bluuebunny/crossref_metadata_2025 huggingface dataset:
Clitics are/become Minimal(ist)
Authors: Franks Steven L.
Published: November 2016

This paper considers the general question of what properties distinguish clitics from other sorts of words. Focusing on South Slavic and in particular Slovenian data, it is argued that canonically clitics are minimal vocabulary items with respect to sound, meaning, and syntax: they lack (i) prosodic structure (above the syllable), (ii) semantic features (beyond the purely grammatical), and (iii) syntactic structure (above the head). For some items, however, departures from this canonical characterization exist, as do additional restrictions.
The left periphery of multiple wh-questions in Slovenian
Authors: Mišmaš Petra
Published: November 2016

In this paper I focus on multiple wh-questions in Slovenian and argue for an analysis in which wh-phrases move to the extended left periphery of the sentence. Assuming the Cartographic approach, I consider the order of wh-phrases in Slovenian multiple wh-questions, which was previously described as free, e.g. Golden (1997). While I confirm that the order of wh-phrases in the left periphery is generally free, I show that there are some exceptions, e.g. zakaj ‘why’ and kako ‘how’ tend to precede other wh-phrases. In addition, I show that the order of wh-phrases with respect to focus and topic phrases is free, but that one wh-phrase needs to appear in a clause initial position for a question to get a true wh-question reading. Based on this, I propose that the clause initial wh-phrase moves to the Interrogative Projection, in the sense of Rizzi (2001a), and the remaining wh-phrases to Wh-Projections. Crucially, because wh-movement is not restricted by a requirement on chains, cf. Krapova & Cinque (2005), the order of wh-phrases is free.
Geographic variation in a non-canonical infinitive structure with the modal verb brauchen
Authors: Van Praet Pascale , Magnus Gilbert
Published: November 2016

The objective of the present paper is to demonstrate that it is possible to measure and situate an atypical construction. The focus will be on a “satellite” modal verb in modern German: the verb brauchen followed by an infinitive construction, and therefore marked or not marked as an infinitive complementation. Referring to descriptive grammars, the first part will summarize the typical construction of modal verbs in German and of the verb brauchen + infinitive and diverging opinions on the structure (nicht) brauchen + infinitive verb without any marker. The second part presents a corpus-based analysis of European newspapers in German-speaking regions over the last ten years areas. Observations and quantifications will show that there are important differences between Northern and Southern Germany, Southern Germany and Austria, Austria and Switzerland. The third part is a contextual study of non-marked infinitive constructions following brauchen which leads to syntactic, semantic and pragmatic analyses of the occurrences. In the pragmatic study we will consider the context of the occurrences so that written and oral conception will be discussed. The pragmatic study will show some recurrent speech acts. The last part reflects upon the semantics of brauchen inside the modality as one of the means to express necessity, similarities and differences with müssen, and at least the geographic factors that could explain the phenomenon of variation.
Introduction to Healthcare for Arabic-speaking Interpreters and Translators
Authors: Crezee Ineke H.M. , Gailani Nawar , Gailani Anna N.
Published: November 2016

Arabic is a language of substantial cultural and religious importance. It is spoken by about 300 million people, predominantly in the 22 countries of the Arab world, as well as in several other regions where the Arab diaspora has settled. Arabic is also the language of Islam and underpins the religious practice of about 1.5 billion Muslims worldwide.
In view of the above, the authors thought it important to create an easily accessible handbook for interpreters, translators, educators and other practitioners working between Arabic and English in healthcare settings. Introduction to Healthcare for Arabic-speaking Interpreters and Translators follows the seminal publication Introduction to Healthcare for Interpreters and Translators (Crezee, 2013) and has been supplemented with Arabic glossaries and comments about health communication between Anglophones and Arabic speakers. This practical resource book will help inform interpreters and translators about healthcare settings, anatomy, physiology, medical terminology and frequently encountered conditions, diagnostic tests and treatment options.
Arabic is divided into two categories: formal (Classical, Standard or literary) Arabic, and local dialects (colloquial Arabic). Formal Arabic is the official language of all Arab countries. In each of these, there are regional dialects which color formal Arabic and add character to a poetic and expressive language. Poetic nature is found in many daily expressions, and not only in Arabic literature, for example, “Good morning” in Arabic is “Ssabah al khair”, which in essence wishes others a morning of goodness; and, the pan-Arab greeting “Salam Alaykum”, which literally means “may peace be upon you”. Dialects once existed principally in spoken form but these days they are increasingly used in writing in social media and its paraphernalia (mobile phones, tablets, etc.). In this book, formal Arabic is used in the glossaries, simply because it is the recognized language of literacy across the Arabic-speaking world.
Gesturing more diminishes recall of abstract words when gesture is allowed and concrete words when it is taboo
Authors: Matthews-Saugstad Krista M. , Raymakers Erik P. , Kelty-Stephen Damian G.
Published: November 2016

Gesture during speech can promote or diminish recall for conversation content. We explored effects of cognitive load on this relationship, manipulating it at two scales: individual-word abstractness and social constraints to prohibit gestures. Prohibited gestures can diminish recall but more so for abstract-word recall. Insofar as movement planning adds to cognitive load, movement amplitude may moderate gesture effects on memory, with greater permitted- and prohibited-gesture movements reducing abstract-word recall and concrete-word recall, respectively. We tested these effects in a dyadic game in which 39 adult participants described words to confederates without naming the word or five related words. Results supported our expectations and indicated that memory effects of gesturing depend on social, cognitive, and motoric aspects of discourse.
Frame Analysis in Climate Change Communication
Authors: Schäfer Mike S. , O'Neill Saffron
Published: November 2016

Framing—selecting certain aspects of a given issue and making them more salient in communication in order to “frame” the issue in a specific way—is a key concept in the study of communication. At the same time, it has been used very differently in scholarship, leading some to declare it a “fractured paradigm,” or an idea whose usefulness has expired. In studies of climate change communication, frame analyses have been used numerous times and in various ways, from formal framing approaches (e.g., episodic vs. thematic framing) to topical frames (both generic and issue-specific). Using methodological approaches of frame analysis from content analysis over discourse analysis and qualitative studies to experimental research, this research has brought valuable insights into media portrayals of climate change in different countries and their effects on audiences—even though it still has limitations that should be remedied in future research.
Research Findings on the Evolution of Peacekeeping
Authors: Gizelis Theodora-Ismene , Dorussen Han , Petrova Marina
Published: November 2016

Peacekeeping has evolved both in its focus and in setting increasingly ambitious goals. In effect, the referent object of peacekeeping—what and whose peace is to be kept—has changed. The peace that is to be kept has evolved from a negative conception of peace to an increasingly positive understanding of peace. Similarly, the object of the peace has shifted from the global to the national and ultimately to the local. In effect, this has raised the bar for peacekeeping.

Peacekeeping research has mirrored these changes in the expectations and practice of peacekeeping, and the (in)effectiveness of peacekeeping has remained a constant concern. The evaluation has shifted from the authorization and organization of peacekeeping missions to the impact of peacekeepers in avoiding the recurrence of conflict and ultimately to the ability of peacekeepers to change the situation on the ground as well as the interaction between peacekeepers and the local population.

Research on peacekeeping has become increasingly methodologically sophisticated. Originally, qualitative case studies provided a largely critical evaluation of the effect of peacekeeping. Large-n quantitative studies have reassessed where peacekeepers are deployed and who provides peacekeepers. Controlling for selection bias and possible endogeneity, quantitative research finds that peacekeeping makes the recurrence of conflict less likely. Disaggregate data on peacekeeping confirm that peacekeeping contains local conflict and protects local civilian populations. At the same time, recent research suggests that peacekeepers have had notable success in positively affecting conflict societies by means of security sector reform and building state capacity. There is also preliminary evidence that peacekeeping is able to support democratization and economic development.
Foreign Aid as Foreign Policy Tool
Authors: Apodaca Clair
Published: November 2016

The majority of countries around the world are engaged in the foreign aid process, as donors, recipients, or, oftentimes, both. States use foreign aid as a means of pursuing foreign policy objectives. Aid can be withdrawn to create economic hardship or to destabilize an unfriendly or ideologically antagonistic regime. Or, conversely, aid can be provided to bolster and reward a friendly or compliant regime.

Although foreign aid serves several purposes, and not least among them the wish to increase human welfare, the primary reason for aid allocations or aid restrictions is to pursue foreign policy goals. Strategic and commercial interests of donor countries are the driving force behind many aid programs. Not only do target countries respond to the granting of bilateral and multilateral aid as an incentive, but also the threat of aid termination serves as an effective deterrent. Both the granting and the denial of foreign assistance can be a valuable mechanism designed to modify a recipient state’s behavior.

Donors decide which countries will receive aid, the amount of aid provided, the time frame in which aid is given, and the channel of aid delivery. The donor’s intentions and the recipient’s level of governance determine the type or sector of foreign aid. States can choose between bilateral or multilateral methods of disbursing foreign assistance in order to pursue their interests. Although bilateral disbursements allow the donor state to have complete control over the aid donation, the use of multilateral forums has its advantages. Multilateral aid is cheaper, it disperses accountability, and it is often viewed as less politically biased.

Foreign aid, once the exclusive foreign policy instrument of rich powerful states, is now being provided by middle-income countries, too. The motivation for foreign aid allocations by nontraditional donors parallels the motives of traditional Development Assistance Committee (DAC) donors. A main difference between traditional and nontraditional aid donors is that nontraditional aid donors generally do not place conditionalities on their loans.

The issue of fungibility can obstruct the donor government’s purpose behind the allocation of foreign aid. If the preferences of the recipient government are different from those of the donor, the recipient can often divert the aid and use it for other purposes. A recipient government may reallocate its budget after it determines how much aid it is slated to receive. The recipient government will redirect its resources to areas it deems a priority that cannot be funded externally, for example the military or prestige projects.
Historical Approaches to the Study of Crime, Media, and Popular Culture
Authors: Knepper Paul
Published: November 2016

Historical study of crime, media, and popular culture has been underway since “the cultural turn” in the social sciences and humanities in the 1980s. Since then, a diverse literature has emerged presenting different theories, dealing with various time periods and topics, and challenging contemporary assumptions. Much of this work has focused on the press, because newspaper archives offer a familiar source for researchers accustomed to working with documents in libraries and because “moral panic” has provided a theory that can be easy moved from one time and place to another. However, crime, media, and popular culture presents a vast history and much of this has yet to be examined by criminologists. It includes broadcast radio, television, and feature films, as well as folklore, ballad and song, and theatrical performance, not to mention novels and stories. There has been enough historical research by specialists in literature, journalism history, film history, and other fields to demonstrate the value of historical research for criminology. But making to most of this history will require methodological innovation and theoretical development. To understand the history of crime, media, and popular culture, criminologists will need to move away from document-based historical research and toward digital forms of archived media. They will also need to develop theoretical perspectives beyond 1970s sociology.
Police Dramas on Television
Authors: Dowler Ken
Published: November 2016

Since the inception of television, portrayal of crime and justice has been a central feature on television. In particular, the police are featured as prominent characters in many fictional crime programs. Some television cops, such as Joe Friday, Columbo, and Kojak transcend the genre and become enshrined within popular culture. Sometimes referred to as a police procedural, the police drama is a staple of both current and past television programming. In fact, almost 300 police dramas have aired on American network, cable, and syndicated television, with several new shows premiering each year. The vast majority of these shows are short-lived and are largely forgotten. However, some police dramas capture large viewing audiences and/or achieve critical acclaim. Sweeping changes within society have resulted in shifting portrayals of the police on television. Early portrayals focused on a law and order approach, in which the police were moral agents who represented a conservative, pro-establishment point of view. These types of shows represent the so-called “authentic” police drama. The authentic police drama features storylines and characters that engage in somewhat realistic investigative practices and depict relatively common criminal events. The classic example of an authentic police drama is Dragnet, while more recent versions would include shows such as the very popular Law and Order franchise. The 1970s represented the golden age of the police drama, with numerous shows that can be described as gimmicky, with police appearing as super-cops who could singlehandedly fight corruption and achieve justice. Moreover, demographic shifts in the field of policing led to more diversity in media depictions of police, with shows that featured female and African-American characters. In the 1980s, the portrayal of police became even more complex with the appearance of Hill Street Blues, a genre altering show that introduced serialized storylines and characters that were depicted with distinctly human characteristics, with real emotions and flaws. Moreover, the standard law and order approach was challenged, as a more liberal explanation of crime emerged with social inequality as a cause of criminal behavior. Contemporary police dramas, especially shows that appear on network television, tend to focus on a law and order approach. The emergence of cable networks has allowed the police drama to push the limits of television by depicting the police in a more realistic fashion.
Juries in Film and Television
Authors: Marder Nancy S.
Published: November 2016

The early jury films typically portray the jury as a passive group of men who simply watch the trial with little reaction. They are meant to stand in for the viewer. The viewer, like the jury, is supposed to reach a verdict as to the defendant’s guilt or innocence. There are a few exceptions to this traditional portrayal of the jury. The exceptions involve a holdout juror who is dissatisfied with the verdict and conducts his or her own investigation. The most well-known jury film, 12 Angry Men, which aired in 1957, marks a departure from these traditional and exceptional portrayals of a jury. This film is an outlier in the annals of jury films because it shows the jury at work; all the action takes place as the jury deliberates in the jury room. It also depicts an unusual scenario in which a single juror is able to stand up against the other 11 jurors and ultimately persuade them to change their votes. One reason this film has endured is that it depicts an individual’s uphill battle against a group. Another reason is that the plot has been incorporated into episodes of popular television shows so that new generations of viewers learn about it. There have been only a few modern films that focus on the jury. Some of these films return to the theme of the holdout juror who carries out a subsequent investigation to uncover the truth, whereas others show a juror who engages in misconduct or self-help in the face of a defendant who has abused the trial process. Although the focus on the holdout juror in many of these films, both old and new, provides drama, holdout jurors are hard to find in actual jury trials, especially when there are just one or two jurors who are holdouts.
Professional Criminals and White-Collar Crime in Popular Culture
Authors: Holmes Timothy
Published: November 2016

In 1940, Edwin Sutherland claimed that the discipline of criminology was operating with an inaccurate view of criminal behavior. He argued that criminology focused too much on the offending of working-class people via the causal mechanisms of poverty, psychopathy, and sociopathy. His theory on white-collar crime was an observation that people of high social class commit crimes and have their own forms of offending behavior. Of this behavior, Sutherland noted that it could be more far-reaching and damaging than offenses committed by the working class, while at the same time encountering less scrutiny and condemnation from society. By taking the first steps into the study of crimes of the powerful, Sutherland opened up discussion of a wide range of nonviolent, financially motivated offenses such as corruption of state officials, fraud, and embezzlement. He proposed the theory of differential association as an attempt to provide a more effective explanation of offending behavior inclusive of the offending of the rich and powerful.

During the 20th century, research into white-collar criminals and the professional con artist has revealed broad typologies of offending behavior and patterns of offending. Today, white-collar crime is a broad term that applies to a range of activities and has become shorthand for discussions of crimes that involve deception, abuse of trust, and intelligent criminals.

Media representations have emphasized these characteristics and portrayed white-collar criminals and con artists as offending elites, both in terms of social class and type of offending. Film and television depictions present an elaborate form of criminality based on guile and manipulation of victims. The image of the white-collar criminal, the professional con artist, and their victims in popular culture are equally nuanced and tap into ideas about the moral acceptability of this kind of offending. The influence of popular culture on attitudes toward white-collar crime is of great interest in the study of criminology.
Cultural Studies Approaches to the Study of Crime in Film and on Television
Authors: King Neal , Streeter Rayanne , Rose Talitha
Published: November 2016

Crime film and television has proliferated such influential variations as the Depression-era gangster film; the post–World War studies in corruption known as film noir; the pro-police procedural of that time; and then the violent rogue-cop stories that eventually became cop action in the 1980s, with such hits as television’s Miami Vice and cinema’s Die Hard. Mobster movies enjoyed a resurgence with the works and knockoffs of Scorcese (Goodfellas) and Tarantino (Reservoir Dogs), resulting in such TV series as The Sopranos, and with a return to “blaxploitation” with the ’hood movies of the early 1990s. Recent developments include the neo-noir erotic thriller; the rise of the corrupt cop anti-hero, paralleled by the forensic procedural, often focused on baroque serial killers; and the near disappearance of black crime movies from cinema screens. Such developments may owe to shifts in relations between real policing, real crime, and citizens, but they may owe more directly to shifts in the movie/television industries that produce them. Such industry shifts include freewheeling depictions of social problems in early cinema; carefully controlled moralism over the 1930s established by such industrial regulators as the Production Code in Hollywood and the British Board of Film Censors; further repression of subversion as anti-Communism swept through Hollywood in the 1950s; then a return of repressed violence and cynicism in the 1970s as Hollywood regulation of depictions of crime broke down; and a huge spike in box office and ratings success in the 1980s, which resulted in the inclusion of more heroes who are not both white and male. The rise of the prime-time serial on television, enhanced by the introduction of time-shifting technologies of consumption, has allowed for more extended storytelling, usually marketed in terms of “realism,” enabling a sense of unresolved social problems and institutional inertia, for which shows like The Wire have been celebrated.

The content of such storytelling, in Western film and television, tends to include white male heroes meeting goals (whether success as criminals or defeat of them as cops) through force of will and resort to violence. Such stories focus on individual attributes more than on social structure, following a longstanding pattern of Hollywood narrative. And they present crime as ubiquitous and both it and the policing of it as violent. The late 1980s increase in the depiction of women of all races and men of color as heroes did little to alter those patterns. And gender patterns persist, including the absence of solidarity among women and the absence of women from stories of political corruption or large-scale combat.
Postcolonialism and Education
Authors: Enslin Penny
Published: November 2016

Education was a strategy in the colonization of large parts of the globe by European colonial powers. Postcolonialism, a diverse school of thought, demands that the ongoing destructive consequences of the colonial era be exposed, analyzed, and addressed through action. Postcolonial literature, while illuminating the dehumanizing effects of colonization, has understandably focused on the hegemony of Western culture and its effects on education, but it has been vulnerable to criticism that it ought also to pay attention to colonialism as the capitalist exploitation of colonies and former colonies, for their wealth and labor and as markets for manufactured goods. Postcolonial education addresses cultural imperialism by recognizing and unsettling its legacy in the school curriculum and the Western assumptions about knowledge and the world that underpin it, fostering a pedagogy of critique and transformation in the metropole and the periphery. Globalization in the 21st century has intensified interactions between the metropole and former colonies, in an increasingly integrated world system in which neo-liberal influences have created a new form of empire that embraces education. While demands for the restoration of indigenous forms of education are understandable as a response to cultural dispossession, new directions in postcolonial educational thought will also need to accommodate hybridity and to attend to the material conditions of global inequality.
School Climate
Authors: Berkowitz Ruth , Iachini Aidyn , Moore Hadass , Capp Gordon , Astor Ron Avi , Pitner Ronald , Benbenishty Rami
Published: November 2016

Educational practitioners and researchers have increasingly recognized the importance of the context in which learning occurs, particularly the influence of school climate on students’ academic, social, and emotional outcomes. School climate is based on the subjective experiences of school life for students, staff members, school leaders, parents, and the entire school community. A school’s climate reflects its norms, goals, values, interpersonal relationships, teaching and learning practices, and organizational structures. A large body of evidence connects a positive school climate to improvements in children’s learning and healthy development in school. A positive school climate is also an essential component within comprehensive school improvement processes. Nonetheless, the divergence and disagreement in defining and measuring school climate in the literature are evident. There is a major interest in school climate improvement and school climate policy. However, the policy context that supports school climate varies considerably across the United States and internationally. Clarification regarding the dimensions of school climate and continued research on how a positive school climate contributes to both school and student outcomes remain important.
Martin Luther in Global Pentecostalism
Authors: Wilson Sarah Hinlicky
Published: November 2016

Global Pentecostalism encompasses three distinct waves or movements: the Classical Pentecostal denominations inspired by the Azusa Street revival in the early 20th century; the Charismatic renewal in historic mainline churches starting in the 1950s; and independent Neocharismatic congregations and networks that began to multiply dramatically starting in the 1980s. Early Classical Pentecostals tended to have a positive attitude toward Luther as the beginning of the “restoration” of the lost doctrine and practice of the apostolic church, but only Jonathan Paul and his Mühlheimer Verband in Germany engaged in any meaningful way with Lutheran theology. Faced with fierce opposition within their denominations, Lutheran Charismatics such as Theodore R. Jungkuntz saw a need to correlate their spiritual distinctives with the Lutheran Confessions, which reached its most detailed expression in Welcome, Holy Spirit, edited by Larry Christenson. The Evangelical Church Mekane Yesus in Ethiopia responded most positively to Charismatic renewal of all Lutheran churches in the world with its 1976 statement, “The Work of the Holy Spirit.” While contemporary Classical Pentecostal theologians have only begun to engage with Luther, notable examples include Frank D. Macchia, Veli-Matti Kärkkäinen, and David J. Courey, who deal primarily with the doctrine of justification and the theology of the cross. The encounter of Lutheran theology with Pentecostalism suggests that both sides need to develop more comprehensive accounts of Christian experience and its role in doctrine, piety, and church life.
Advanced Boolean modeling of biological networks applied to systems pharmacology
Authors: Irurzun-Arana Itziar , Pastor José Martín , Trocóniz Iñaki F , Gómez-Mantilla José David
Published: November 2016

Motivation

Literature on complex diseases is abundant but not always quantitative. Many molecular pathways are qualitatively well described but this information cannot be used in traditional quantitative mathematical models employed in drug development. Tools for analysis of discrete networks are useful to capture the available information in the literature but have not been efficiently integrated by the pharmaceutical industry. We propose an expansion of the usual analysis of discrete networks that facilitates the identification/validation of therapeutic targets.

Results

In this article, we propose a methodology to perform Boolean modeling of Systems Biology/Pharmacology networks by using SPIDDOR (Systems Pharmacology for effIcient Drug Development On R) R package. The resulting models can be used to analyze the dynamics of signaling networks associated to diseases to predict the pathogenesis mechanisms and identify potential therapeutic targets.

Availability and Implementation

The source code is available at https://github.com/SPIDDOR/SPIDDOR.

Supplementary information

Supplementary data are available at Bioinformatics online.
Computational prediction of species-specific malonylation sites via enhanced characteristic strategy
Authors: Wang Li-Na , Shi Shao-Ping , Xu Hao-Dong , Wen Ping-Ping , Qiu Jian-Ding
Published: November 2016

Motivation

Protein malonylation is a novel post-translational modification (PTM) which orchestrates a variety of biological processes. Annotation of malonylation in proteomics is the first-crucial step to decipher its physiological roles which are implicated in the pathological processes. Comparing with the expensive and laborious experimental research, computational prediction can provide an accurate and effective approach to the identification of many types of PTMs sites. However, there is still no online predictor for lysine malonylation.

Results

By searching from literature and database, a well-prepared up-to-data benchmark datasets were collected in multiple organisms. Data analyses demonstrated that different organisms were preferentially involved in different biological processes and pathways. Meanwhile, unique sequence preferences were observed for each organism. Thus, a novel malonylation site online prediction tool, called MaloPred, which can predict malonylation for three species, was developed by integrating various informative features and via an enhanced feature strategy. On the independent test datasets, AUC (area under the receiver operating characteristic curves) scores are obtained as 0.755, 0.827 and 0.871 for Escherichia coli (E.coli), Mus musculus (M.musculus) and Homo sapiens (H.sapiens), respectively. The satisfying results suggest that MaloPred can provide more instructive guidance for further experimental investigation of protein malonylation.

Availability and Implementation

http://bioinfo.ncu.edu.cn/MaloPred.aspx.

Supplementary information

Supplementary data are available at Bioinformatics online.
Intrathecal Amphotericin B: A 60-Year Experience in Treating Coccidioidal Meningitis
Authors: Ho Jackie , Fowler Pete , Heidari Arash , Johnson Royce H
Published: November 2016

Coccidioidal meningitis (CM) is a devastating complication of coccidioidomycosis. Since the late 1950s, intrathecal (IT) amphotericin B deoxycholate (AmBd) has been successfully used to treat and often cure this disease, reducing mortality rates from 100% to approximately 30%. The introduction of azoles further revolutionized the treatment of coccidioidal infections. However, IT AmBd remains the only known curative option in the management of CM. While the use of IT AmBd is well described in many articles, few discuss the actual methods behind preparation, titration, and dosing strategies utilized. The practitioners at Kern Medical (Bakersfield, California) have >60 years of experience in the utilization of IT AmBd and the treatment of CM. This article describes the practice experience in the treatment of CM, preparation of IT AmBd, and the different dosing strategies used in regard to route of administration (ie, cisternal, lumbar, ventricular).
Graphics help patients distinguish between urgent and non-urgent deviations in laboratory test results
Authors: Zikmund-Fisher Brian J , Scherer Aaron M , Witteman Holly O , Solomon Jacob B , Exe Nicole L , Tarini Beth A , Fagerlin Angela
Published: November 2016

Objective: Most electronic health record systems provide laboratory test results to patients in table format. We tested whether presenting such results in visual displays (number lines) could improve understanding.

Materials and Methods: We presented 1620 adults recruited from a demographically diverse Internet panel with hypothetical results from several common laboratory tests, first showing near-normal results and then more extreme values. Participants viewed results in either table format (with a “standard range” provided) or one of 3 number line formats: a simple 2-color format, a format with diagnostic categories such as “borderline high” indicated by colored blocks, and a gradient format that used color gradients to smoothly represent increasing risk as values deviated from standard ranges. We measured respondents’ subjective sense of urgency about each test result, their behavioral intentions, and their perceptions of the display format.

Results: Visual displays reduced respondents’ perceived urgency and desire to contact health care providers immediately for near-normal test results compared to tables but did not affect their perceptions of extreme values. In regression analyses controlling for respondent health literacy, numeracy, and graphical literacy, gradient line displays resulted in the greatest sensitivity to changes in test results.

Discussion: Unlike tables, which only tell patients whether test results are normal or not, visual displays can increase the meaningfulness of test results by clearly defining possible values and leveraging color cues and evaluative labels.

Conclusion: Patient-facing displays of laboratory test results should use visual displays rather than tables to increase people’s sensitivity to variations in their results.
Operating Room Efficiency: Benefits of an Orthopaedic Traumatologist at a Level II Trauma Center
Authors: Althausen Peter L. , Kauk Justin R. , Shannon Steven , Lu Minggen , O’Mara Timothy J. , Bray Timothy J.
Published: November 2016

Objectives:

Fellowship-trained orthopaedic traumatologists are presumably taught skill sets leading to “best practice” outcomes and more efficient use of hospital resources. This should result in more favorable economic opportunities when compared with general orthopaedic surgeons (GOSs) providing similar clinical services. The purpose of our study was to compare the operating room utilization and financial data of traumatologists versus GOSs at a level II trauma center.

Design:

Retrospective review.

Setting:

Level II community-based trauma hospital.

Patients/Participants:

Patients who presented to the emergency room at our institution with fractures and orthopaedic conditions requiring surgical intervention from January 1, 2010, to December 31, 2011.

Intervention:

Operative fracture fixation by members of our orthopaedic trauma panel, including fellowship and nontrauma fellowship-trained orthopaedic surgeons.

Main Outcome Measurements:

Our institutional database was queried to determine operative times, surgical supply and implant costs, and surgery labor expenses. Patients were stratified according to those treated by our trauma panel’s 3 traumatologists and those treated by the 15 GOSs on our trauma panel. These 2 groups were then compared using standard statistical methods.

Results:

A total of 6449 orthopedic cases were identified and 2076 of these involved fracture care. One thousand one hundred ninety-nine patients were treated by traumatologists and 877 by GOSs. There was no statistical difference detected in American Society of Anesthesiologists score between trauma and nontrauma groups. Overall, the traumatologist group demonstrated significantly decreased procedure times when compared with the GOS group (55.6 vs. 75.8 minutes, P , 0.0001). In 16 of 18 most common procedure types, traumatologists were more efficient. This led to significantly decreased surgical labor costs ($381.4 vs. $484.8; P < 0.0001) and surgical supply and implant costs ($2567 vs. $3003; P < 0.0001).

Conclusions:

This study demonstrates that in our communitybased trauma system, fracture care provided by traumatologists results in improved utilization of hospital-based resources when compared with equivalent services provided by GOSs. Significantly decreased operative times, surgical labor expenses, and supply and implant costs by the fellowship-trained group represent enhanced control of the design, plan, execution, and monitoring of orthopaedic trauma care. Traumatologists can provide leadership recommendations for operating room efficiency in community-based orthopaedic trauma care models.

Level of Evidence:

Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Gateways to the Laboratory: How an MD–PhD Program Increased the Number of Minority Physician–Scientists
Authors: Gotian Ruth , Raymore Jemella C. , Rhooms Shauna-Kay , Liberman Laura , Andersen Olaf S.
Published: November 2016

Traditional underrepresented minority (URM) groups (African Americans, Hispanic Americans, Native Americans) remain underrepresented among physician–scientists. To address the dearth of URM physician–scientists, in 1993 the Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD–PhD Program developed a pipeline program, Gateways to the Laboratory (Gateways), which focuses on increasing the breadth and depth of the URM physician–scientist pipeline by offering an all-encompassing summer research training program which mirrors the life of a physician–scientist. This includes hypothesis-driven research and clinical shadowing opportunities, coupled with weekly career development workshops and extensive multitiered mentoring. Among the 245 alumni who had “graduated” from Gateways as of 2013, 88% have pursued or completed advanced degrees. Among these, 74% completed or are pursuing MD, PhD, or MD–PhD degrees; and 17% completed or are pursuing combined MD–PhD degrees, over one-third of whom are enrolled in the Tri-Institutional MD–PhD Program. Gateways outcomes are compared to other programs with similar missions, which shows that Gateways has been successful at preparing URMs for MD–PhD Programs. The program serves as a model for how to increase the national pool of competitive URM MD–PhD applicants.
Electrocochleography in Cochlear Implant Recipients With Residual Hearing: Comparison With Audiometric Thresholds
Authors: Koka Kanthaiah , Saoji Aniket A. , Litvak Leonid M.
Published: November 2016

Objectives:

To determine whether electrocochleography (ECoG) thresholds, especially cochlear microphonic and auditory nerve neurophonic thresholds, measured using an intracochlear electrode, can be used to predict pure-tone audiometric thresholds following cochlear implantation in ears with residual hearing.

Design:

Pure-tone audiometric thresholds and ECoG waveforms were measured at test frequencies from 125 to 4000 Hz in 21 Advanced Bionics cochlear implant recipients with residual hearing in the implanted ear. The “difference” and “summation” responses were computed from the ECoG waveforms measured from two alternating phases of stimulation. The interpretation is that difference responses are largely from the cochlear microphonic while summating responses are largely from the auditory nerve neurophonic. The pure-tone audiometric thresholds were also measured with same equipment used for ECoG measurements.

Results:

Difference responses were observed in all 21 implanted ears, whereas summation response waveforms were observed in only 18 ears. The ECoG thresholds strongly correlated (r
2 = 0.87, n = 150 for difference response; r
2 = 0.82, n = 72 for summation response) with audiometric thresholds. The mean difference between the difference response and audiometric thresholds was −3.2 (±9.0) dB, while the mean difference between summation response and audiometric thresholds was −14 (±11) dB. In four out of 37 measurements, difference responses were measured to frequencies where no behavioral thresholds were present.

Conclusions:

ECoG thresholds may provide a useful metric for the assessment of residual hearing in cochlear implant subjects for whom it is not possible to perform behavioral audiometric testing.
Antegrade endosteal fibular strut augmentation for periprosthetic femoral fracture above stemmed total knee arthroplasty
Authors: Snoap Tyler , Jaykel Matthew , Roberts Jason
Published: November 2016

Total knee arthroplasty is one of the most common procedures performed in orthopaedics. As the population prevalence of total knee replacements increases, so does the incidence of revision procedures and periprosthetic fractures. A fracture adjacent to a stemmed femoral component poses a challenge to the treating surgeon. Bone quality, bone loss, and limits imposed by the femoral stem restrict the number of fixation options. The goal of surgical intervention is to allow early range of motion and weight bearing in this often elderly population. This article presents a surgical technique using an antegrade endosteal fibular strut to augment lateral locking plate fixation. The technique was used in an elderly patient who sustained a pathologic fracture with medial cortex loss above a femoral stem prosthesis.
Melanocytic Nevi of Special Sites
Authors: Ahn Christine S. , Guerra Analia , Sangüeza Omar P.
Published: November 2016

Melanocytic nevi located on specific regions of the body can demonstrate unusual histopathological features such as asymmetry, irregular nesting patterns, pagetoid spread, cytologic atypia, and rarely, mitotic activity. However, despite these features that may raise concern for malignant melanoma, these lesions follow a benign clinical course and do not require intervention. Also known as nevi of special sites or nevi with site-related atypia, these melanocytic nevi were initially described on acral sites and genitalia. Now, additional anatomical sites with known site-related atypia include the ear, conjunctivae, scalp, breast, flexural skin, legs, and back and shoulder. This continuing medical education article presents a review of the histopathological characteristics of special site nevi based on anatomic location. It is imperative for dermatologists, pathologists, and dermatopathologists to distinguish benign melanocytic nevi with site-related atypia from malignant melanoma to avoid unnecessary surgical intervention or treatment.
A Comparative Study of the Water Drinking Test in Eyes With Open-Angle Glaucoma and Prior Trabeculectomy or Tube Shunt
Authors: Martinez Patricia , Trubnik Valerie , Leiby Benjamin E. , Hegarty Sarah E. , Razeghinejad Reza , Savant Shravan , Myers Jonathan S.
Published: November 2016

Purpose:

To compare the intraocular pressure (IOP) response after the water drinking test (WDT) in patients who have undergone trabeculectomy or tube shunt surgery.

Methods:

This prospective study examined 40 eyes of 34 open-angle glaucoma subjects who had undergone trabeculectomy (n=20) or tube shunt surgery (n=20). Both groups were matched by IOP range and by number of topical antiglaucoma medications used. After a baseline IOP assessment, subjects drank 10 mL water per kg body weight over 15 minutes. IOP was then measured with a Goldman tonometer every 15 minutes over a 1-hour period. Outcomes measures were IOP peak, fluctuation, mean, and range.

Results:

No significant differences in baseline demographics, baseline clinical characteristics or IOP changes during the WDT were observed between the 2 surgical procedure groups. Mean baseline IOPs for the tube shunt and trabeculectomy groups were 12.55±4.23 and 12.3±4.28 mm Hg, respectively (P=0.854). In the trabeculectomy and tube shunt groups, respectively, peak IOP was 16.25±5.55 and 16.15±5.36 mm Hg (P=0.954); IOP fluctuation (IOP max—IOP baseline) was 3.95±2.17 and 3.6±2.23 mm Hg (P=0.618), and IOP range was 2.78±1.56 and 2.8±1.47 mm Hg (P=0.959). Statistical analysis of IOP fluctuation associations using multivariable linear regression determined that the use of systemic antihypertensive blood pressure medication was associated with an increase in IOP fluctuation of approximately 2 mm Hg.

Conclusions:

Subjects who had undergone either trabeculectomy or tube shunt surgery showed a similar IOP response to the WDT. Subjects on systemic antihypertensive medications experienced significantly greater IOP fluctuations during the test.
Caregiver Expectations and Satisfaction of Urgent Care in a Pediatric Emergency Department
Authors: Marconi Greg P. , Pham Phung K. , Nager Alan L.
Published: November 2016

Health care delivery expectations that may affect patient and caregiver satisfaction are not clearly understood. This study examined caregiver expectations and satisfaction with urgent care in a pediatric emergency department. Of 201 caregivers surveyed, we found that caregivers have specific expectations regarding clinical care of their child in terms of radiographic imaging, blood testing, antibiotics, pain management, and subspecialty consultation. Caregivers were generally less dissatisfied with the actual care provided than the urgent care physicians expected.
Ready for Change? The Role of Physician and Staff Engagement, Burnout, and Workplace Attributes
Authors: Hung Dorothy , Chen Po-Han
Published: November 2016

We examined factors associated with change readiness among 343 primary care physicians and 590 nonphysician staff undergoing “Lean”-based process improvements. Baseline levels of engagement were associated with greater readiness for change across all measured domains. Job-related burnout correlated with greater need for change, but lower self-efficacy and perceived support, whereas a personal sense of accomplishment was associated with higher efficacy to implement changes. At a department level, teamwork, participation in decision making, and change history were associated with higher engagement and lower burnout among physicians and staff; conversely, a busy or stressful department correlated with lower engagement and higher burnout.
Novel Mutations in EPCAM Cause Congenital Tufting Enteropathy
Authors: Tang Wenjuan , Huang Taosheng , Xu Zhongyao , Huang Ying
Published: November 2016

Background and Aims:

Congenital tufting enteropathy (CTE) is a rare autosomal recessive form of intractable diarrhea of infancy. Patients develop chronic diarrhea within days after birth, leading to severe malabsorption and significant mortality. CTE is characterized by subtotal villous atrophy with crypt hyperplasia. Typical features include abnormal villi in the intestinal epithelium and disorganization of surface enterocytes with focal crowding, resembling tufts. The pathogenesis of CTE remains poorly understood. CTE has been reported in Western populations, but until now had not been reported in China. The objective of this study was to identify the gene responsible for CTE in a Chinese individual.

Methods:

A 13-year-old girl with suspected CTE, whose parents were both healthy, was evaluated in our clinic. Tissues were obtained by endoscopy and examined by electron microscopy. Genomic DNA, extracted from the peripheral blood of the child and parents, was subjected to whole-exome sequencing. After mutations in the gene encoding epithelial cell adhesion molecule (EPCAM) were identified, expression of EPCAM was examined by immunohistochemistry staining.

Results:

Whole-exome sequencing revealed compound heterozygous mutations in EPCAM in the patient, with immunohistochemical analysis showing complete loss of EPCAM expression in the intestinal villi and crypts.

Conclusions:

We identified compound heterozygous mutations in EPCAM, with loss of EPCAM expression in duodenal enterocytes, in a patient with intractable diarrhea since infancy who was subsequently diagnosed with CTE. This is the first case of CTE to be reported in a Chinese patient.