for land use and movement. In addition, we include place name evidence for the early medieval period and the little we have from the Romano-British period. The results of our model are compared with possible routes on land and water for various periods to throw light on patterns of movement and impediments to connections between areas.
Relative clauses
Authors: Pinkster Harm
Published: May 2021

Chapter 18 deals with relative clauses, of which two types are distinguished: adnominal relative clauses, which modify an antecedent (a head-noun), and autonomous relative clauses, without an antecedent. Adnominal relative clauses can be restrictive or non-rectrictive. Autonomous relative clauses can fulfil various syntactic functions within their sentence and can be modified by determiners (especially is) and quantifiers. In addition, the connecting relative can be used to connect sentences.
Information structure and extraclausal expressions
Authors: Pinkster Harm
Published: May 2021

Chapter 22 deals with various aspects of the pragmatic organization of Latin texts and sentences. A distinction is made between constituents that function as topic or as focus in their clause. In addition constituents can be contrastive or emphatic. Emphasis is often made clear through emphatic particles, which are discussed in detail. Three types of extraclausal constituents are distinguished: themes, settings, and tails. Other extraclausal constituents are curses, interjections, and forms of address.
The Jewish Reformation
Authors: Gottlieb Michah
Published: May 2021

Beginning in the late eighteenth century, Jews entered the German middle class with remarkable speed. This process has often been identified with Jews’ increasing alienation from religion and Jewish nationhood. In fact, this period was one of intense engagement with Jewish texts and traditions. An expression of this was the remarkable turn to Bible translation. In the century and a half between Moses Mendelssohn’s pioneering translation and the final one by Martin Buber and Franz Rosenzweig, German Jews produced fifteen different translations of at least the Pentateuch. Buber and Rosenzweig famously critiqued bourgeois German Judaism as a craven attempt to establish social respectability to facilitate Jews’ entry into the middle class through a vapid, domesticated account of Judaism. Exploring Bible translations by Moses Mendelssohn, Leopold Zunz, and Samson Raphael Hirsch, the author argues that each sought to ground a “reformation” of Judaism along bourgeois lines, which involved aligning Judaism with a Protestant concept of religion. They did so because they saw in bourgeois values the best means to serve God and the authentic actualization of Jewish tradition. Through their learned, creative Bible translations, Mendelssohn, Zunz, and Hirsch presented distinct visions of middle-class Judaism that affirmed Jewish nationhood while lighting the path to a purposeful, emotionally rich, spiritual life grounded in ethical responsibility.
A Man of No Party
Authors: Gottlieb Michah
Published: May 2021

This chapter covers the role of Bible translation in Hirsch’s youthful Nineteen Letters on Judaism. Hirsch was educated in the tradition of Mendelssohn’s moderate Haskalah, and he came to see his mission as defending Judaism on a new basis. Hirsch developed a new vision of Judaism by engaging with four central German Jewish ideologies of his day: Haskalah, Wissenschaft des Judentums, Reform, and Jewish traditionalism. Hirsch criticized elements of these ideologies while weaving other elements into a new account of Judaism that would unite German Jews. In the Nineteen Letters he used Bible translation to elaborate this new vision. This chapter also explores Hirsch’s concept of Jewish education and gender.
Empirical and Rational Psychology
Authors: Proops Ian
Published: May 2021

This chapter examines the conceptions of rational and empirical psychology developed in the writings of Kant’s predecessors and in his own pre-critical writings. The views of the following figures are examined in detail: Wolff, Gottsched, Baumgarten, Meier, and the Kant of the ‘L1’ metaphysics lectures. Once this background has been surveyed, the chapter goes on to explore: Kant’s conception of a distinctively pure rational psychology; his science of self-consciousness; and his two contrasting understandings of how rational psychology might be pursued. The chapter argues that Kant’s target in the Paralogisms chapter is an idealized ‘pure’ rational psychology, an aspiring a priori ‘science’ of the soul, whose closest antecedents in the tradition are the views of Baumgarten, on the one hand, and his own views in the ‘L1’ metaphysics lectures, on the other.
The First Paralogism
Authors: Proops Ian
Published: May 2021

This chapter addresses a range of questions relating to the Paralogisms in general and the first Paralogism in particular. In particular it is asked: What is Kant’s notion of a paralogism? and How is transcendental illusion supposed to operate in the first paralogism? The answer to the first of these questions is surprising. Kant understands a paralogism as an argument that has true premises but is ‘false with respect to form’. But, crucially, he understands falsity with respect to form more expansively than as formal invalidity: arguments that are ‘false with respect to form’ include certain informal fallacies, including the fallacy of ignoratio elenchi—a fallacy of overestimation of the strength of one’s proven conclusion. This explains how it could be that the A-edition first paralogism is ‘false with respect to form’ (as a paralogism must, by definition, be) even though it is not in fact an invalid argument.
The Mathematical Antinomies Presented
Authors: Proops Ian
Published: May 2021

The chapter examines Kant’s conception of the phenomenon of ‘antinomy’. It argues that his classification of antinomies is grounded in his trichotomous division of oppositions (into contraries, sub-contraries, and contradictories). According to Kant’s diagnosis, while all the antinomies consist of pairs of propositions that appear to be contradictories, the mathematical antinomies are merely contraries and the dynamical antinomies sub-contraries. The chapter makes a case for the centrality of the phenomenon of antinomy to Kant’s diagnosis of dogmatic speculative metaphysics. The general form of an antinomy is discussed, along with Kant’s notion of infinity. The arguments for the thesis and antithesis position of the first two antinomies are presented in detail.
The Mathematical Antinomies Resolved
Authors: Proops Ian
Published: May 2021

This chapter identifies two lines of resolution in the mathematical antinomies, which lines, it argues, correspond to two traditional ways of attempting to generate counter-examples to the law of excluded middle. One line involves positing an instance of category clash, the other the suggestion that ‘the world’ is a non-referring singular term. The upshot, in either case, is that the thesis and antithesis are not contradictories but merely contraries (and both are false). The chapter criticizes, and then charitably reformulates, Kant’s indirect argument for Transcendental Idealism. It considers why Kant did not seek to resolve the antinomies by arguing that thesis or antithesis are nonsense. Also discussed are: reductio proofs in philosophy (and Kant’s attitude toward them, which is argued to be more sympathetic than is often supposed), regresses ad infinitum and ad indefinitum; the cosmological syllogism; the sceptical representation; the Lambert analogy, the indifferentists; and the comparison with Zeno.
The Ontological Argument
Authors: Proops Ian
Published: May 2021

This chapter argues that Kant’s criticism of the ontological argument is targeted, in the first instance, at Leibniz’s sympathetic revamping of the Cartesian argument. But Kant’s discussion actually contains a suite of objections to the ontological argument, some of them effective against Descartes, others (less successfully) directed against Wolff and Baumgarten, and one—the famous objection that being is not a real predicate—directed exclusively against Leibniz. It argues that this last objection, which appeals to the example of a hundred thalers, succeeds against Leibniz because he is prevented by his stance on the Euthyphro contrast from offering the obvious reply. Kant’s most famous objection is thus an ‘ad hominem’ argument in the original (and now largely forgotten) sense of that term: a perfectly rational argument that does not attack an opponent’s character, but rather uses one of their own commitments against them.
The Regulative Use of the Ideas
Authors: Proops Ian
Published: May 2021

This chapter examines Kant’s thesis that the Ideas of Pure Reason, and especially the Ideas of God and of the soul, though not admitting of sensible illustration, nonetheless have a valuable employment as so-called ‘regulative principles’. By proceeding as if these Ideas have existent objects we can, he supposes, be fruitfully guided in our natural-scientific inquiries. In particular, by acting as if nature expresses the purposes of a wise and benevolent creator—a being who creates the world through the operation of his faculty of freedom rather than through his essence (by emanation)—we are led to make a range of discoveries that would otherwise not be made. The chapter examines the meaning of the various principles that Kant identifies as regulative principles and explains with concrete examples how following them can promote natural scientific inquiry in a range of fields, including: optics, geology, engineering, geodesy, biology, potamology, and astronomy.
Genetic Architecture of Maize Rind Strength Revealed by the Analysis of Divergently Selected Populations
Authors: Kumar Rohit , Gyawali Abiskar , Morrison Ginnie D , Saski Christopher A , Robertson Daniel J , Cook Douglas D , Tharayil Nishanth , Schaefer Robert J , Beissinger Timothy M , Sekhon Rajandeep S
Published: May 2021

The strength of the stalk rind, measured as rind penetrometer resistance (RPR), is an important contributor to stalk lodging resistance. To enhance the genetic architecture of RPR, we combined selection mapping on populations developed by 15 cycles of divergent selection for high and low RPR with time-course transcriptomic and metabolic analyses of the stalks. Divergent selection significantly altered allele frequencies of 3,656 and 3,412 single- nucleotide polymorphisms (SNPs) in the high and low RPR populations, respectively. Surprisingly, only 110 (1.56%) SNPs under selection were common in both populations, while the majority (98.4%) were unique to each population. This result indicated that high and low RPR phenotypes are produced by biologically distinct mechanisms. Remarkably, regions harboring lignin and polysaccharide genes were preferentially selected in high and low RPR populations, respectively. The preferential selection was manifested as higher lignification and increased saccharification of the high and low RPR stalks, respectively. The evolution of distinct gene classes according to the direction of selection was unexpected in the context of parallel evolution and demonstrated that selection for a trait, albeit in different directions, does not necessarily act on the same genes. Tricin, a grass-specific monolignol that initiates the incorporation of lignin in the cell walls, emerged as a key determinant of RPR. Integration of selection mapping and transcriptomic analyses with published genetic studies of RPR identified several candidate genes including ZmMYB31, ZmNAC25, ZmMADS1, ZmEXPA2, ZmIAA41 and hk5. These findings provide a foundation for an enhanced understanding of RPR and the improvement of stalk lodging resistance.
Ensuring COVID-19 vaccines for low-income countries
Authors: Corpuz Jeff Clyde G
Published: May 2021

Ensuring global access for coronavirus disease-2019 (COVID-19) vaccines is key to avoiding severe COVID-19 disease and achieving herd immunity. This correspondence highlights the importance of advocating for effective and safe COVID-19 vaccines for low-income countries while ensuring equitable access to COVID-19 vaccines. Global access to COVID-19 vaccines for the common good is much needed.
THE POTENTIAL TO USE TLD MEASUREMENTS TO VALIDATE THE OCCUPATIONAL RADIATION PROTECTION AT THE DEPARTMENT OF NUCLEAR MEDICINE
Authors: Nilsson Isabelle , Himmelman Jakob , Khan Jehangir , Dalmo Johanna
Published: May 2021

Diagnostic examinations in nuclear medicine increase. This can cause a higher radiation burden to the personnel. The aim of this study was to create and apply a method to validate the occupational radiation protection at the Department of Nuclear Medicine using thermoluminescence dosemeters (TLD).

Occupational doses in- and outside of the department and the dose rate distribution around the positron emission tomography/computed tomography (PET/CT) were validated in terms of Hp(10) using TLD-100. Backscatter correction factors were estimated to implement the TLD measurements on different materials.

After correction for backscatter, the result indicates that doses in- and outside of the department are below recommended values and dose limits. The highest and the lowest dose rate were measured beside the 18F-autoinjector and the PET/CT gantry, respectively.

The method of using TLD gives a good estimate of how the occupational radiation protection performs at the Department of Nuclear Medicine and can thus help in the optimization of radiation protection.
Penicillium and Talaromyces Species as Postharvest Pathogens of Pear Fruit (Pyrus communis) in Serbia
Authors: Stošić Stefan , Ristić Danijela , Savković Željko , Grbić Milica Ljaljević , Vukojević Jelena , Živković Svetlana
Published: May 2021

Pears are one of the oldest and the third most important fruit species grown in temperate regions. They are consumed because of their nutritional and health benefits, in fresh form or as various processed products. This article resolves the etiology of the Penicillium-like mold symptoms on pear fruits in Serbia. Samples of pear fruits with blue mold and other Penicillium-like mold symptoms were collected in Serbia from 2016 to 2019, from four storages. The recovered isolates were identified and characterized according to a polyphasic approach. Morphological and physiological analyses were performed on three media and five temperatures, respectively. Four loci (internal transcribed spacer, beta-tubulin, calmodulin, and DNA-dependent RNA polymerase II second largest subunit) were used for sequencing, genetic identification, and phylogenetic analyses. The results of the identification by conventional and molecular methods were in agreement, and they revealed that the obtained isolates belong to five species: Penicillium crustosum, P. expansum, P. italicum, Talaromyces minioluteus, and T. rugulosus. In a pathogenicity test, P. crustosum, P. expansum, T. minioluteus, and T. rugulosus produced decay on artificially inoculated pear fruits, and P. italicum induced tissue response lesions. The results of this study are the first reports of T. minioluteus and T. rugulosus as postharvest pear pathogens. Also, these are the first world records of T. minioluteus, T. rugulosus, and P. italicum on fruits of European pear. Furthermore, this is the first finding of P. crustosum, P. expansum, P. italicum, T. minioluteus, and T. rugulosus on pear fruit in Serbia.
High Reliability Organization Principles Improve VA Workplace Burnout
Authors: Isaacks David B. , Anderson Tim M. , Moore Scott C. , Patterson William , Govindan Sushant
Published: May 2021

Provider burnout is a significant health care concern. It is unclear whether high reliability organization (HRO) practices can prevent it. The Truman Veterans Affairs Medical Center (VAMC) undertook an initiative implementing HRO principles and assessed for impact on burnout metrics. This became known as the Transformative HRO Initiative Via Employee Engagement (THRIVE2) model. THRIVE2 consisted of Just Culture training, Clinical Team Training, and continuous process improvement through Lean. Truman VAMC was compared with other Veterans Health Affairs (VHA) facilities regarding burnout and employee satisfaction metrics. Truman VAMC saw significant changes in multiple HRO metrics (P < 0.001) as well as improvements in work group psychological safety and employee exhaustion (P < 0.001). High burnout rates decreased by 52% (6.2%–2.95%; P < 0.001). Truman VAMC went from 75th to the No. 1 ranked VHA facility regarding Best Places to Work. These findings have significant national policy implications given the effects of burnout.
A Quality Improvement Intervention Leveraging a Safety Net Model for Surveillance Colonoscopy Completion
Authors: Desai Sonali P. , Jajoo Kunal , Taber Kreager , Chukwu Ashley , Emani Srinivas , Neville Bridget A. , Shen Lin , Sequist Thomas
Published: May 2021

Systems to address follow-up testing of clinically positive surveillance colonoscopy results are lacking. The impact of an ambulatory safety net (ASN) intervention on rates of colonoscopy completion was assessed. The ASN team identified patients using an electronic registry, conducted patient outreach, coordinated care, and tracked colonoscopy completion. In all, 701 patients were captured in the ASN program: 58.1% (407/701) had possible barriers to follow-up colonoscopy completion, with rates of 80.1% (236/294) if no barrier, and 40.9% (287/701) overall. Colonoscopy completion likelihood increased with prior polypectomy (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.3), and decreased with White race (OR, 0.5; 95% CI, 0.3-0.9), increased inpatient visits (OR, 0.6; 95% CI, 0.4-0.9), more outreach attempts (OR, 0.6; 95% CI, 0.5-0.7), and fair/poor/inadequate preparation (OR, 0.4; 95% CI, 0.2-0.7) in logistic regression models. An ASN model for quality improvement promotes colonoscopy completion rates and identifies patient barriers.
Respecting End-of-Life Decisions
Authors: Donahue Nadine
Published: May 2021

It may be hard for a nurse to accept what the patient wants, but it's essential.
Pregnancy and COVID-19
Authors: McSpedon Corinne
Published: May 2021

The continuing impact of the pandemic on pregnant women and obstetric care.
New Drug Protects Against Myelosuppression Secondary to Lung Cancer Chemotherapy
Authors: Aschenbrenner Diane S.
Published: May 2021

Trilaciclib (Cosela) is approved to protect normal bone marrow cells from damage secondary to chemotherapy in adults receiving a platinum–etoposide chemotherapy regimen or a topotecan chemotherapy regimen for extensive-stage small cell lung cancer.
A Case of Heart Palpitations and Shortness of Breath
Authors: Kupchik Nicole , Green Joel
Published: May 2021

Editor's note: This is the next installment in a series on electrocardiogram (ECG) interpretation. Nurses in all settings should know the basics, as medications and physiological changes can cause cardiac arrhythmias. Each article will start with a brief case scenario and an ECG strip and then take you step by step through analyzing the heart rhythm.
Kelly McGrady: ‘Help Me Help My People’
Authors: Fauteux Nicole
Published: May 2021

A Native American nurse draws on her heritage, faith, and leadership training to tackle whatever crisis is at hand.
Lost and Found in the Bronx
Authors: Jackson Kristopher J.
Published: May 2021

As dying alone became the norm during the pandemic, nurses kept family connection alive.
Placental Cord Insertion Distance From the Placental Margin and Its Association With Adverse Perinatal Outcomes
Authors: Bigelow Catherine A. , Robles Brittany N. , Pan Stephanie , Overbey Jessica , Robin Esther , Melamed Alexander , Bianco Angela , Mella Maria Teresa
Published: May 2021

(Abstracted from Eur J Obstet Gynecol Reprod Biol 2020;255:51–55)

Detection of an abnormal placental cord insertion (PCI)—either marginal or velamentous—can be assessed in the midtrimester. Marginal PCIs are defined as occurring at a distance of <2 cm from the placental edge; velamentous PCIs occur when the placental cord inserts into the fetal membrane.
Racial and Ethnic Disparities in Reproductive Health Services and Outcomes, 2020
Authors: Sutton Madeline Y. , Anachebe Ngozi F. , Lee Regina , Skanes Heather
Published: May 2021

(Abstracted from Obstet Gynecol 2021;137(2):225–233)

Racial-ethnic disparities in access and outcomes in the context of women's reproductive health continue to be pervasive in the United States. Contraceptive use, sexually transmitted infection care, human papillomavirus vaccination among younger women aged 18 to 25 years, reproductive cancers, preterm deliveries, and low-birth-weight neonates, as well as maternal morbidity and mortality, continue to have documented disparities.
Longitudinal Milestone Assessment Extending Through Subspecialty Training: The Relationship Between ACGME Internal Medicine Residency Milestones and Subsequent Pulmonary and Critical Care Fellowship Milestones
Authors: Heath Janae K. , Wang Tisha , Santhosh Lekshmi , Denson Joshua L. , Holmboe Eric , Yamazaki Kenji , Clay Alison S. , Carlos W. Graham
Published: May 2021

Purpose

Accreditation Council for Graduate Medical Education (ACGME) milestones were implemented across medical subspecialties in 2015. Although milestones were proposed as a longitudinal assessment tool potentially providing opportunities for early implementation of individualized fellowship learning plans, the association of subspecialty fellowship ratings with prior residency ratings remains unclear. This study aimed to assess the relationship between internal medicine (IM) residency milestones and pulmonary and critical care medicine (PCCM) fellowship milestones.

Method

A multicenter retrospective cohort analysis was conducted for all PCCM trainees in ACGME-accredited PCCM fellowship programs, 2017–2018, who had complete prior IM milestone ratings from 2014 to 2017. Only professionalism and interpersonal and communication skills (ICS) were included based on shared anchors between IM and PCCM milestones. Using a generalized estimating equations model, the association of PCCM milestones ≤ 2.5 during the first fellowship year with corresponding IM subcompetencies was assessed at each time point, nested by program. Statistical significance was determined using logistic regression.

Results

The study included 354 unique PCCM fellows. For ICS and professionalism subcompetencies, fellows with higher IM ratings were less likely to obtain PCCM ratings ≤ 2.5 during the first fellowship year. Each ICS subcompetency was significantly associated with future lapses in fellowship (ICS01: β = −0.67, P = .003; ICS02: β = −0.70, P = .001; ICS03: β = −0.60, P = .004) at various residency time points. Similar associations were noted for PROF03 (β = −0.57, P = .007).

Conclusions

Findings demonstrated an association between IM milestone ratings and low milestone ratings during PCCM fellowship. IM trainees with low ratings in several professionalism and ICS subcompetencies were more likely to be rated ≤ 2.5 during the first PCCM fellowship year. This highlights a potential use of longitudinal milestones to target educational gaps at the beginning of PCCM fellowship.
Medication safety in nonoperating room anesthesiology
Authors: Mack Patricia Fogarty
Published: May 2021

Purpose of review

Medication errors remain a prominent source of medical harm in spite of over 20 years of effort in establishing standardized protocols and procedures, implementing assistive electronic technologies to identify medications and prevent administration errors and in establishing a just culture with regard to reporting events and near misses.

Recent findings

Some of these interventions are even more necessary in the nonstandard environment of a non-operating room anesthesiology (NORA) procedure suite, where the anesthesiologist is often far removed from colleagues, in a dark room, lacking the standard medications commonly found in their operating room. Medication availability in NORA sites may be limited because of lack of standardization or distance from the operating room pharmacy. Proper preparation of medication may be impaired by poor lighting and cramped conditions. Medication administration might be hampered by a lack of infusion pumps or pumps without the proper medication library needed by the anesthesiologist.

Specific attention must be paid to enhancement of medication safety in NORA sites to overcome additional challenges inherent in the provision of anesthesia care remote from the standard operating room setting.
Perceived Injustice Is Associated With Pain-related Function and Mood in Youth With Acute Musculoskeletal Pain
Authors: Battison Eleanor A.J. , Wilson Anna C. , Holley Amy L.
Published: May 2021

Objectives:

Perceived injustice (PI), which is one’s appraisal of justice or fairness regarding the pain experience, is an emerging area of interest in pediatric pain research. No previous studies have investigated PI in youth with acute pain. To fill this gap, this study examined (1) associations among PI, pain-related function, and psychological function in treatment-seeking youth with acute musculoskeletal (MSK) pain, and (2) the impact of parent-child PI discordance on children’s pain and psychosocial function.

Materials and Methods:

Participants were youth (aged 11 to 17, 55% male) with acute pain (onset <1 mo) recruited from emergency departments or outpatient clinics and participating parents (102 parent-child dyads). Dyads completed study questionnaires within 1 month of the child’s pain onset.

Results:

Youth-reported PI was significantly correlated with poorer physical and psychosocial quality of life, higher pain catastrophizing, higher fear of pain, increased pain-related disability, and greater depression and anxiety. Furthermore, PI was significantly associated with the physical quality of life, psychosocial quality of life, and pain-related disability. Moreover, discordance in youth and parent ratings of PI was associated with children’s psychological and pain-related function. Specifically, compared with Concordant dyads, youth in the Discordant dyads (youth high PI/parent low PI) reported significantly poorer physical quality of life, psychosocial quality of life, higher pain-related disability, depression, anxiety, and pain catastrophizing.

Discussion:

These findings reveal that PI in youth with acute MSK pain is associated with quality of life and pain-related disability. Furthermore, results highlight the importance of discordance between youth and parent reports of PI on pain-related functioning.
The Relationship Between Disorders of Bone Metabolism and Benign Paroxysmal Positional Vertigo: A Systematic Review
Authors: Lee Ambrose , Hassannia Fatemeh , Bergin Michael J. , Al Zaabi Khalid , Misale Priyanka , Rutka John Alexander
Published: May 2021

Objectives:

Several studies have reported an association between benign paroxysmal positional vertigo (BPPV) and bone mineral density or serum vitamin D levels. The aim of this review is to provide further clarification regarding the relationship between BPPV and calcium metabolism.

Design:

PubMed and MEDLINE databases were systematically reviewed to identify all English language papers regarding the relationship between BPPV and the following terms: osteoporosis, osteopenia, bone mineral density, serum vitamin D levels, and bone metabolism.

Results:

Of the 456 identified records, 28 studies were eligible for this review. Most were retrospective studies with inherent limitations and often conflicting results. While the literature is not conclusive, osteoporosis in patients of at least 50 years old appears to have an association with BPPV. Similarly, an association was observed between recurrent BPPV and vitamin D deficiency.

Conclusion:

There is only weak evidence to support the relationship between BPPV and osteoporosis or low serum 25-hydroxyvitamin D levels. Further prospective studies with more robust methodologies are needed to clarify the association between BPPV and disorders of bone metabolism.
Orthopaedic Manifestations of Transverse Myelitis in Children
Authors: Hariharan Arun R. , Choi Joseph H. , Cook Ralph W. , Neal Kevin M. , Rogers Kenneth J. , Shrader M. Wade , Ulusaloglu Armagan C. , Howard Jason J.
Published: May 2021

Background:

Transverse myelitis (TM) is a rare inflammatory disorder of the spinal cord. It can have a heterogeneous presentation with sensory, motor, and autonomic dysfunction. Neurological sequelae of TM include autonomic dysfunction, motor weakness, and/or spasticity. Studies describing orthopaedic deformities and treatments associated with TM are nonexistent. This purpose of this study was to describe the orthopaedic manifestations of TM in children.

Methods:

A multicenter retrospective review was conducted of patients, 0 to 21 years of age, with TM presenting over a 15-year period at 4 academic children’s hospitals. Those with confirmed diagnosis of TM and referred to an orthopaedic surgeon were included. Demographics, orthopaedic manifestations, operative/nonoperative treatments, and complications were recorded. Descriptive statistics were used for data reporting.

Results:

Of 119 patients identified with TM, 37 saw an orthopaedic surgeon. By etiology, 23 were idiopathic (62%), 10 infectious (27%), 3 (8%) inflammatory/autoimmune, and 1 (3%) vascular. The mean age at diagnosis was 6.7 (SD: 5.5) years and at orthopaedic presentation was 8.4 (SD: 5.2) years. Orthopaedic manifestations included scoliosis in 13 (35%), gait abnormalities in 7 (19%), foot deformities in 7 (19%), upper extremity issues in 7 (19%), symptomatic spasticity in 6 (16%), lower extremity muscle contractures in 6 (16%), fractures in 6 (16%), hip displacement in 3 (8%), pain in 2 (5%), and limb length discrepancy in 2 (5%) patients. Seven children (19%) were seen for establishment of care. In all, 14 (38%) underwent operative intervention, mainly for soft-tissue and scoliosis management. Four patients had baclofen pump placement for spasticity management. Postoperative complications occurred in 36% of cases, most commonly because of infection. Neither topographic pattern nor location of lesion had a significant relationship with need for hip or spine surgery.

Conclusions:

This report describes the orthopaedic manifestations associated with TM in children, nearly 40% of whom required operative intervention(s). Understanding the breadth of musculoskeletal burden incurred in TM can help develop surveillance programs to identify and treat these deformities in a timely manner.

Level of Evidence:

Level IV
Operative Pediatric Hand Infections: A Retrospective Review
Authors: Grome Luke J. , Raj Sarth , Abu-Ghname Amjed , Bell Bryce , Reece Edward M. , Pederson William C. , Koshy John C.
Published: May 2021

Background:

Infections in the pediatric population are a less well studied topic in hand surgery. Crucial aspects of the management of pediatric hand infections differ from adults, though much of current treatment is generalized from adult care. This study evaluates our clinical experience with regards to the epidemiology, management, and outcomes of pediatric hand infections requiring operative intervention.

Methods:

A 7-year retrospective chart review was performed of all pediatric patients who required operative intervention for hand infections at Texas Children’s Hospital. Clinical information was collected and analyzed, including demographics, infection characteristics, management, and outcomes.

Results:

Fifty-seven patients met the inclusion criteria for our study over the 7-year period. Of these, 7% (n=4) had a pre-existing diagnosis of diabetes mellitus, and 5% (n=3) had a recent history of upper extremity infections. The most common infection was a discrete abscess, whereas urgent/emergent conditions represented 25% (n=14) of infections. Radiographic changes consistent with osteomyelitis were present in over one-quarter of patients (n=13, 23%). The median length of hospital stay was 3 days (95% confidence interval: 3.05-5.05) and the most common pathogen was Staphylococcus aureus (n=33, 58%), with slightly more being methicillin sensitive (MSSA) than resistant (MRSA) (n=19, 33% vs. n=14, 25%). The incidence of reoperation was 12.5% (n=7).

Conclusions:

Hand infections are a common problem in the pediatric population. Cases tend to be associated with accidental trauma and discrete abscesses colonized by MSSA/MRSA. The vast majority of cases require only one operation and a short course of wound care before discharge.

Level of Evidence:

Level IV—therapeutic study.
Improved Bowel Function With Oral Methylnaltrexone Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis
Authors: Lin Adrian J. , Costandi Andrew J. , Kim Eugene , Skaggs David L. , Andras Lindsay M. , Patel Neha , Lo Carl , Illingworth Kenneth D.
Published: May 2021

Background:

Methylnaltrexone, a peripheral opioid antagonist, is used to decrease opioid-induced constipation; however, there is limited evidence for its use in children. The primary objective of the study is to assess the efficacy of per os (PO) methylnaltrexone in inducing bowel movements (BMs) in patients with adolescent idiopathic scoliosis who underwent a posterior spinal fusion and instrumentation (PSFI). Secondary outcomes include hospital length of stay, postoperative pain scores, and postoperative opioid usage.

Methods:

Retrospective chart review identified all adolescent idiopathic scoliosis patients above 10 years of age who underwent PSFI with a minimum of 24 hours of postoperative opioid analgesia after the initiation of the new bowel regimen protocol. The bowel regimen included daily administration of PO methylnaltrexone starting on postoperative day 1 until BM is achieved. A case-matched cohort was obtained with patients who did not receive PO methylnaltrexone and otherwise had the same bowel function regimen. Case-matched controls were also matched for age, sex, body mass index, and curve severity.tTests and Pearson χ2tests were used for statistical analysis.

Results:

Fifty-two patients received oral methylnaltrexone (14±2.6 y) and 52 patients were included in the case-matched control group (14±2.1 y). The methylnaltrexone group had a significantly shorter hospital length of stay (3.09±0.66) compared with controls (3.69±0.80) (P<0.01). 59% (31 of 52) of the methylnaltrexone group had a BM by postoperative day postoperative day 2, compared with 30% (16 of 52) of the control group (P<0.01). In the methylnaltrexone group, 44% (23 of 52) of the patients required a Dulcolax (bisacodyl) suppository and 11% (6 of 52) required an enema, compared with 50% (26 of 52) and 33% (12 of 52) of the control group respectively (P=0.43 and 0.12). In addition, significantly less patients had abdominal distension during their postoperative stay in the methylnaltrexone group (17%, 9 of 52) compared with the control group (40%, 21 of 52) (P<0.01). There was no significant difference in self-reported average FACES pain score (P=0.39) or in opioid morphine equivalents required per hour (P=0.18).

Conclusions:

Patients who received PO methylnaltrexone after PSFI had decreased length of stay and improved bowel function. Administration of methylnaltrexone did not increase maximum self-reported FACES pain values or opioid consumption compared with controls. The use of oral methylnaltrexone after PSFI reduces postoperative constipation, which has implications for reducing hospital length of stay and overall morbidity.

Level of Evidence:

Level III—retrospective comparative study.
Predictors of Arthrofibrosis After Pediatric Anterior Cruciate Ligament Reconstruction: What Is the Impact of Quadriceps Autograft?
Authors: Ouweleen Abraham J. , Hall Tyler B. , Finlayson Craig J. , Patel Neeraj M.
Published: May 2021

Background:

Recent literature on arthrofibrosis after anterior cruciate ligament reconstruction (ACLR) in children and adolescents is limited, especially with regards to quadriceps tendon (QT) autograft. The purpose of this study was to identify predictors of arthrofibrosis after ACLR, with attention to the impact of graft type.

Methods:

Patients that underwent primary ACLR at a tertiary children’s hospital were reviewed for this retrospective case-control study. Those with multiligament reconstructions, lateral extra-articular tenodesis procedures, allografts, or a modified MacIntosh reconstruction were excluded. Arthrofibrosis was defined as a deficit of 10 degrees of extension and/or 20 degrees of flexion at 3 months after ACLR. Univariate analysis was followed by purposeful entry logistic regression to adjust for confounding factors.

Results:

A total of 378 patients (mean age 15.9±1.7 y, 49.7% female) were included in the analysis, of which there were 180 patellar tendon (PT), 103 hamstrings tendon (HT), and 95 QT grafts. The rate of arthrofibrosis was 1.9% for HT, 6.3% for QT, and 10.0% for PT (P=0.04). Females developed arthrofibrosis more frequently than males (10.6% vs. 3.2%, P=0.004). Those that ultimately experienced this complication had lower median flexion at 6 weeks after ACLR (88 vs. 110 degrees, P<0.001). In multivariate analysis, PT graft raised the odds of arthrofibrosis 6.2 times compared to HT [95% confidence interval (CI): 1.4-27.6, P=0.02], but there were no significant differences between QT and other grafts. Females were at 4.2 times higher odds than males (95% CI: 1.6-10.8; P=0.003). Patients that were unable to attain 90 degrees of flexion 6 weeks after ACLR had 14.7 times higher odds of eventually developing arthrofibrosis (95% CI: 5.4-39.8; P<0.001). Finally, those with an extension deficit of ≥5 degrees 6 weeks after ACLR had 4.7 times higher odds of experiencing this complication (95% CI: 1.8-12.2, P=0.001).

Conclusion:

The rate of arthrofibrosis with QT autograft is 6.3% after pediatric ACLR. PT autograft, female sex, and motion deficits at 6 weeks after ACLR were predictive of arthrofibrosis in children and adolescents.

Level of Evidence:

Level III—prognostic study.
Prognosis of Congenital Pseudarthrosis of the Tibia: Effect of Site of Tibial Pseudarthrososis and Fibular Involvement
Authors: Zargarbashi Ramin , Bagherpour Ali , Keshavarz-Fathi Mahsa , Panjavi Behnam , Bagherpour Zarchi Masoud
Published: May 2021

Background:

Congenital pseudarthrosis of the tibia is a rare condition that has long been one of the most challenging concerns in pediatric orthopedic surgery. When the fracture occurs, a recalcitrant nonunion is expected. This is why successful treatment means maintaining a long-term union. In this study, we aimed to assess the therapeutic outcomes for the middle and distal third fractures of the tibia and to explore whether the treatment of concurrent fibular pseudoarthrosis affects the outcome.

Methods:

We studied 12 patients with congenital pseudarthrosis of the tibia (Crawford type 4) from 2014 to 2019. A combination approach including intramedullary rod, Ilizarov apparatus, corticocancellous bone graft, and periosteal graft was used. In the initial surgery, we did not fix the ankle and subtalar joints.

Results:

As a result, the union was achieved in 67% of the cases after the index surgery. All of the cases with primary nonunion were related to the concurrent fibular and distal third tibial pseudarthrosis. In addition, ignoring the treatment of fibular pseudarthrosis in the index surgery led to ankle valgus deformity both in the middle and in the distal third tibial pseudarthrosis. We finally achieved a 100% union rate in all cases, with no subsequent refracture.

Conclusions:

Surgery at an early age was associated with favorable results and minimized deformity. In concurrent fibular and distal third tibial pseudarthrosis, it is recommended to transfix the ankle and subtalar joints to create a cross-union with fibula so that the intense union can be confidently obtained with more cross-section to prevent ankle valgus deformity.

Level of Evidence:

Level IV—case series.