bluuebunny/crossref_metadata_2025 huggingface dataset:
Autonomous Motivation, Internalization, and the Self
Authors: Quirin Markus , Tops Mattie , Kuhl Julius
Published: August 2019

In humanistic psychology, autonomy, internalization, and the self constitute fundamental concepts to explain adaptive behavior and well-being. However, the momentary mental processes, their interactions, and individual differences that constitute a causal fundament for these concepts are yet underexplored. The authors will analyze these processes against the backdrop of a functional approach, Personality Systems Interactions Theory, which conceives the self as one out of several neurocognitive systems and highlights its role for autonomous motivation and self-regulation. We attempt to provide answers to questions such as the following: Which momentary mental processes and underlying neurocognitive systems (e.g., large-scale brain networks) facilitate the establishment of stages of internalization? Can the self become inhibited in a way that even highly internalized goals and values may not manifest in behavior? Which role does the self play in emotion regulation and decision-making, and how do these processes in turn facilitate autonomous behavior? The authors believe that the present functional analysis advances a conciliation between a phenomenologically-oriented, humanities view and a process-oriented natural science view on human motivation.
Motivation in Psychotherapy
Authors: Westermann Stefan , Grosse Holtforth Martin , Michalak Johannes
Published: August 2019

Motivational issues are central to human life. Correspondingly, they are also central to the challenging endeavor of psychotherapy. Assisting patients to change involves motivational issues at various levels and at various stages of therapy. Patients might be more or less motivated to begin and to participate in the different stages of psychotherapy (therapy motivation). Besides these differences in therapy motivation, an understanding of the broader concepts of motivation in psychotherapy should mandate that motivational issues be considered in the treatment of all patients, not only those with obvious deficits in therapy motivation. Motivational issues influence the therapeutic relationship; they should be considered in tailoring specific interventions and they might be important factors for the onset and maintenance of psychological disorders. The present chapter presents theoretical and empirical background information and illustrates therapeutic approaches for dealing with patients’ motivation. Moreover, it summarizes the implications of basic and clinical research for a motivationally informed psychotherapy.
A Self-Regulatory Viewpoint on Human Behavior
Authors: Carver Charles S. , Scheier Michael F.
Published: August 2019

This chapter describes a set of ideas bearing on the structure of action and emotion and how they are regulated. Some of the ideas are associated with the terms feedback control and cybernetics. Those ideas have roots in many sources, including the concept of homeostasis and the creation of mechanical devices to serve as governors for engines. With respect to motivation, the ideas yield a viewpoint in which action is goal directed and reflects a hierarchy of control processes. The creation and reduction of affect are seen as reflecting another set of feedback processes. The portion of the model devoted to affect is of particular interest because it generates two predictions that differ substantially from those deriving from other theories. The first prediction is that both approach and avoidance can give rise to both positive and negative feelings; the second is that positive affect leads to coasting, a reduction in effort regarding the pursued goal. The latter suggests a way in which positive affect is involved in priority management when many goals are in play concurrently. Recent interest in dual process models, which distinguish between top-down guidance of goal pursuit and reflexive responses to cues of the moment, has caused a reexamination of some previous assumptions and consideration of the possibility that behavior emerges in two distinct ways. This line of thought has also recently been applied to conceptualizing diverse types of psychopathology. The chapter closes with brief consideration of how the ideas considered here might be compatible with other viewpoints on motivation.
Least Restrictive Environment and the Education of Children with Disabilities
Authors: Weber Mark C.
Published: August 2019

This chapter discusses the obligation in the federal special education law to provide education to children with disabilities in the least restrictive environment. It describes the relevant statutory and regulatory provisions and the prominent cases, and explores ongoing scholarly controversies about the least restrictive environment requirement and its application. The chapter observes that disputes over the least restrictive environment for a given child are often disputes over the range of accommodations and services that the schools must provide so that appropriate education of a child with disabilities may be achieved without separating the child from peers who do not have disabilities. Both the text and the judicial interpretations of the Individuals with Disabilities Education Act operate in such a way that the negative command to not segregate students with disabilities becomes a positive command to afford services to make inclusive education work. The chapter concludes by briefly comparing the developments in the United States with those in other countries.
Mobilization Strategies and Get Out the Vote
Authors: Michelson Melissa R.
Published: August 2019

Persuading individuals to vote using instrumental arguments about affecting the outcome are generally ineffective, reflecting the irrationality of the likelihood that a single vote will do so. A review of existing randomized experiments suggests the much stronger strategy is to rely instead on messages that encourage individuals to vote as an expression of their identity in a particular group, such as their racial identity or partisan identity, harnessing the power of in-group identity and individual needs for self-esteem. This perspective helps resolve inconsistencies in the outcomes of existing experiments and remaining puzzles about how best to mobilize different subsets of the public. It also unearths an unplumbed well of potential future mobilization experiments.
Contesting the Cuban-Soviet Visual Rhetoric for the Present
Authors: Loss Jacqueline
Published: August 2019

This article suggests that the “recuperation” of Soviet remains and Cubans’ recollections of the Soviets are less significant than an exploration of everydayness in the present—real or reconstructed, in the shadow of the depleted utopic dimensions that were supposed to have molded it. With a focus on photographic series by Alejandro González Méndez; Abel Arcos Soto’s novel 9550: Una posible interpretación del azúl (9550: A Possible Interpretation of the Blue, 2014); and Carlos Machado Quintela’s film La obra del siglo (The Project of the Century, 2015), this project examines how the works of these artists dissect the utopic mechanism, woven into the international fabric of the Cuban-Soviet imaginary, by questioning the past’s framing of the future and the seemingly arbitrary implementation of concrete data and visual rhetoric to create historical narratives.
Specters of Europe and Anticommunist Visual Rhetoric in Romanian Film of the Early 1990s
Authors: Parvulescu Constantin , Turcuș Claudiu
Published: August 2019

This article identifies visions of European identity articulated by the anticommunist propaganda broadcasts of Radio Free Europe Romania (RFER) in the 1980s and traces the way these visions influenced the audiovisual rhetoric of the Romanian cinema of the early 1990s. It examines how RFER listeners envisioned this identity in a context of inner exile and in opposition to the communist system and its legacy. The study presents the political profile of film directors of the 1990s who gave cinematic form to RFER anticommunism. Using the concept of “hauntology,” a psycho-ideological analysis of this cinematic output is provided, with a specific focus on one of the most appreciated films of the immediate post-1989 decade, the 1994 Pepe and Fifi (Dir. Dan Pița).
Ageing as a Confound in Language Attrition Research
Authors: Higby Eve , Lerman Aviva , Korytkowska Marta , Malcolm Taryn , Obler Loraine K.
Published: August 2019

Language attrition research often focuses on adults living in non-native language environments for many years. Many of these individuals are older adults when tested. Because certain aspects of language are vulnerable to both attrition and ageing (e.g., lexical retrieval), some of the changes observed for language attriters may be due in part to ageing. In this chapter we ask: Are native-language changes for older adult attriters solely a result of reduced levels of native-language use or are they due in part to ageing? We consider neurophysiological changes that may play a role in language attrition and in non-pathological ageing to speculate whether the neurobiological sources of these two processes are similar or different. As attrition and ageing appear to exert independent effects on lexical retrieval decline, one must consider the effects of each of these factors on lexical retrieval for older adult bilinguals immersed in a non-native language environment
Phonological Attrition
Authors: Celata Chiara
Published: August 2019

This chapter looks at how the study of native language (L1) phonological attrition reveals that the system of phonological contrasts of the L1 may change as a consequence of new language (L2) acquisition in adulthood. It also reveals that changes at the system level may underpin the variable pronunciation patterns that have been observed in phonetic studies at the local level of individual segments or features. Such changes may include contrast blurring as well as boosting of the distinctiveness among system elements as a reaction to contact with a different phonological system. In addition to speech production, perception is also affected by the effects of phonological changes in L1 attrition, showing how pervasive the attrition phenomena may be for both speaking and listening abilities
Age Effects in Language Attrition
Authors: Bylund Emanuel
Published: August 2019

The present chapter discusses age effects in first language (L1) attrition. In particular, focus is placed on the age-related decline in attrition susceptibility, the extent to which age effects be counterbalanced by other factors, and the underlying mechanisms of age effects. In view of extant evidence, it is suggested that the change in heightened attrition susceptibility occurs at around 12 years of age (or puberty) (though this by no means implies that attrition does not occur past puberty). Relatedly, it is suggests that socio-psychological and cognitive factors have greater compensatory potential for prepubescent than postpubescent attriters. As to the underlying mechanisms of age effects, the impediment account, the psychosocial account, and the maturational account are discussed. It is suggested that out of these, the maturational account has the greatest explanatory potential. The chapter concludes with a number of testable principles of age effects on L1 attrition.
Syntax and Phonology in L2 Attrition
Authors: Bardovi-Harlig Kathleen , Stringer David
Published: August 2019

This chapter asks to what degree syntax and phonology appear to be impervious to second language (L2) attrition and examine the related question of whether there is a critical period for either acquisition or attrition in these domains. Previous research has indicated a critical juncture in development at around 8 to 10 years old, after which target-like L2 acquisition is no longer guaranteed, and before which dramatic reduction in input may lead to apparent global loss of any early-acquired (L1) languages. A comparative review of research in L1 and L2 acquisition and attrition reveals remarkable resilience for aspects of phonology not subject to cross-linguistic influence, but paints a more complicated picture for syntax, which is difficult to investigate independently of lexical retrieval and working memory constraints. The chapter suggests an alternative conceptualization of the critical period in terms of network stabilization of the mental lexicon.
Language Development in Bilingual Returnees
Authors: Flores Cristina
Published: August 2019

The present chapter discusses language development in bilingual returnees, that is second or third generation ex-migrants, who have lived for an extended period in a migration context and have, at some point in their life, returned to their (or their parents’) country of origin. The return to the homeland comes along with a significant shift in the returnees’ input conditions, which allows discussing two different dimensions of this particular bilingual population. On the one hand, research on returnees allows investigating the effects of loss of contact with the ex-environmental (dominant) language. On the other hand, this population experiences increasing exposure to the heritage language (back in the homeland), giving valuable insights to heritage language development in an input setting that is still understudied
Mahler’s Eighth and the Faust Symphonic Tradition
Authors: Zychowicz James L.
Published: August 2019

This chapter sets Gustav Mahler’s Achte Symphonie (Eighth Symphony) in the context of the Faust symphonic tradition, which emerged with the growth of program music. Prior to Liszt’s monumental Faust-Symphonie (Faust Symphony), Faust overtures were composed by Richard Wagner and the Czech composer Bedřich Smetana. In contrast to Liszt’s Faust-Symphonie, with its explicit setting of verses from Goethe’s Faust at the end of the final movement, Mahler’s setting of the final scene of the drama in his Eighth Symphony integrates his selection from Goethe’s text throughout the entire second part of the work. The structure of Mahler’s Eighth Symphony merits attention for its treatment of Goethe’s text in a single, cohesive movement rather than a sequence of separate scenes. Mahler juxtaposed Faust’s redemption in the second part of the Symphony with a cantata-like presentation of a Latin hymn.
The Genesis, Transformations, Sources, and Style of Gounod’s Faust
Authors: Giroud Vincent
Published: August 2019

Beginning with Charles Gounod’s lifelong interest in Goethe’s Faust, this chapter explores the genesis of the composer’s collaboration with his librettists Jules Barbier and Michel Carré and the circumstances leading to the opera Faust’s 1859 premiere at the Théâtre-Lyrique. It discusses the opera’s transformation from a semi-character opéra-comique-type work with spoken dialogue to a full-fledged through-composed opera, with various additions and changes that make it difficult to speak of a “definitive” version. The libretto, while indebted to the French melodrama tradition, shows that the authors were eager to remain as faithful to Goethe as the nature and conventions of the genre allowed. The result is an admittedly hybrid work, where both Faust and Mephistopheles inevitably emerge as somewhat trivialized, while secondary characters are vividly portrayed and the figure of Marguerite transmutes as the emotional core, which makes her, vocally and dramatically, one of the memorable figures in nineteenth-century opera.
Hanns Eisler and Faust in the German Democratic Republic
Authors: Calico Joy H.
Published: August 2019

When Austrian composer and committed Marxist Hanns Eisler was forced out of the United States in 1948, he returned to Vienna and hoped to settle there. Instead, a commission for Goethe’s bicentennial celebration the following year drew him to East Berlin and the SBZ (Soviet Occupation Zone), soon to be the German Democratic Republic (GDR, or East Germany), and set him on the path to be that country’s most prominent composer. This chapter examines the piece Eisler wrote for that commission, Rhapsodie für großes Orchester (Rhapsody for large orchestra) (1949), which set text from Goethe’s Faust II, as well as his libretto for a proposed opera entitled Johann Faustus. East German reception of these pieces reveals the centrality of Goethe’s Faust for national identity formation in the fledgling GDR.
How Public Engagement Became a Core Part of the House of Commons Select Committees
Authors: Walker Aileen , Jurczak Naomi , Bochel Catherine , Leston-Bandeira Cristina
Published: August 2019

This article explores the role of public engagement by select committees of the House of Commons. It shows that committees’ public engagement activity has been transformed since 1979, when departmental select committees were introduced. We start by outlining the different elements of public engagement, showing that it entails a wide range of types of activity from information about committees’ activity to opportunities through which citizens can shape parliamentary decisions. We then proceed to outline how public engagement has become a core activity of select committees in the House of Commons. We show developments taking place within all elements of public engagement. Through the use of case studies, we illustrate specific innovations that have led towards more agile and inclusive ways to consult and involve the public into committees’ activities. We finish by identifying some of the challenges still present, namely the need to reach new and more varied audiences.
Mid-infrared spectroscopy of zodiacal emission with AKARI/IRC
Authors: Takahashi Aoi , Ootsubo Takafumi , Matsuhara Hideo , Sakon Itsuki , Usui Fumihiko , Chihara Hiroki
Published: August 2019

Interplanetary dust (IPD) is thought to be recently supplied from asteroids and comets. Grain properties of the IPD can give us information about the environment in the proto-solar system, and can be traced from the shapes of silicate features around 10$\, \mu$m seen in the zodiacal emission spectra. We analyzed mid-infrared slit-spectroscopic data of the zodiacal emission in various sky directions obtained with the Infrared Camera on board the Japanese AKARI satellite. After we subtracted the contamination due to instrumental artifacts, we successfully obtained high signal-to-noise spectra and have determined detailed shapes of excess emission features in the 9–12$\, \mu$m range in all sky directions. According to a comparison between the feature shapes averaged over all directions and the absorption coefficients of candidate minerals, the IPD was found to typically include small silicate crystals, especially enstatite grains. We also found variations in the feature shapes and the related grain properties among the different sky directions. From investigations of the correlation between feature shapes and the brightness contributions from dust bands, the IPD in dust bands seems to have a size frequency distribution biased toward large grains and shows indications of hydrated minerals. The spectra at higher ecliptic latitudes showed a stronger excess, which indicates an increase in the fraction of small grains included in the line of sight at higher ecliptic latitudes. If we focus on the dependence of detailed feature shapes on ecliptic latitudes, the IPD at higher ecliptic latitudes was found to have a lower olivine/(olivine + pyroxene) ratio for small amorphous grains. The variation of the mineral composition of the IPD in different sky directions may imply different properties of the IPD from different types of parent bodies, because the spatial distribution of the IPD depends on the type of the parent body.
‘Our Looks, Two Looks’: Miniature Portraits in the Letters of Elizabeth Bishop and Robert Lowell
Authors: Baldock Sophie
Published: August 2019

This article examines parallels between the exchange of miniature portraits in late eighteenth-century letters and the exchange of photographs and keepsakes in the twentieth-century correspondence of American poets Elizabeth Bishop and Robert Lowell. Drawing on theories of the miniature in Susan Stewart’s work, alongside art-historical and literary-critical accounts of the practice of exchanging miniature portraits in letters, the article builds on arguments that portraits go hand-in-hand with the genre of letter writing. I argue that previous criticism of the Bishop-Lowell correspondence has not yet adequately explored their epistolary discussion and exchange of visual materials. As in the case of their eighteenth- and nineteenth-century predecessors, for Bishop and Lowell, letter writing frequently involved a literal and metaphorical exchange of portraits. The article places particular photographs in their original context alongside letters, demonstrating the symbiotic relationship between images and text and the key role played by the visual in letter writing. It provides a fresh reading of Bishop’s and Lowell’s linked poems, ‘The Armadillo’ and ‘Skunk Hour’, arguing that these poems are a means of portrait-painting in relation to the other. The poems are examined alongside descriptions of an antique miniature cameo, sent by Lowell to Bishop as a companion to his poem, which functions as an ambivalently gendered portrait of Bishop. Finally, the poets’ interlocking memoirs, ‘91 Revere Street’ and ‘Memories of Uncle Neddy’, are analysed to show their origin in letters, and their shared preoccupation with portraiture, scale and framing.
Role of good oral hygiene on clinical evolution of rheumatoid arthritis: a randomized study nested in the ESPOIR cohort
Authors: Mariette Xavier , Perrodeau Elodie , Verner Christian , Struillou Xavier , Picard Nicolas , Schaeverbeke Thierry , Constantin Arnaud , Ravaud Philippe , Bouchard Philippe
Published: August 2019

Objective

There is a relationship between RA and periodontal disease. We aimed to investigate if a good oral hygiene could improve activity of RA.

Methods

The patients with RA according to ACR/EULAR 2010 criteria and included in the French early arthritis ESPOIR cohort were included in a randomized nested study into: (i) intervention group: general recommendations of good oral hygiene including teeth brushing, daily antiseptic mouthwash and twice a year scaling; and (ii) control group: no intervention. The primary end point was the delta DAS28-ESR.

Results

Four hundred and seventy-two patients were randomized (238 in intervention and 234 in control). 92/238 from the intervention group accepted the procedure and 81 had a first visit to the dentist. 56% of patients had periodontal disease at baseline. Duration of RA was 9.0±0.7 years. Baseline DAS28-ESR was 2.7±1.3. After a median duration of 24 months, delta DAS28-ESR was −0.17±1.29 and −0.09±1.28 in intervention and control groups, respectively (mean difference (complier average causal effect): −0.37 (95% CI −1.12, 0.37), P = 0.33). In the intervention group, there was a significant decrease of the bacteria involved in the red complex: Porphyromonas gingivalis (P = 0.002), Tannerella forsythia (P = 0.002) and Treponema denticola (P = 0.019). The patients with baseline periodontal disease and those who became negative for one red complex bacterium had a slightly more important decrease of DAS28-ESR.

Conclusion

Oral hygiene instruction together with regular scaling and polishing of the teeth significantly decreased the load of periodontal pathogens but did not decrease RA activity. This intervention should be tested in patients with earlier RA and more active disease.

Trial registration

ClinicalTrials.gov, http://clinicaltrials.gov, NCT01831648.
Leprosy and the Colonial Gaze: Comparing the Dutch West and East Indies, 1750–1950
Authors: Snelders Stephen , van Bergen Leo , Huisman Frank
Published: August 2019

This article is looking at colonial governance with regard to leprosy, comparing two settings of the Dutch colonial empire: Suriname and the Dutch East Indies. Whereas segregation became formal policy in Suriname, leprosy sufferers were hardly ever segregated in the Dutch East Indies. We argue that the perceived needs to maintain a healthy labour force and to prevent contamination of white populations were the driving forces behind the difference in response to the disease. Wherever close contact between European planters and a non-European labour force existed together with conditions of forced servitude (either slavery or indentured labour), the Dutch response was to link leprosy to racial inferiority in order to legitimise compulsory segregation. This mainly happened in Suriname. We would like to suggest that forced labour, leprosy and compulsory segregation were connected through the ‘colonial gaze’, legitimising compulsory segregation of leprosy sufferers who had become useless to the plantation economy.
17Theory on Theory
Authors: Sims Robin
Published: August 2019

This chapter reviews work published in 2018 which involves consideration of the significance of critical and cultural theory in the present day as well as the diverse legacies of some of its key figures. Books discussed include the English translation of Alain Badiou’s seminar on Lacan, a new series examining the legacies of Lacan alongside those of Derrida, Foucault, and Said, and Thomas Docherty’s analyses of the University’s turn towards servicing the market and of the relation between literature and capital. The chapter demonstrates the ongoing vitality of theory today, as well as its capacity to examine and challenge the supposed obviousness of the assumptions that underpin the status quo.
Soybean Resistance LocusRhg1Confers Resistance to Multiple Cyst Nematodes in Diverse Plant Species
Authors: Butler Katelyn J. , Chen Shiyan , Smith John M. , Wang Xiaohong , Bent Andrew F.
Published: August 2019

Cyst nematodes consistently threaten agricultural production, causing billions of dollars in losses globally. The Rhg1 (resistance to Heterodera glycines 1) locus of soybean (Glycine max) is the most popular resistance source used against soybean cyst nematodes (H. glycines). Rhg1 is a complex locus that has multiple repeats of an ≈30-kilobase segment carrying three genes that contribute to resistance. We investigated whether soybean Rhg1 could function in different plant families, conferring resistance to their respective cyst nematode parasites. Transgenic Arabidopsis thaliana and potato (Solanum tuberosum) plants expressing the three soybean Rhg1 genes were generated. The recipient Brassicaceae and Solanaceae plant species exhibited elevated resistance to H. schachtii and Globodera rostochiensis and to G. pallida, respectively. However, some negative consequences including reduced root growth and tuber biomass were observed upon Rhg1 expression in heterologous species. One of the genes at Rhg1 encodes a toxic version of an alpha-SNAP protein that has been demonstrated to interfere with vesicle trafficking. Using a transient expression assay for Nicotiana benthamiana, native Arabidopsis and potato alpha-SNAPs (soluble NSF [N-ethylamine sensitive factor] attachment protein) were found to compensate for the toxicity of soybean Rhg1 alpha-SNAP proteins. Hence, future manipulation of the balance between Rhg1 alpha-SNAP and the endogenous wild-type alpha-SNAPs (as well as the recently discovered soybean NSF-RAN07) may mitigate impacts of Rhg1 on plant productivity. The multispecies efficacy of soybean Rhg1 demonstrates that the encoded mechanisms can function across plant and cyst nematode species and offers a possible avenue for engineered resistance in diverse crop species.
“Progress in Medicine Is Slower to Happen”: Qualitative Insights Into How Trans and Gender Nonconforming Medical Students Navigate Cisnormative Medical Cultures at Canadian Training Programs
Authors: Butler Kat , Yak Adryen , Veltman Albina
Published: August 2019

Purpose

Trans and gender nonconforming (TGNC) people face significant health disparities compared with their cisgender (nontrans) counterparts. Physician-level factors play a role in these disparities, and increasing the participation of individuals from sexuality and gender minority (SGM) communities in medical training has been proposed as one way of addressing this issue; however, very little is known about the experiences of TGNC medical students. This study aimed to understand the experiences of TGNC medical students in Canada.

Method

Between April 2017 and April 2018, 7 TGNC participants either currently enrolled in or recently graduated from a Canadian medical school completed audiorecorded semistructured interviews. Interviewers asked about experiences with admissions; academic, clinical, and social environments; and interactions with administration. The authors analyzed interviews using a constructivist grounded theory approach.

Results

The authors developed 5 overarching themes: navigating cisnormative medical culture; balancing authenticity, professionalism, and safety; negotiating privilege and power differentials; advocating for patients and curricular change; and seeking mentorship in improving access and quality of care to TGNC patients. This article focuses on the first theme, with associated subthemes of culture and context; interactions with classmates, curriculum, policy, and administration; and gendered spaces.

Conclusions

The results of this study delineate heterogeneous experiences of medical cultures with a shared underlying pattern of erasure of TGNC people as both patients and clinicians. Findings were largely consistent with previously published recommendations for improving academic medical institutional climates for SGM people, though the need for access to appropriate gendered spaces beyond washrooms was highlighted.
Closing the Gap Between Preclinical and Clinical Training: Impact of a Transition-to-Clerkship Course on Medical Students’ Clerkship Performance
Authors: Ryan Michael S. , Feldman Moshe , Bodamer Cheryl , Browning Joel , Brock Ellen , Grossman Catherine
Published: August 2019

Problem

Medical students typically perform worse on clinical clerkships that take place early in their training compared with those that occur later. Some institutions have developed transition-to-clerkship courses (TTCCs) to improve students’ preparedness for the clinical phase of the curriculum. Yet, the impact of TTCCs on students’ performance has not been evaluated.

Approach

The authors developed and implemented a TTCC at Virginia Commonwealth University School of Medicine and measured its impact on students’ clerkship performance. During the 2014–2015 academic year, they introduced a 2-week intersession TTCC. The goal was to improve students’ readiness for clerkships by fostering the knowledge, skills, and attitudes required to care for patients throughout a hospitalization. The TTCC included panel discussions, skills development sessions, case-based workshops, and a 4-station standardized patient simulation. The authors assessed the feasibility of designing and implementing the TTCC and students’ reactions and clerkship performance.

Outcomes

The total direct costs were $3,500. Students reacted favorably and reported improved comfort on entering clerkships. Summative performance evaluations across clerkships were higher for those students who received the TTCC with simulation compared with those students who received the standard clerkship orientation (P < .001–.04, Cohen’s d range = 0.23–0.62). This finding was particularly apparent in those clerkships that occurred earlier in the academic year.

Next Steps

Future plans include evaluating the impact of the TTCC on student well-being and incorporating elements of the TTCC into the preclinical curriculum.
Career Impact of the Chief Resident in Quality and Safety Training Program: An Alumni Evaluation
Authors: Aboumrad Maya , Carluzzo Kathleen , Lypson Monica , Watts Bradley V.
Published: August 2019

Purpose

Most evaluations of quality improvement and patient safety (QI/PS) training programs provide inadequate data on their impact on alumni careers and QI/PS involvement. To address this gap, the authors investigated continued participation in and barriers to QI/PS work, employment, and satisfaction with training among alumni of the Department of Veterans Affairs (VA) Chief Resident in Quality and Safety (CRQS) program.

Method

A cross-sectional, web-based survey was administered in January 2018 to all 238 CRQS program alumni (program years 2009–2017, 54 program sites).

Results

A total of 145 alumni (61%) completed the survey, of whom 40% were employed at the VA. Participants reported various professional roles including academic appointments, QI/PS-specific positions, and hospital leadership positions. Most respondents reported involvement in QI/PS activities within the past year, including conducting QI or PS projects and teaching QI or PS. Alumni dedicated a median 15% of their work time to QI/PS. Almost all alumni reported experiencing barriers to QI/PS involvement, most frequently lack of time given clinical responsibilities. Most were satisfied with the training, and almost all reported CRQS participation helped their professional career advancement.

Conclusions

The continued involvement in QI/PS reported by alumni suggests training programs such as the CRQS program may be successful in building a workforce of leaders equipped to conduct and teach QI/PS. Dedicated time for QI/PS efforts is an important barrier. Future research should address possible career options and assess the larger, overall effect training physicians in QI/PS has on health systems and patient care.
Realizing One’s Own Subjectivity: Assessors’ Perceptions of the Influence of Training on Their Conduct of Workplace-Based Assessments
Authors: Hodwitz Kathryn , Kuper Ayelet , Brydges Ryan
Published: August 2019

Purpose

Assessor training is essential for defensible assessments of physician performance, yet research on the effectiveness of training programs for promoting assessor consistency has produced mixed results. This study explored assessors’ perceptions of the influence of training and assessment tools on their conduct of workplace-based assessments of physicians.

Method

In 2017, the authors used a constructivist grounded theory approach to interview 13 physician assessors about their perceptions of the effects of training and tool development on their conduct of assessments.

Results

Participants reported that training led them to realize that there is a potential for variability in assessors’ judgments, prompting them to change their scoring and feedback behaviors to enhance consistency. However, many participants noted they had not substantially changed their numerical scoring. Nonetheless, most thought training would lead to increased standardization and consistency among assessors, highlighting a “standardization paradox” in which participants perceived a programmatic shift toward standardization but minimal changes in their own ratings. An “engagement effect” was also found in which participants involved in both tool development and training cited more substantial learnings than participants involved only in training.

Conclusions

Findings suggest that training may help assessors recognize their own subjectivity when judging performance, which may prompt behaviors that support rigorous and consistent scoring but may not lead to perceptible changes in assessors’ numeric ratings. Results also suggest that participating in tool development may help assessors align their judgments with the scoring criteria. Overall, results support the continued study of assessor training programs as a means of enhancing assessor consistency.
Role of Distal Femoral Replacement for Periprosthetic Fractures Above a Total Knee Arthroplasty: When and How?
Authors: Haidukewych George J.
Published: August 2019

With increasing incidence of total knee arthroplasty (TKA), a concurrent rise in periprosthetic fractures is also expected. Although many periprosthetic fractures about a TKA can be fixed through locked plating, retrograde intramedullary nailing, or both, some fracture patterns combined with poor bone stock and/or osteolysis can offer a loose femoral component requiring TKA revision. TKA revision in the setting of periprosthetic fracture can be challenging and, often, nearly impossible as fractures that extend proximally may not be amenable to standard revision components. Distal femoral replacement may offer a more efficient, facile approach to treating periprosthetic fractures about a loose TKA component. Here, the role of distal femoral replacement is reviewed, offering indications, salient technical points, and tips to avoid pitfalls while allowing for immediate, reliable weight bearing in this challenging patient population.
Use of Antibiotic Plates and Spacers for Fracture in the Setting of Periprosthetic Infection
Authors: Maceroli Michael A. , Yoon Richard S. , Liporace Frank A.
Published: August 2019

Prosthetic joint infection is a common cause of hip revision surgery, typically managed with a staged protocol and an antibiotic cement spacer. Patients being treated for prosthetic joint infection are at risk of fracture below the level of the spacer. Fracture in the setting of periprosthetic infection is a complex problem that requires the treating surgeon to use multiple techniques to achieve a successful outcome. The purpose of this case report is to highlight surgical strategies to successfully manage periprosthetic fractures complicated by infection.
Vancouver B3 Fractures: Treatment Options and Tips
Authors: Khan Saad , Kyle Richard
Published: August 2019

The incidence of periprosthetic fracture around hip arthroplasty has increased with the rise of total hip arthroplasty. These fractures are challenging to treat and often require revision of the femoral prosthesis. Vancouver B3 fractures are particularly difficult to treat because of extensive bone loss and limited options. A revised stable femoral component requires distal femoral fixation. Most cases can be performed with a tapered component or a long-stem fully coated prosthesis. Femoral allograft composite and proximal femoral replacement has been recommended for Vancouver B3 fractures with extremely poor bone stock but is rarely performed today. We present our surgical technique, as well as pearls and pitfalls in treating Vancouver B3 fractures with a loose prosthesis and proximal bone loss.
Syme Amputation: Function, Satisfaction, and Prostheses
Authors: Morrison Stewart G. , Thomson Phoebe , Lenze Ulrich , Donnan Leo T.
Published: August 2019

Background:

Syme amputation (SA) is a term used to describe an amputation at the level of the ankle joint in which the heel pad is preserved. It is performed for a number of indications in a pediatric population. SA is purported to hold the advantage of allowing weight bearing without a prosthesis. A limb length discrepancy (LLD) is useful for ambulation without a prosthesis but can be restrictive with regards to the fitting of modern prostheses.

Methods:

A voluntary survey was distributed to persons living with SA. Recruitment occurred through hospital electronic database and electronic advertising. Data collected included baseline demographic information, data pertaining to weight bearing in different environments, as well as 2 validated outcome measures: the Trinity Amputation and Prosthesis Experience Scales-Revised (TAPES-R activity restriction scale) and the Locomotor Capabilities Index-5 (LCI-5). An illustration was designed to allow participants to classify their LLD by zone in relation to their nonamputated limb.

Results:

At total of 47 persons living with SA participated. The average age at amputation was 3.7 years (range, 0.5 to 14.1 y), and at survey completion 15.8 years (1.7 to 60.3). Five of the described “zones” of LLD were represented. Average LCI-5 score was 52.6. Mean TAPES-R activity restriction scale was 0.59, the lowest mean being achieved by zone E participants, indicating the least restriction. Ability to walk without a prosthesis was lower in those participants over 11 years, when compared with those under, as well as being dependent on the walking environment.

Conclusions:

Our study found no trend indicating that a very low LLD was functionally optimal, and indeed found participants with a moderate LLD (zone E) to have the least mean restriction with regard to their prosthesis. Our study demonstrates that ambulation without a prosthesis depends on the environment (ie, flooring), and rates decrease significantly into adulthood. Optimal care should not focus simply “preserving length,” but rather functional optimization and length modulation in parallel with a nuanced understanding of actual daily activities and prosthetic options.

Level of Evidence:

Level III—retrospective comparative study.
Long-Acting Basal Insulins
Authors: Gallegos Aragon Kelsea , Elmaoued Amre Adel , Pham Ngoc-Yen T. , Conklin Jessica R. , Ray Gretchen M.
Published: August 2019

Long-acting basal insulins are used for the management of both type 1 and type 2 diabetes mellitus. Long-acting basal insulins were developed utilizing recombinant DNA technology and have been available since 2000 with the approval of insulin glargine U-100 followed by insulin detemir in 2005. In recent years, diabetes management has become more complex with the approval of insulin glargine U-300 and insulin degludec U-100 and U-200. Both insulin glargine U-300 and insulin degludec have been compared with insulin glargine U-100 and have demonstrated longer durations of action, as well as lower rates of hypoglycemia. This review discusses the Food and Drug Administration-approved long-acting insulins with a focus on recently approved agents and their efficacy and safety compared with the first long-acting basal insulins.
Central American Immigrant Mothers' Mental Health in the Context of Illegality
Authors: Letiecq Bethany L. , Mehta Swati , Vesely Colleen K. , Goodman Rachael D. , Marquez Marlene , Moron Leanna P.
Published: August 2019

Using a community-based participatory research approach, we surveyed 134 undocumented Central American immigrant mothers to examine correlates of maternal mental health. Drawing upon an ecosystemic framework, predictors of depression included structural and familial stressors, parental concerns, and maternal health factors. Mothers' perceptions of child affect, traumatic stress, and general health ratings were among the most salient predictors. However, structural and familial stressors, such as food insecurity and single parenting, also accounted for significant variance in depression scores. Findings informed community actions such as advocating for mental health care and building awareness of families' lived experiences within the local school system.
Thermal Imaging Facilitates Design of a Keystone Perforator Island Flap for a Myxofibrosarcoma Resection Reconstruction: Case Report
Authors: Patel Shimul S. , Homsy Christopher , Atamian Elisa K. , Chaffin Abigail E.
Published: August 2019

Lower extremity defects are challenging to reconstruct. The keystone perforator island flap proves useful in difficult cases. Traditionally, a handheld Doppler is used to confirm perforator vessel(s) within the flap but has disadvantages including low sensitivity/specificity. Surgeons can use thermal imaging to localize “hot spots” on the skin, corresponding to perforators. FLIR ONE (FLIR Systems Inc., Wilsonville, OR) is a portable thermal camera with high concordance with computed tomographic angiography. In this case, when faced with handheld Doppler failure, we used intraoperative thermal imaging to continue planning and raising of a complex lower extremity keystone perforator island flap.
Latissimus Dorsi Musculocutaneous Flap for Complex Breast Reconstruction: Indications, Outcomes and a Proposed Algorithm
Authors: Kokosis George , Khavanin Nima , Nahabedian Maurice Y.
Published: August 2019

Purpose:

The latissimus dorsi (LD) flap is an ideal flap for salvage following failed primary breast reconstruction in the setting of radiation therapy. This study will review outcomes following secondary reconstruction with the LD flap with or without a tissue expander (TE) or implant (I).

Methods:

The following 4 cohorts were included: 1-stage LD only in 28 patients (48.3%), 1-stage LD + I in 7 patients (12.1%), 2-stage LD + TE/I in 8 patients (13.8%), and 3-stage LD + TE + I in 15 patients (25.9%).

Results:

The average age across all patients was 53.2 years. Complications did not differ significantly across the 4 cohorts. Complications included partial flap necrosis, wound dehiscence, seroma, and infection occurring in 4 of 28 patients of 1-stage LD alone, 2 of 7 (28.6%) patients of 1-stage LD + I, 5 of 8 (52.5%) patients of 2-stage LD + TE/I, and 4 of 15 (26.7%) patients of 3-stage LD + TE + I (P = 0.055). Reoperation rates were 10.7%, 14.3%, 25%, and 0% across the 4 cohorts, respectively (P = 0.295). The LD only cohort had a 14.3% surgical revision rate, compared with 42.9% in the 1-stage + I, 50% in the 2-stage + TE/I, and 33.3% in the 3-stage LD + TE + I (P = 0.135). The rate of contralateral symmetry procedures was 10.7%, 0%, 25%, and 6.7%, across the 4 cohorts, respectively (P = 0.410).

Conclusion:

Secondary breast reconstruction with the LD flap in 1, 2, or 3 stages has demonstrated success. A decision-making algorithm is provided.
Exercise Interventions in Patients With Implantable Cardioverter-Defibrillators and Cardiac Resynchronization Therapy
Authors: Steinhaus Daniel A. , Lubitz Steven A. , Noseworthy Peter A. , Kramer Daniel B.
Published: August 2019

Purpose:

Physical activity improves outcomes across a broad spectrum of cardiovascular disease. The safety and effectiveness of exercise-based interventions in patients with implantable cardioverter-defibrillators (ICDs) including cardiac resynchronization therapy defibrillators (CRT-Ds) remain poorly understood.

Methods:

We identified clinical studies using the following search terms: “implantable cardioverter-defibrillators”; “ICD”; “cardiac resynchronization therapy”; “CRT”; and any one of the following: “activity”; “exercise”; “training”; or “rehabilitation”; from January 1, 2000 to October 1, 2015. Eligible studies were evaluated for design and clinical endpoints.

Results:

A total of 16 studies were included: 8 randomized controlled trials, 5 single-arm trials, 2 observational cohort trials, and 1 randomized crossover trial. A total of 2547 patients were included (intervention groups = 1215 patients, control groups = 1332 patients). Exercise interventions varied widely in character, duration (median 84 d, range: 23-168 d), and follow-up time (median 109 d, range: 23 d to 48 mo). Exercise performance measures were the most common primary endpoints (87.5%), with most studies (81%) demonstrating significant improvement. Implantable cardioverter-defibrillator shocks were uncommon during active exercise intervention, with 6 shocks in 635 patients (0.9%). Implantable cardioverter-defibrillator shocks in follow-up were less common in patients receiving any exercise intervention (15.6% vs 23%, OR = 0.68; 95% CI, 0.48-0.80, P < .001).

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o
2 peak improved significantly in patients receiving exercise intervention (1.98 vs 0.36 mL/kg/min, P < .001).

Conclusion:

In conclusion, exercise interventions in patients with ICDs and CRT-Ds appear safe and effective. Lack of consensus on design and endpoints remains a barrier to broader application to this important patient population.