bluuebunny/crossref_metadata_2025 huggingface dataset:
The of (d. 1707) Muḥibb Allāh al-Bihārī
Authors: Ahmed Asad Q.
Published: November 2016

This chapter argues that the Sullam al-ʿulūm of Muḥibb Allāh al-Bihārī is a milestone textbook in Arabo-Islamic logic, both in it larger pedagogical aims and insofar as it posits conceptualizations as significantly foundational for logical operations. This orientation toward conceptualizations seems to have opened up new possible directions in the field of logic on several fronts. The chapter has three sections. The author and the general nature of his project are introduced in the first section. The structure of the work and its relation to two leading commentaries are discussed in the second section. And a brief assessment of the work’s contributions to the field of Arabo-Islamic logic is presented in the last section on the basis of a few examples.
Muḥammad Bāqir al-Ṣadr (d. 1979) on the Logical Foundations of Induction
Authors: Agha Saleh J.
Published: November 2016

Mohammad Baqir as-Sadr’s book on the logical foundations of induction is an attempt to solve “the problem of induction,” with the ultimate aim of establishing that faith in God is based on the same rational principles as science. The book argues against two main attempts to solve that problem—the Aristotelian/rationalist and the empiricist attempts, rejecting both as inadequate. The book argues for a new epistemological theory that distinguishes between an objective and a subjective axis along which knowledge can grow, based on an analysis of knowledge into an objective content and a subjective attitude. Objective growth relies on the theory of probability, while subjective growth is a matter of increasing certainty. Sadr’s solution of the problem of induction operates at the subjective level and fundamentally relies on an inadequate assumption. The project ultimately fails; but its execution is highly instructive and introduces new methods into Islamic philosophy.
Zakī Najīb Maḥmūd (d. 1993), ()
Authors: Khalidi Muhammad Ali
Published: November 2016

Zaki Najib Mahmud (1905–1993) occupies a unique position in the development of twentieth-century Arab thought, as a follower of logical empiricism and the emerging analytic school of philosophy. The task of explicating and promoting the philosophical ideas of logical empiricism to an Arab audience dominated his early work. However, in his later work, he addressed some of the issues that preoccupied other Arab thinkers of his era, notably the possibility of reconciling tradition and modernity, the compatibility of Islamic religious thought with liberalism and democracy, and general questions of progress, secularism, and the state of Arab and Egyptian society. This chapter focuses on Naḥwa Falsafah ʿ–Ilmiyya (Toward a Scientific Philosophy), first published in 1958, which propounds and defends logical empiricism, engaging with its principal arguments and relate it to the work of others. The chapter concludes with an assessment of Mahmud’s work and its place in twentieth-century Arab thought.
Ibn Masarra’s (d. 931) Third Book
Authors: Stroumsa Sarah
Published: November 2016

Although Muslim sources mention several books written by the Andalusī thinker Muḥammad Ibn Masarra (d. 319/931), only two books of his are extant and identified with certainty. This chapter reviews the evidence regarding Ibn Masarra and his books, and focuses on a quotation from a third book. Despite its brevity, this quotation adds some important information to our scanty knowledge about Ibn Masarra. An analysis of this quotation can therefore serve as a basis for a critical examination of what we already know, from other sources, of his thought.
Ibn Sīnā (d. 428/1037)
Authors: Bertolacci Amos
Published: November 2016

The chapter deals with the metaphysical section (Ilāhiyyāt, “Science of Divine Things”) of Avicenna’s philosophical masterpiece Kitāb al-Šifāʾ (Book of the Healing), discussing preliminarily its presumed date of composition and place within Avicenna’s biography, and its distinctive traits with respect to other works of Avicenna dealing with metaphysics. Three further issues are then primarily addressed: the Ilāhiyyāt as a prime example of the idea that the science of metaphysics is first among the philosophical disciplines and possesses epistemological unity despite its internal articulation; the philosophical sources of the work, both in ancient Greek philosophy and in Arabic pre-Avicennian falsafa, and the cultural setting in which the Ilāhiyyāt is meant to circulate as well as its intended audience; its main doctrines, pertaining both to ontology (the doctrine of being qua being and its afferents) and to philosophical theology (God’s existence, nature, and agency).
Al-Ghazālī’s (d. 1111)
Authors: Griffel Frank
Published: November 2016

In his Incoherence of the Philosophers (Tahāfut al-falāsifa) al-Ghazali (d. 505/1111) addresses in twenty discussions teachings of the falāsifa and tries to show that these are not proven demonstratively. The falāsifa in al-Ghazālī’s book are mostly Ibn Sīnā (Avicenna, d. 427/1037) and his followers. By exposing the nondemonstrative character of these teachings, al-Ghazālī aims at destroying the conviction of the falāsifa that their sciences are superior to revelation. Al-Ghazālī argues that many teachings handed down from one generation of falāsifa to the next are merely based on the blind emulation (taqlīd) of authorities such as Aristotle. Thus he creates the impression of falsafa as a quasi-religious tradition that lies outside of Islam. In the Incoherence of the Philosophers he applies numerous strategies of integrating the movement of falsafa into Islam. Part of that strategy is his condemnations of three key teachings as unbelief and apostasy from Islam. Incoherence
Perceptual Dialectology
Authors: Cramer Jennifer
Published: November 2016

This chapter introduces the topic of Perceptual Dialectology (PD), an area of sociolinguistics concerned with how nonlinguists understand dialectal variation. The chapter provides a brief history of the field and explores the ways in which the perceptions and language attitudes of nonlinguists have typically been elicited in research conducted within the modern tradition of PD with a particular focus on mental maps. Additionally, this chapter identifies ways in which these methods have been improved upon, specifically through the use of geographic information systems (GIS) tools. As an illustration of both the typical tools used in PD research and these recent advances in data analysis, a research project on the perceptions of dialectal variation within and across the state of Kentucky is presented.
Prosecution in France
Authors: Hodgson Jacqueline , Soubise Laurène
Published: November 2016

This essay examines the increasingly ambivalent role and status of the French prosecutor, the procureur. As a judicial officer (magistrat), she is required to act in and to uphold the public interest, but her hierarchical accountability to the executive and her role in the formation and implementation of local criminal justice policy threaten her independence, notably in the eyes of her fellow magistrats. The dominance of the executive, both politically and through the imposition of managerialist imperatives, is felt in the ever-expanding role of the procureur, especially in the local sphere. While the limited forms of legal and structural accountability in place leave the prosecutor with broad discretion, this is diminished through the drive to standardization resulting from the delegation of work to fulfill the demands of dealing with greater numbers of cases more quickly, with fewer resources.
Jesuits and India
Authors: Fernando Leonard
Published: November 2016

Jesuits have been a continuing presence in India since the sixteenth century. With the help of local people, they not only spread the Christian faith but also did a lot for the growth of the Indian nation, especially through education, scientific advancements, and betterment of the lives of underprivileged people. They attempted enculturation of the Christian faith in multicultural India; learnt of, discussed, and respected other religions; and mastered and contributed to the growth of Indian languages. Now about 4,000 Jesuits—mostly Indians—are working in eighteen Provinces/Regions in India. There are three major phases in the history of Jesuits in India—the beginning, suppression, and restoration. All along, true to the Ignatian charism, members of the Society of Jesus have kept their daring missionary zeal of moving to the frontiers—challenging, unknown, and unexplored.
Sexual Politics in Environmental Ethics
Authors: Cuomo Chris
Published: November 2016

Matters related to sex and gender are central in environmental ethics, intersecting with class and race. In Western capitalist and other colonizing systems, negative views about nature are deeply interwoven with derogatory views about those people who are associated with nature, including women and the feminine. Gendered relationships with nature and other species are highly varied across classes and cultures. Nonetheless, these days nearly everywhere females are more directly and negatively impacted by environmental harms, because gendered work and labor roles, including unpaid, domestic, caretaking and “flexible” work, often put women in closest proximity to environmental risks and challenges. Critical and reconstructive attention to specific systems and realities of sex and gender is therefore needed to develop adequate understanding of many issues at the heart of environmental ethics, and to bring diverse knowledge and more caring, empowering and effective moral responses to the fore.
The Two Cultures
Authors: Liebling Alison , Kant Deborah
Published: November 2016

This chapter assesses how correctional officers exercise their authority over inmates. How officers influence prison climates is discussed in conjunction with their roles in impeding or facilitating the goals of confinement, and in particular their impact on a climate supportive of offender change. The authors draw from ethnography on prisons across the United Kingdom to explain some correctional officers’ distrust of managers, their cynicism toward correctional reform, and their alienation from liberal humanitarian goals. Examples of officer “cultures,” informal rules of conduct, and the origins of cultural values are identified toward the end of discussing how such values might shape inmates’ attitudes toward legal authority. An important question is whether the origins of these cultural values are structural and inherent in the prison, or whether these cultures differ so greatly across prisons that other explanations must play a part.
The Effect of Prisons on Crime
Authors: Tahamont Sarah , Chalfin Aaron
Published: November 2016

This chapter presents empirical evidence regarding the (in)effectiveness of prisons for reducing crime. The authors begin with a brief discussion of the mechanisms through which incarceration affects crime, followed by a review of research that presents empirical evidence on the relationship between prisons and crime. This section separates empirical research on the total effect of prison on crime from empirical studies intended to isolate the deterrent or incapacitation effects of prison. Death penalty studies are also reviewed for insight into whether capital punishment has any short- or long-term effects on homicide rates. The chapter concludes with a brief discussion of the policy implications that follow from the empirical research on prison effects on crime.
Current recommendations for treating autosomal dominant polycystic kidney disease
Authors: Ness Becky , Stovall Kathryn
Published: November 2016

Autosomal dominant polycystic kidney disease is the most common inherited kidney disease in the United States, causing hypertension, cerebral aneurysms, nephrolithiasis, and kidney failure. This article reviews the pathogenesis, diagnosis, associated complications, and current treatment recommendations for the condition.
Liquid biopsy for early detection of lung cancer
Authors: Hofman Paul
Published: November 2016

Purpose of review

The possibility of complete recovery for a lung cancer patient depends on very early diagnosis, as it allows total surgical resection. Screening for this cancer in a high-risk population can be performed using a radiological approach, but this holds a certain number of limitations. Liquid biopsy could become an alternative and complementary screening approach to chest imaging for early diagnosis of lung cancer.

Recent findings

Several circulating biomarkers indicative of lung cancer can be investigated in blood, such as circulating tumor cells, circulating free nucleic acids (RNA and DNA) and proteins. However, none of these biomarkers have yet been adopted in routine clinical practice and studies are ongoing to confirm or not the usefulness and practical interest in routine early diagnosis and screening for lung cancers.

Several potential circulating biomarkers for the early detection of lung cancer exist. When coupled to thoracic imaging, these biomarkers must give diagnosis of a totally resectable lung cancer and potentially provide new recommendations for surveillance by imagery of high-risk populations without a detectable nodule. Optimization of the specificity and sensitivity of the detection methods as well as standardization of the techniques is essential before considering for daily practice a liquid biopsy as an early diagnostic tool, or possibly as a predictive test, of lung cancer.
Enhancing Descemet Membrane Endothelial Keratoplasty in Postvitrectomy Eyes With the Use of Pars Plana Infusion
Authors: Sorkin Nir , Einan-Lifshitz Adi , Ashkenazy Zach , Boutin Tanguy , Showail Mahmood , Borovik Armand , Alobthani Murad , Chan Clara C. , Rootman David S.
Published: November 2016

Purpose:

To present a modified surgical technique to perform Descemet membrane endothelial keratoplasty (DMEK) in previously vitrectomized eyes and to analyze its safety and efficacy.

Methods:

A retrospective analysis of previously vitrectomized eyes that underwent DMEK at Toronto Western Hospital was performed. The modified DMEK technique that was used included placement of a posterior pars plana infusion to reduce fluctuations in the anterior chamber depth and its excessive deepening.

Results:

Twelve eyes of 12 patients (5 females and 7 males) aged 65.3 ± 21.5 years were included. Mean best-corrected visual acuity improved significantly from 1.72 ± 0.62 logMAR (mean Snellen ∼20/1040) preoperatively to 1.01 ± 0.64 logMAR (mean Snellen ∼20/200) at 6 months postoperatively (P = 0.017). Mean donor endothelial cell density was 2658 ± 229 cells/mm2 preoperatively and 1732 ± 454 cells/mm2 at 6 months after the procedure (mean percentage cell loss of 31.8%) (P = 0.046). There were no significant intraoperative complications, and no graft failures. One eye had graft detachment, which resolved after 2 rebubbling procedures. One eye had retinal detachment, which was corrected surgically.

Conclusions:

The use of posterior pars plana infusion in previously vitrectomized eyes stabilizes the anterior segment during DMEK, allowing for performance of DMEK surgery, and can potentially reduce intraoperative and postoperative complications.
A Novel Method to Measure Artificial Eye Motility
Authors: Mourits Daphne L. , Hartong Dyonne T. , van Beek Johannes H. M. , Witte Birgit I. , Tan H. Stevie , Moll Annette C.
Published: November 2016

Purpose:

To measure objectively, reproducibly, and noninvasively artificial eye motility, a fundamental aspect in the (cosmetic) outcome of enucleation.

Method:

A gaze- and pupil-tracking system, the “iView X,” was implemented to measure horizontal eye motility. The system, with adjusted software, was tested with patients wearing 1 prosthetic eye after enucleation for retinoblastoma. Measurements were repeated 5 times in every patient and analyses were performed twice by 2 independent observers. Reproducibility was tested via linear mixed models. After the implementation of the method, more data were obtained, including more patients with a history of enucleation for the treatment of retinoblastoma for eye tracker measurement, and differences in motility percentages between implant types and sizes were analyzed via Mann-Whitney U tests.

Results:

The intraclass correlation coefficient of the interobserver variable in the patient test group (n = 27, 6–53 years) was 0.98 and 0.96 for measurement of left gaze and right gaze, respectively. Intraobserver variation was <0.001. In the total of 58 included patients for comparative analysis, mean difference of prosthesis motility compared with the contralateral eye in abduction was 57.1% (range 3.2–91.5%); in adduction 65.8% (range 24.0–92.0%). No statistical differences were found between the different implant types and sizes.

Conclusion:

Motility measurements of the prosthetic eye in comparison to the contralateral eye using the iView X system are reproducible and reliable. This is, to the authors’ knowledge, the first easy applicable, noninvasive, reproducible, and commercially available instrument to evaluate prosthesis motility. With the adjusted software program (freely available on request), a similar objective measurement can be performed worldwide. The implant size or type did not influence the outcome of the motility measurement; this finding deserves additional study.
Cognitive Function Predicts Risk for Clinically Significant Weight Gain in Adults With Heart Failure
Authors: Dolansky Mary A. , Hawkins Misty A.W. , Schaefer Julie T. , Gunstad John , Sattar Abdus , Redle Joseph D. , Vehovec Anton , Josephson Richard , Moore Shirley M. , Hughes Joel W.
Published: November 2016

Background:

Few investigators have examined whether cognitive deficits predict poorer self-care of weight management recommendations and weight gain in adults with heart failure.

Objective:

The purposes of this study were (1) to examine whether cognition is associated with adherence to daily weighing and weight gain incidence and (2) to explore self-reported symptom perception and management when a weight increase occurs.

Methods:

In this observational study, participants completed neuropsychological testing, were given an electronic scale, and were instructed to record their weight for 21 days. Data for 301 participants were collected at baseline and 3 weeks after weight monitoring.

Results:

At baseline, only 35% of the enrolled respondents knew when to call their physician for increased weight gain, and 37% of the analyzed sample (n = 110/301) experienced a clinically significant weight gain. Regressions tested whether baseline attention, executive function, or memory predicted adherence to daily weighing and the likelihood of weight gain incidence. In unadjusted and adjusted covariate analyses, none of the cognitive domains predicted adherence to daily weighing (P ≥ .375); however, all 3 cognitive domains predicted an increased risk of a clinically significant weight gain (P ≤ .05). Importantly, 65% of participants with a weight gain did not identify this symptom on self-report questions.

Conclusions:

Although cognitive deficits are not associated with adherence to daily weighing, adults with cognitive deficits may be at an increased risk for experiencing a clinically significant weight gain, and most do not perceive symptoms.

Clinical Implications:

Adults with heart failure require more than directions on self-care related to weight monitoring.
Get the Picture
Authors: de Heide John , Vroegh C.J. , Szili Torok T. , Gobbens R.J.J. , Zijlstra F. , Takens-Lameijer M. , Lenzen M.J. , Yap S.C. , Scholte op Reimer W.J.M.
Published: November 2016

Background:

Postprocedural complications after elective cardiac interventions include hematomas and infections. Telemedical wound assessment using mobile phones with integrated cameras may improve quality of care and help reduce costs.

Aims:

We aimed to study the feasibility of telemedical wound assessment using a mobile phone. The primary aim was the number of patients who were able to upload their pictures. Secondary aims were image interpretability, agreement between nurse practitioners, and patient evaluation of the intervention.

Methods:

This is a prospective study of all consecutive patients who underwent an elective cardiac intervention. Patients were instructed to photograph their wound or puncture site after hospital discharge and upload the pictures to a secure email address 6 days after hospital discharge. Received photos were assessed by 2 nurse practitioners. The intervention was evaluated using a peer-reviewed questionnaire and photo assessment scheme.

Results:

In total, 46 eligible patients were included in the study, with 5 screen failures (eg, clinical stay ≥ 6 days) and 1 patient lost to follow-up. Thirty-three of 40 patients (83%) were able to upload their pictures. Smartphone users were more successful in uploading their pictures compared with feature phone users (93% vs 55%, P < .01). Eighty-eight percent of the clinical pictures were interpretable. The interobserver variability had an agreement between 93% and 97%.

Conclusions:

Patients are able to take and upload the mobile clinical photos to the secure email address, and the vast majority was interpretable. Smartphone users were more successful than feature phone users in uploading their pictures. The interobserver variability was good.
Quality of Life, Depression, and Anxiety in Ventricular Assist Device Therapy
Authors: Bidwell Julie T. , Lyons Karen S. , Mudd James O. , Gelow Jill M. , Chien Christopher V. , Hiatt Shirin O. , Grady Kathleen L. , Lee Christopher S.
Published: November 2016

Background:

Patients who receive ventricular assist device (VAD) therapy typically rely on informal caregivers (family members or friends) to assist them in managing their device.

Objective:

The purpose of this study is to characterize changes in person-oriented outcomes (quality of life [QOL], depression, and anxiety) for VAD patients and their caregivers together from pre-implantation to 3 months post-implantation.

Methods:

This was a formal interim analysis from an ongoing prospective study of VAD patients and caregivers (n = 41 dyads). Data on person-oriented outcomes (QOL: EuroQol 5 Dimensions Visual Analog Scale; depression: Patient Health Questionnaire-8; anxiety: Brief Symptom Inventory) were collected at 3 time points (just prior to implantation and at 1 and 3 months post-implantation). Trajectories of change for patients and caregivers on each measure were estimated using latent growth modeling with parallel processes.

Results:

Patients’ QOL improved significantly over time, whereas caregiver QOL worsened. Depression and anxiety also improved significantly among patients but did not change among caregivers. There was substantial variability in change on all outcomes for both patients and their caregivers.

Conclusions:

This is the first quantitative study of VAD patient-caregiver dyads in modern devices that describes change in person-oriented outcomes from pre-implantation to post-implantation. This work supports the need for future studies that account for the inherent relationships between patient and caregiver outcomes and examine variability in patient and caregiver responses to VAD therapy.
Review of Pediatric Spondylolysis and Spondylolisthesis
Authors: Randall Rachel M. , Silverstein Michael , Goodwin Ryan
Published: November 2016

Pediatric spondylolysis and spondylolisthesis present with a wide spectrum of pathology and clinical findings, including back pain, leg pain, crouch gait, or neurological deficit. The treatment of spondylolysis alone is typically conservative with bracing, non-steroidal anti-inflammatory drug, and activity restriction, but refractory pain can be successfully surgically managed with intralaminar compression screw, wires, or pedicle screws with rods and laminar hook constructs. The treatment of dysplastic spondylolisthesis is aggressive to prevent neurological deficit, whereas even high-grade isthmic slips can be treated safely with nonoperative measures if no significant neurological deficits are present. However, patients with higher slip angles tend to progress and require fusion. More long-term data are needed to compare the outcomes of operative versus nonoperative treatment of high-grade slips. Although more evidence will be helpful in guiding surgical treatment, fortunately, the vast majority of these patients are successfully managed nonsurgically.
Unique Issues in the Rehabilitation of the Pediatric and Adolescent Athlete After Musculoskeletal Injury
Authors: Paterno Mark V.
Published: November 2016

Youth sports participation is on the rise, resulting in an increase in sports-related injuries in the pediatric and adolescent population. The presentation of injury, pathology, and disease in this younger population is often unique and may require customize and novel medical and rehabilitation interventions to optimize the outcome. The purpose of this review is to highlight unique considerations in the rehabilitation management of the pediatric and adolescent athlete. General guidelines for progression of this population through a criteria-based rehabilitation program with a focus on a systematic return to sport algorithm will be reviewed.
Provider, Patient, and Practice Factors Shape Hepatitis B Prevention and Management by Primary Care Providers
Authors: Mukhtar Nizar A. , Kathpalia Priya , Hilton Joan F. , Lau Gene , Yu Albert , Grumbach Kevin , Nguyen Tung T. , Chan Daniel , Khalili Mandana
Published: November 2016

Goals:

To evaluate provider knowledge, attitudes and barriers to hepatitis B virus (HBV) care and management practices across diverse primary care settings.

Background:

Factors influencing adherence to recommended HBV screening and management guidelines are poorly defined.

Materials and Methods:

Providers across various health care settings in San Francisco were surveyed. Multivariate analyses were used to identify factors associated with recommended HBV screening, vaccination, and disease monitoring.

Results:

Of 277 (41.3%) responding providers, 42% reported performing HBV screening in >50% of at-risk patients, and 49%, HBV vaccination in >50% of eligible patients. Most reported appropriate monitoring of a majority of HBV-infected patients with alanine aminotransferase (79%) and HBV viral load (67%) every 6 to 12 months, but performed any hepatocellular carcinoma screening in 49%. Provider factors significantly associated with HBV screening were speaking an Asian language [odds ratio (OR), 3.27], offering HBV treatment (OR, 3.00), having >25% of Asian patients in practice (OR, 2.10), practicing in safety net settings (OR, 7.51) and having higher barrier score (OR, 0.74). Appropriate HBV monitoring was associated with provider speaking an Asian language (OR, 3.43) and provider age (OR, 0.68/decade). Hepatocellular carcinoma screening was associated with having >25% of patients speaking English as a second language (OR, 4.26) and practicing in safety net settings (OR, 0.14).

Conclusions:

Rates of adherence to HBV guidelines were suboptimal irrespective of practice setting and were influenced by certain provider, patient and practice factors. This study reinforces the importance of engaging primary care providers in development, dissemination, and implementation of evidence-based HBV practice guidelines.
The Impact of Chronic Health Conditions on Length of Stay and Mortality in a General PICU*
Authors: O’Brien Scott , Nadel Simon , Almossawi Ofran , Inwald David P.
Published: November 2016

Objectives:

Each year approximately 20,000 children are admitted to PICUs across the United Kingdom. It is highlighted in several international studies that 40–70% of children admitted to PICUs have at least one chronic health condition that leads to increased length of stay and higher mortality rates. The prevalence of chronic health conditions in children admitted to U.K. PICUs is unknown. The purpose of this study was to use existing clinical data to explore the prevalence and impact of chronic health conditions on length of stay and mortality in a tertiary U.K. PICU.

Design:

Single-centre retrospective observational cohort study.

Setting:

Single, tertiary referral PICU.

Patients:

One thousand one hundred ninety-seven children 0–18 years old admitted between March 1, 2009, and February 28, 2013.

Interventions:

None.

Measurements and Main Results:

Data were derived from the unit’s data submitted to the Paediatric Intensive Care Audit Network, the U.K. national PICU dataset. Data included demographics, diagnosis, Pediatric Index of Mortality-2 score, PICU interventions, PICU outcomes, chronic health condition etiologies, admission, and discharge dates and times. In total, 554 of 1,197 (46.3%) had at least one chronic health condition. Of 554, 371 patients (67.1%) presented with a single chronic health condition, 126 (22.6%) with two chronic health conditions, and 57 (10.3%) with at least three chronic health conditions to a maximum of four chronic health conditions. There was a statistically significant difference in length of stay in those with a chronic health condition compared with those without (medians, 4 vs 3 d [interquartile range, 1–7 d]; Mann-Whitney U test, p < 0.001). The length of stay also increased significantly according to the number of chronic health conditions (Kruskal-Wallis test, p < 0.001). Mortality was significantly different between those with and without chronic health conditions (8.8% vs 5.4%; chi-square test, p = 0.024). Having two or at least three chronic health conditions significantly increased mortality compared with no chronic health conditions (odds ratio, 2.3 [CI, 1.2–4.55]; p = 0.013 and 2.95 [CI, 1.28–6.8]; p = 0.011), respectively.

Conclusions:

The increasing number of chronic healthcare conditions is associated with length of stay and mortality.
Clinical Examination Does Not Predict Response to Albuterol in Ventilated Infants With Bronchiolitis
Authors: Schramm Craig M. , Sala Kathleen A. , Carroll Christopher L.
Published: November 2016

Objective:

Bronchiolitis is a common respiratory infection in infants that is sometimes treated with albuterol. Response to albuterol is determined by clinical assessment, but this subjective determination is potentially unreliable. In this study, we compared providers’ clinical assessment of response to albuterol with the measurement of response by pulmonary mechanics in intubated, sedated, and ventilated infants.

Design:

Before and 20 minutes following racemic albuterol therapy, a nurse, respiratory therapist, and physician performed simultaneous examinations and assessed response to albuterol in a population of intubated infants with bronchiolitis. Measurements of ventilator-derived pulmonary mechanics were obtained at these same times.

Setting:

This study was conducted in a PICU of a children’s hospital.

Patients:

Seventy-five paired clinical assessments were made in 25 infants who were intubated and mechanically ventilated for severe bronchiolitis.

Interventions:

Pulmonary function measurements and clinical assessments before and after administration of albuterol.

Measurements and Main Results:

Response to albuterol was defined using a threshold of improvement in respiratory system resistance from baseline. Nine children (36%) had greater than 20% change and were deemed responders. Providers’ discrimination of response was poor. The positive predictive values of nurses, respiratory therapists, and physicians were 38%, 25%, and 25%, respectively, and the negative predictive values were 67%, 54%, and 59%, respectively. Overall accuracy was 44% for nurses, 40% for respiratory therapists, and 48% for physicians. When comparing separate assessments of wheezing, aeration, and expiratory time, there was poor agreement between groups of providers in all variables (κ < 0.4 for each).

Conclusions:

A provider’s clinical assessment was not a reliable method for determining response to albuterol in children with bronchiolitis. Without assessment of pulmonary mechanics, caution should be used in classifying children with bronchiolitis as responders to albuterol.
Essentials of Pediatric Emergency Medicine Fellowship Part 7
Authors: Allen Coburn H. , Anders Jennifer , Ishimine Paul , Roskind Cindy , Shook Joan
Published: November 2016

This article is the last in a 7-part series that aims to comprehensively describe the current state and future directions of pediatric emergency medicine fellowship training from the essential requirements to considerations for successfully administering and managing a program to the careers that may be anticipated on program completion. This article focuses on the many career paths as educators, researchers, advocates, innovators, consultants, administrators, and leaders available to pediatric emergency medicine physicians, in both clinical and nonclinical realms, and how fellows and junior faculty can enrich and prolong their careers through diversification.
System Issues Leading to “Found-on-Floor” Incidents: A Multi-Incident Analysis
Authors: Shaw James , Bastawrous Marina , Burns Susan , McKay Sandra
Published: November 2016

Background

Although attention to patient safety issues in the home care setting is growing, few studies have highlighted health system–level concerns that contribute to patient safety incidents in the home. Found-on-floor (FOF) incidents are a key patient safety issue that is unique to the home care setting and highlights a number of opportunities for system-level improvements to drive enhanced patient safety.

Methods

We completed a multi-incident analysis of FOF incidents documented in the electronic record system of a home health care agency in Toronto, Canada, for the course of 1 year between January 2012 and February 2013.

Results

Length of stay (LOS) was identified as the cross-cutting theme, illustrating the following 3 key issues: (1) in the short LOS group, a lack of information continuity led to missed fall risk information by home care professionals; (2) in the medium LOS group, a lack of personal support worker/carer training in fall prevention led to inadequate fall prevention activity; and (3) in the long LOS group, a lack of accountability policy at a system level led to a lack of fall risk assessment follow-up.

Conclusions

Our study suggests that considering LOS in the home care sector helps expose key system-level issues enabling safety incidents such as FOF to occur. Our multi-incident analysis identified a number of opportunities for system-level changes that might improve fall prevention practice and reduce the likelihood of FOF incidents in the home. Specifically, investment in electronic health records that are functional across the continuum of care, further research and understanding of the training and skills of personal support workers, and enhanced incentives or more punitive approaches (depending on the circumstances) to ensure accountability in home safety will strengthen the home care sector and help prevent FOF incidents among older people.
The Effects of the Second Victim Phenomenon on Work-Related Outcomes: Connecting Self-Reported Caregiver Distress to Turnover Intentions and Absenteeism
Authors: Burlison Jonathan D. , Quillivan Rebecca R. , Scott Susan D. , Johnson Sherry , Hoffman James M.
Published: November 2016

Objectives

Second victim experiences can affect the well-being of healthcare providers and compromise patient safety. The purpose of this study was to assess the relationships between self-reported second victim–related distress to turnover intention and absenteeism. Organizational support was examined concurrently because it was hypothesized to explain the potential relationships between distress and work-related outcomes.

Methods

A cross-sectional, self-report survey (the Second Victim Experience and Support Tool) of nurses directly involved in patient care (N = 155) was analyzed by using hierarchical linear regression. The tool assesses organizational support, distress due to patient safety event involvement, and work-related outcomes.

Results

Second victim distress was significantly associated with turnover intentions (P < 0.001) and absenteeism (P < 0.001), while controlling for the effects of demographic variables. Organizational support fully mediated the distress–turnover intentions (P < 0.05) and distress-absenteeism (P < 0.05) relationships, which indicates that perceptions of organizational support may explain turnover intentions and absenteeism related to the second victim experience.

Conclusions

Involvement in patient safety events and the important role of organizational support in limiting caregiver event–related trauma have been acknowledged. This study is one of the first to connect second victim distress to work-related outcomes. This study reinforces the efforts health care organizations are making to develop resources to support their staff after patient safety events occur. This study broadens the understanding of the negative effects of a second victim experience and the need to support caregivers as they recover from adverse event involvement.
Objective Assessment of Checklist Fidelity Using Digital Audio Recording and a Standardized Scoring System Audit
Authors: Salgado Douglas , Barber Kimberly R. , Danic Michael
Published: November 2016

Objectives

The use of the World Health Organization Surgical Safety Checklist (SSC) has been reported to significantly reduce operative morbidity and mortality rates. Recent findings have cast doubt on the efficacy of such checklists in improving patient safety. The effectiveness of surgical safety checklists cannot be fully measured or understood without an accurate assessment of implementation fidelity, most effectively through direct observations of the checklist process. Here, we describe the use of a secure audio recording protocol in conjunction with a novel standardized scoring system to assess checklist compliance rates.

Methods

We used a black box digital audio recording protocol to observe the execution of SSCs in real time. A novel checklist scoring system was used to quantify the implementation fidelity of a modified version of the SSC. Physician and staff perception of patient safety was also surveyed before and after implementation.

Results

Audio-recorded audits revealed a precisely executed checklist 73.6% of the time compared with a previously reported compliance rate of 97.6%. Implementation fidelity was highest during preanesthesia and preincision checklist sections, whereas postprocedure checklist compliance and fidelity was consistently the lowest. Positive attitudes on patient safety by surgical staff increased by 11% from baseline.

Conclusions

The use of a secure digital audio recording protocol is a simple yet effective tool for observing checklist performance. Moreover, the implementation of a standardized scoring system allows for the objective evaluation of checklist fidelity. Together, they provide a powerful auditing tool for identifying improvement.
Physician Perspectives on Interhospital Transfers
Authors: Mueller Stephanie K. , Schnipper Jeffrey L.
Published: November 2016

Objective

The transfer of patients between acute care hospitals (interhospital transfer [IHT]) is a common but nonstandardized process leading to variable quality and safety. The goal of this study was to survey accepting physicians regarding problems encountered in the transfer process.

Methods

A cross-sectional survey of residents and inpatient attendings from internal medicine, neurology, and surgery services at a large tertiary care referral hospital was undertaken to identify problematic aspects of the IHT process as perceived by accepting frontline providers. The frequency that specific scenarios were encountered in caring for transferred patients and whether these processes impacted patient safety were determined using 5- and 3-point Likert scales, respectively. The frequency of responses to each question were measured using proportions.

Results

Approximately 51% of the 284 physicians surveyed responded. Pertinent findings included the following: physician subject surveys found that transferred patients sometimes, frequently, or always arrived without requiring specialized care in 56% of responses, arrived with unrealistic expectations of care in 77.2% of responses, arrived more than 24 hours after accepted for transfer in 80.1% of responses, and arrived without necessary transfer records in 86.9% of responses. Most respondents felt that lack of availability of transfer records and the time of day of arrival frequently posed a risk to transferred patients (57.2% and 53.1%, respectively). Response variation was noted between resident and attending physician respondents.

Conclusions

Expectations of care, delays and timing of transfer, and information exchange at time of transfer were identified as all too common problems in IHT, which creates a risk for patient safety. These areas are important targets for investigation and the development of interventions to improve patient safety.
Stomatal design principles in synthetic and real leaves
Authors: Zwieniecki Maciej A. , Haaning Katrine S. , Boyce C. Kevin , Jensen Kaare H.
Published: November 2016

Stomata are portals in plant leaves that control gas exchange for photosynthesis, a process fundamental to life on Earth. Gas fluxes and plant productivity depend on external factors such as light, water and CO
2
availability and on the geometrical properties of the stoma pores. The link between stoma geometry and environmental factors has informed a wide range of scientific fields—from agriculture to climate science, where observed variations in stoma size and density are used to infer prehistoric atmospheric CO
2
content. However, the physical mechanisms and design principles responsible for major trends in stomatal patterning are not well understood. Here, we use a combination of biomimetic experiments and theory to rationalize the observed changes in stoma geometry. We show that the observed correlations between stoma size and density are consistent with the hypothesis that plants favour efficient use of space and maximum control of dynamic gas conductivity, and that the capacity for gas exchange in plants has remained constant over at least the last 325 Myr. Our analysis provides a new measure to gauge the relative performance of species based on their stomatal characteristics.
Top-down models in biology: explanation and control of complex living systems above the molecular level
Authors: Pezzulo Giovanni , Levin Michael
Published: November 2016

It is widely assumed in developmental biology and bioengineering that optimal understanding and control of complex living systems follows from models of molecular events. The success of reductionism has overshadowed attempts at top-down models and control policies in biological systems. However, other fields, including physics, engineering and neuroscience, have successfully used the explanations and models at higher levels of organization, including least-action principles in physics and control-theoretic models in computational neuroscience. Exploiting the dynamic regulation of pattern formation in embryogenesis and regeneration requires new approaches to understand how cells cooperate towards large-scale anatomical goal states. Here, we argue that top-down models of pattern homeostasis serve as proof of principle for extending the current paradigm beyond emergence and molecule-level rules. We define top-down control in a biological context, discuss the examples of how cognitive neuroscience and physics exploit these strategies, and illustrate areas in which they may offer significant advantages as complements to the mainstream paradigm. By targeting system controls at multiple levels of organization and demystifying goal-directed (cybernetic) processes, top-down strategies represent a roadmap for using the deep insights of other fields for transformative advances in regenerative medicine and systems bioengineering.
Shunt peaking in neural membranes
Authors: Heras Francisco J. H. , Laughlin Simon B. , Niven Jeremy E.
Published: November 2016

Capacitance limits the bandwidth of engineered and biological electrical circuits because it determines the gain–bandwidth product (GBWP). With a fixed GBWP, bandwidth can only be improved by decreasing gain. In engineered circuits, an inductance reduces this limitation through shunt peaking but no equivalent mechanism has been reported for biological circuits. We show that in blowfly photoreceptors a voltage-dependent K
+
conductance, the fast delayed rectifier (FDR), produces shunt peaking thereby increasing bandwidth without reducing gain. Furthermore, the FDR's time constant is close to the value that maximizes the photoreceptor GBWP while reducing distortion associated with the creation of a wide-band filter. Using a model of the honeybee drone photoreceptor, we also show that a voltage-dependent Na
+
conductance can produce shunt peaking. We argue that shunt peaking may be widespread in graded neurons and dendrites.
Observation, experiment or autonomy in the domestic sphere? Women's familiar science writing in Britain, 1790–1830
Authors: Peters Eleanor Anne
Published: November 2016

This paper examines three female writers who chose to affiliate their educational scientific works with the ‘domestic sphere’: Priscilla Wakefield, Jane Marcet and Maria Edgeworth. It shows that within what is now broadly categorized as ‘familiar science’, differing motivations for writing, publishing and reading existed. Between 1790 and 1830 many educationalists claimed that the best way for children to learn was for them to exercise their memory on things encountered in everyday life. Religious allegiances, attitudes towards female science education and the utility of science in the home help to explain why these writers chose to introduce their readers to the illimitable world of science by setting their books in the seemingly restrictive domestic sphere. Furthermore, this paper argues that three different authors envisioned subtly different domestic spheres as settings for their work. Rather than there being a single homogeneous domestic sphere in which women and children received their education, and about which such authors wrote, there existed a multiplicity of domestic spheres depicted across the genre of educational science texts.
Systemic corazonin signalling modulates stress responses and metabolism inDrosophila
Authors: Kubrak Olga I. , Lushchak Oleh V. , Zandawala Meet , Nässel Dick R.
Published: November 2016

Stress triggers cellular and systemic reactions in organisms to restore homeostasis. For instance, metabolic stress, experienced during starvation, elicits a hormonal response that reallocates resources to enable food search and readjustment of physiology. Mammalian gonadotropin-releasing hormone (GnRH) and its insect orthologue, adipokinetic hormone (AKH), are known for their roles in modulating stress-related behaviour. Here we show that corazonin (Crz), a peptide homologous to AKH/GnRH, also alters stress physiology inDrosophila. The Crz receptor (CrzR) is expressed in salivary glands and adipocytes of the liver-like fat body, and CrzR knockdown targeted simultaneously to both these tissues increases the fly's resistance to starvation, desiccation and oxidative stress, reduces feeding, alters expression of transcripts ofDrosophilainsulin-like peptides (DILPs), and affects gene expression in the fat body. Furthermore, in starved flies, CrzR-knockdown increases circulating and stored carbohydrates. Thus, our findings indicate that elevated systemic Crz signalling during stress coordinates increased food intake and diminished energy stores to regain metabolic homeostasis. Our study suggests that an ancient stress-peptide in Urbilateria evolved to give rise to present-day GnRH, AKH and Crz signalling systems.