bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Dizziness Handicap in Adolescents and Adults with Auditory Neuropathy Spectrum Disorder
Authors: Prabhu Prashanth , Jamuar Pratyasha
Published: April 2017

Introduction Vestibular symptoms and damage to the vestibular branch of the eighth cranial nerve is reported in individuals with auditory neuropathy spectrum disorder (ANSD). However, the real life handicap caused by these vestibular problems in individuals with ANSD is not studied.

Objective The present study attempted to evaluate the dizziness-related handicap in adolescents and adults with ANSD.

Method The dizziness handicap inventory (DHI) was administered to 40 adolescents and adults diagnosed with ANSD. The study also attempted to determine if there is any gender effect on DHI scores and its correlation to the reported onset of hearing loss.

Results The results of the study showed that adolescents and adults with ANSD had a moderate degree of dizziness-related handicap. The dizziness affected their quality of life, causing emotional problems. There was no gender effect, and the level of the handicap was greater in the cases in which the onset of the hearing loss was reported soon after the diagnosis of ANSD. There could be a vestibular compensation that could have resulted in a reduction in symptoms in individuals in whom the onset of the hearing loss was reported later on.

Conclusion Thus, a detailed assessment of vestibular problems and their impact on quality of life is essential in adolescents and adults with ANSD. Appropriate management strategies should be considered to resolve their vestibular problems and improve their quality of life.
Development of Multiple-Unit Floating Drug Delivery System of Clarithromycin: Formulation, in vitro Dissolution by Modified Dissolution Apparatus, in vivo Radiographic Studies in Human Volunteers
Authors: Reddy Arun , Reddy Narendar
Published: April 2017

Clarithromycin (CM), a broad spectrum macrolide antibiotic used to eradicate H. pylori in peptic ulcer. Clarithromycin (CM) is well absorbed from the gastrointestinal tract, but has a bioavailability of 50% due to rapid biodegradation. The aim of this investigation was to increase the gastric residence time, and to control the drug release of clarithromycin by formulating into multiple unit floating mini-tablets. Floating tablets were prepared by using direct compression method with HPMC K4M and Polyox WSR 1105 as release retarded polymers and sodium bicarbonate as gas generating agent. The prepared mini-tablets were evaluated for thickness, weight variation, friability, hardness, drug content, in vitro buoyancy, swelling studies, in vitro dissolution studies by using modified Rossett-Rice test and in vivo radiographic studies in healthy human volunteers in fasting conditions. DSC analysis revealed that no interaction between drug and excipients. All the physical parameters of the tablets were within the acceptable limits. The optimized formulation (F6) had showed controlled drug release of 99.16±3.22% in 12 h, by zero-order release kinetics, along with floating lag time of 9.5±1.28 s and total floating time of 12±0.14 h. X-ray imaging studies revealed that in vivo gastric residence time of clarithromycin floating mini-tablet in the stomach was about 3.5 h. The results demonstrated that the developed floating mini-tablets of clarithromycin caused significant enhancement in gastric retention time along with sustained effect and increased oral bioavailability.
Alpha-2-Makroglobulin-Serumspiegel bei Patienten mit Alpha-1-Antitrypsin-Mangel
Authors: Kotke V. , Wiedmann S. , Nell C. , Vogelmeier C. , Bals R. , Greulich T. , Klemmer A.
Published: April 2017

Hintergrund und Ziele Alpha-2-Makroglobulin (A2 M) ist ein Plasmaprotein mit proteolytischer Wirkung auf viele Proteasen. Bei Patienten mit einem angeborenen Alpha-1-Antitrypsinmangel (AATM) liegt ein funktioneller Protease-Überschuss vor. Ziel dieser Studie war es, die Hypothese zu prüfen, dass bei Patienten mit AATM ein erhöhter A2M-Spiegel nachweisbar ist.

Methoden Patienten mit AATM (Genpolymorphismus Pi*ZZ, Pi*SZ, Pi*MZ und seltene Genvarianten) wie auch Probanden mit einem normwertigen AAT-Spiegel (gesunde Probanden, Pi*MM) wurden der A2M- und AAT-Testung unterzogen. Die Serumkonzentrationen der Proteine wurden mittels Nephelometrie bestimmt. Die Polymorphismen Pi*Z und Pi*S wurden durch Polymerase-Kettenreaktion (PCR) nachgewiesen, seltene Genvarianten wurden durch Sequenzierung ermittelt.

Ergebnisse In unsere Studie wurden insgesamt 291 Individuen eingeschlossen. Es konnte gezeigt werden, dass es bei Vorliegen eines Genpolymorphismus (Pi*ZZ) und einem Alpha-1-Antitrypsin-Serumspiegel < 50 mg/dl zu einem signifikanten Anstieg des A2M-Spiegels im Serum gegenüber den gesunden Probanden kommt.

Schlussfolgerungen In dieser Studie konnte eine inverse Korrelation zwischen den Serumspiegeln von AAT und A2M bei Vorliegen eines Genpolymorphismus (Pi*ZZ) nachgewiesen werden. Weitere Studien sind erforderlich, um zu erfassen, welche klinische Bedeutung erhöhte A2M-Serumpiegel bei Patienten mit einem schweren AAT-Mangel Pi*ZZ und seltenen Genvarianten, deren AAT-Serumspiegel unter 50 mg/dl liegt, haben könnten.
Dual RAAS Blockade with Aliskiren in Patients with Severely Impaired Chronic Kidney Disease
Authors: Rasche Franz , Joel Claudia , Ebert Thomas , Frese Thomas , Barinka Filip , Busch Volker , Rasche Wilma , Lindner Tom , Schneider Jochen , Schiekofer Stephan
Published: April 2017

Dual renin-angiotensin-aldosterone blockade (dRAASb) is purposed in the prevention of the cardiorenal syndrome (CRS). However, all attempts with dRAASb even in patients with moderate impaired chronic kidney disease (CKD) were terminated due to the typical severe adverse events (SAE), e. g., hyperkalemia and rise of serum creatinine. The aim of our study with the direct renin inhibitor aliskiren was to evaluate the effect of dRAASb with a washout phase in patients with severely advanced CKD.

We have studied 45 patients (G3b to 4, A2 and >A3; median glomerular filtration rate (GFR) CKD-EPI 31 (23–40) ml/min per 1.73 m² BSA (body surface area), albumin-creatinine-ratio in urine (UACR) (0.413 (0.164 to 1.39) g/g) and proteinuria (0.5 (0.2 to 0.9) g/l) before, with and without aliskiren (150 respectively 300 mg per day) added to an angiotensin-converting enzyme inhibitor (ACEi) or an AT1-receptor blocker (ARB) over 4 ½ years.

The dRAASb with aliskiren showed a significant decrease of proteinuria (0.5 to 0.38 g/l), especially in patients with an UACR≥350 mg/g and in the subgroup analysis e. g., in patients with diabetes, but proteinuria increased in the washout phase again. The blood pressure (130/80 mm Hg), serum potassium (4.9 to 5.0 mmol/l) and GFR remained nearly constant (31 to 29.5 ml/min per 1.73 m2 BSA). A more than 30% increase in serum creatinine was associated with an UACR>300 mg/g.

The dRAASb has beneficial effects on proteinuria and is safe in patients with severely advanced CKD. However, in patients with high UACR (>300 mg/g) raise of creatinine and potassium have to be controlled.
Isotropic-nematic phase transition of uniaxial variable softness prolate and oblate ellipsoids
Authors: Rickayzen G. , Heyes D. M.
Published: April 2017

Onsager’s theory of the isotropic-nematic phase separation of rod shaped particles is generalized to include particle softness and attractions in the anisotropic interparticle force field. The procedure separates a scaled radial component from the angular integral part, the latter being treated in essentially the same way as in the original Onsager formulation. Building on previous treatments of more idealised hard-core particle models, this is a step toward representing more realistic rod-like systems and also allowing temperature (and in principle specific chemical factors) to be included at a coarse grained level in the theory. The focus of the study is on the coexisting concentrations and associated coexistence properties. Prolate and oblate ellipsoids are considered in both the small and very large aspect ratio limits. Approximations to the terms in the angular integrals derived assuming the very large (prolate) and very small (oblate) aspect ratios limits are compared with the formally exact treatment. The approximation for the second virial coefficient matches the exact solution for aspect ratios above about 20 for the prolate ellipsoids and less than ca. 0.05 for the oblate ellipsoids from the numerical evaluation of the angular integrals. The temperature dependence of the coexistence density could be used to help determine the interaction potential of two molecules. The method works at temperatures above a certain threshold temperature where the second virial coefficient is positive.
Energy spectrums of bilayer triangular phosphorene quantum dots and antidots
Authors: Jiang Z. T. , Li S. , Lv Z. T. , Zhang X. D.
Published: April 2017

We theoretically investigate the confined states of the bilayer triangular phosphorene dots and antidots by means of the tight-binding approach. The dependence of the energy levels on the size, the type of the boundary edges, and the orientation of the dots and antidots, and the influences of the electric and magnetic fields on the energy levels, are all completely analyzed. It is found that the energy level numbers of the bilayer dots and antidots are determined by the energy levels in two layers. The external electric field can effectively tune the energy levels of the edge states in both layers to move in opposite directions. With the increase of the magnetic field, the magnetic energy levels can approach the Landau levels of the phosphorene monolayer, the phosphorene bilayer, or both, depending on the specific geometry of the monolayer-bilayer hybrid phosphorene quantum dots. This research should be helpful for the overall understanding of the electronic properties of the multilayer hybrid phosphorene nanostructures and designing the corresponding phosphorene devices.
CAPN1 gene as a potential marker for growth performance and carcass characteristics in pigs
Authors: Ropka-Molik K. , Robert E. , Tyra M. , Piórkowska K. , Oczkowicz M. , Szyndler-Nędza M. , Bereta A.
Published: April 2017

The calcium-activated neutral proteinase 1 (CAPN1) gene, which encodes µ-calpain, is considered to be associated with the majority of meat-quality traits. The objective of the present study was to evaluate the effect of CAPN1 polymorphism on the most important slaughter, fattening and pork-quality traits. The genotype frequency of g.1429G>A polymorphism was estimated on 860 pigs represented by five breeds (Polish Landrace, Polish Large White, Pietrain, Duroc and Pulawska). In all breeds, the most frequent were pigs with an AA genotype (60–74%), with the exception of Duroc pigs where the largest number of GG animals was observed (14%). The results showed that g.1429G>A polymorphism significantly affected the number of days on test (P ≤ 0.05) and age at slaughter (P ≤ 0.01), the weight of ham and primary cuts (P ≤ 0.05, P ≤ 0.01 respectively), loin eye area (P ≤ 0.01) and average backfat thickness (P ≤ 0.05). The g.1429G>A single-nucleotide polymorphism showed no clear influence on complex pork-quality traits. At the present stage of research, the results obtained allow for the use of g.1429G>A polymorphism in CAPN1 gene as genetic marker in pig selection to improve several slaughter or fattening traits.
Contraceptive efficacy of priming and boosting doses of controlled-release PZP in wild horses
Authors: Rutberg Allen , Grams Kayla , Turner Jr John W. , Hopkins Heidi
Published: April 2017

Context
At some sites, wild horse populations have been effectively and non-invasively regulated using remote darting with porcine zona pellucida (PZP) immunocontraceptive vaccines. However, this model has not been widely applied to wild horse herds in western USA, many of which are difficult to access because they roam large areas and are wary of people. Single-treatment, multi-year contraceptive vaccines would significantly broaden the scope for successful contraceptive management.

Aims
The aims of the present field studies were to (1) test the contraceptive effectiveness and longevity of primers incorporating PZP–adjuvant emulsions plus PZP and adjuvant in controlled-release pellets (‘PZP-22’); and (2) compare the contraceptive effectiveness and duration of PZP–adjuvant emulsion-only boosters with those of PZP-22 boosters when administered by hand or remote darting to PZP-22-primed mares.

Methods
Wild horses in herd management areas in Colorado and Utah, USA, were rounded up in 2008 and in Utah again in 2012. Previously untreated females received a single hand-injection of PZP–emulsion plus controlled-release PZP pellets (‘PZP-22’ vaccine) and were then released. In Autumn 2010, 50 Colorado females treated in 2008 were booster-darted with either the PZP-22 vaccine or the PZP emulsion alone. In Utah, 57 previously treated females rounded up in 2012 received hand-injections of either the PZP emulsion–pellet vaccine or the PZP emulsion alone. Maternity was established through field observation of nursing and other close associations.

Key results
Effectiveness of initial controlled-release PZP treatments over 2 years was low relative to previous trials. However, boosters delivered by dart or by hand to PZP-22-primed mares yielded high levels of contraceptive effectiveness for 3 years, with no consistent difference between simple PZP-emulsion boosters and boosters incorporating controlled-release pellets.

Conclusions
Priming mares with PZP-22 extends the efficacy of a subsequent PZP booster to at least 3 consecutive years.

Implications
Regulation of wild horse populations may be achieved with existing contraceptive agents by developing models and management plans that account for the increased longevity of repeated contraceptive treatments.
Growth and Spawning Dynamics of Southern Flounder in the North-Central Gulf of Mexico
Authors: Corey Morgan M. , Leaf Robert T. , Brown-Peterson Nancy J. , Peterson Mark S. , Clardy Samuel D. , Dippold David A.
Published: April 2017

Southern Flounder Paralichthys lethostigma is the most commonly harvested flatfish in the north-central Gulf of Mexico (GOM), yet knowledge of this species’ growth and reproduction is limited for the Mississippi region. Given the offshore spawning migrations and likely mixing between state-managed units of the GOM Southern Flounder stock, small-scale environmental influences may constitute a major driver of life history dynamics during early life residency in nearshore estuaries. Therefore, estimates of local demographic characteristics are needed for effective fishery management. Here, we describe critical life history traits of Southern Flounder, including estimation of growth rates and maturity. The three-parameter von Bertalanffy growth function best described female-specific growth: mean asymptotic length L∞ was 514 mm TL, mean growth coefficient k was 0.67 year–1, and mean theoretical age at zero length t0 was –0.50 years. The estimated female-specific mean length at 50% maturity (L50) was 303 mm TL, and the female-specific mean age at maturity was 0.96 years. Although we observed significant differences between L50 estimates in the GOM, length-at-age parameter estimates were similar to those reported for other areas of the GOM. Both individual growth and length-at-maturity estimates were significantly different from those reported for the Atlantic, suggesting basin-level differences in population characteristics, with faster growth and earlier maturation in the GOM. Histological indicators and gonadosomatic index data indicated that the spawning season in the north-central GOM occurs from November to January and that Southern Flounder are batch spawners with asynchronous oocyte development. Our study provides a description of growth and spawning dynamics that will contribute to future stock assessment efforts focused on the Southern Flounder fishery in Mississippi and the GOM.
Introduction
Authors: Leeb Claudia
Published: April 2017

“Introduction” introduces the reader to the tensions inherent in theorizing the when, who, how, and what of sociopolitical change and the controversial debates it has created. It shows how the ideas of the “moment of the limit” and the “political subject-in-outline” allow one to creatively engage with these tensions and solve the dilemmas inherent in the idea of the political subject. It furthermore introduces the reader to the figures that are central in the book: Marx, Adorno, and Lacan. It explains why these figures have been kept at the margins of political and feminist theory, and why people need to engage with these thinkers to theorize sociopolitical change. Finally, it explains the structure of the book in two parts, where the first part develops the idea of the political subject-in-outline, and the second part applies this idea to the feminist political subject and the working-class woman as a political subject.
Who Changes the World
Authors: Leeb Claudia
Published: April 2017

“Who Changes the World: The Political Subject-in-Outline” introduces the idea of the political subject-in-outline to creatively engage with the tension between the exclusionary character of the political subject and its necessity for agency. It explains why giving up on the subject altogether or theorizing it as a constantly shifting entity is implicated in the project of capitalism, and acknowledges the necessity of defining a political subject to critique and transform capitalism. Yet its outline reminds people that any definition of the political subject must remain permanently open for contestation to avoid its exclusionary character. This chapter also explains that the subject-in-outline aims to establish a mediated relation between the universal and particular, as well as mind and body. Furthermore, it shows that the idea of a political subject-in-outline can help people avoid alienation, instrumental relations, and the coldness of love in capitalism.
How to Transform the World
Authors: Leeb Claudia
Published: April 2017

“How to Transform the World: Rethinking Theory and Practice” explains that the idea of the political subject-in-outline also aims to theorize a mediated relation between theory and practice. Mediation implies first that theory and practice are equally important tools of how people can change the world into a better one, and second that people must acknowledge the moment of the limit in our theorizing as well as practice, which suggests that both theory and practice are always ongoing projects. It challenges a theory that abstracts from practice, as well as a practice that abstracts from theory, and explains the connection between knowledge production and power. It also explains how people transform the world through outlining the central components of a critical theory and practice. This chapter also takes a critical look at those sociopolitical aspects that might hinder a successful transformative theory and practice.
What Makes Us Rebel
Authors: Leeb Claudia
Published: April 2017

“What Makes Us Rebel: Suffering Reconsidered” draws on Marx to expose the suffering capitalism causes—alienation, exploitation, and isolation—and explains how such suffering is connected to discourse. It also explains Marx’s notion of the commodity fetish that exposes that people are not completely subjected or subordinated by capitalist power structures, which allows them to envision agency. It introduces a new concept of suffering to further theorize such agency and to establish a mediated relation between mind and body. To do so it returns to Adorno and Lacan to explain the ways in which the moment of the limit (non-identity and the real) is connected to the unbearable physical moment of suffering in capitalism that spurs people on social change.
Rejecting the Politics of (Mis)Recognition
Authors: Leeb Claudia
Published: April 2017

“Rejecting the Politics of (Mis)Recognition: Butler Revisited,” applies some of the ideas of Part I of the book to the idea of the feminist political subject. It explains that although Butler does not propose a wholeness of power, her selective reading of Lacan—her rejection of the real and his notion of the unconscious, her holding on to the language of recognition, and her use of his notion of the ego—generates a wholeness of power, which makes it difficult to envision agency within her theoretical framework. It explains that the idea of the (feminist) political subject-in-outline embraces limit concepts and the concept of the unconscious, and aims at a clear break with the language of recognition and the politics of the ego.
The Working-Class Woman and Marx
Authors: Leeb Claudia
Published: April 2017

“The Working-Class Woman and Marx: Biased Constructions” shows that Marx, a thinker whose political thought aims to challenge hierarchical oppositions, reinforces hierarchical thought in his writings on the working-class woman. This exposes that oppositions concern deep unconscious structures in capitalism that are gendered, classed, sexed, and raced. It argues that we can only theorize a mediated relationship between hierarchical oppositions (such as mind/body, theory/practice, subject, and subject/object), if we make the unconscious link of women, racial and sexual minorities as well as the working-classes to the negative pole of oppositions conscious and delink groups of people from these oppositions. This is necessary, because such links are used to justify and cover up the division of labor and exploitation along class, gender, racial, and sexual lines. This chapter also discusses the moment when working-class women can rebel against their exploitation.
Regional differences in coronary revascularization procedures and outcomes: a nationwide 11-year observational study
Authors: Vaez Marjan , Dalén Magnus , Friberg Örjan , Nilsson Johan , Frøbert Ole , Lagerqvist Bo , Ivert Torbjörn
Published: April 2017

Aims

The study investigated whether regional differences in choice of coronary revascularization affected outcomes in Sweden.

Methods and results

We conducted a prospective nationwide study of outcome in patients undergoing coronary artery bypass grafting (CABG, n = 47 065) or percutaneous coronary intervention (PCI, n = 140 945) from 2001 through 2011, tracked for a median of 5 years. During this period, the proportion of CABG in revascularization procedures decreased nationwide from an average of 38% to 18%e. Three-vessel disease and left main stem coronary artery stenosis were more common among CABG patients than in PCI patients. In both males and females, all-cause mortality was higher in CABG patients than in PCI patients, while repeat PCI was performed more frequently in the PCI group. CABG proportions in 21 counties ranged from 13% to 42% in females and males. The combined outcomes of repeat revascularization, non-fatal acute myocardial infarction, and death during the tracking period was recorded in 151 936 patients without ST-elevation myocardial infarction after PCI (n = 37 820, 36%) and CABG (n = 18 903, 40%). The multivariable adjusted risk of combined outcomes was higher after both PCI and CABG in both females and males in the three quartiles of counties with a smaller proportion of CABG than in the quartile of counties with the highest proportion of CABG. Similar patterns persisted after including only mortality in the analyses.

Conclusion

There are subgroups of patients who have prognostic benefits of CABG in addition to symptomatic improvement that is well documented with both PCI and CABG.
Does the Internet Need a Hegemon?
Authors: Rovner Joshua , Moore Tyler
Published: April 2017

Hegemonic stability theory holds that a dominant power can produce international cooperation by providing public goods and resolving collective action dilemmas. Successful hegemons also resist the temptation to exploit their advantages in order to reduce other states’ fear of domination. This article asks whether or not the internet needs the United States to play a similar role. If so, Washington should pursue policies designed to strengthen internet security while eschewing espionage and cyberattacks that rely on some degree of internet insecurity. If not, it can go on the offensive without fear of undermining the system as a whole. We examine the technical and political fallout from revealed offensive cyberoperations to assess the relative fragility of the internet. Our findings suggest that it is relatively resilient.
Horace's Epistles and Ars Poetica
Authors: McCarter Stephanie
Published: April 2017

The Epistles and the Ars Poetica consist of verse letters written in dactylic hexameter. Epistles 1, published in 19 bce, comprises twenty letters with a range of real and fictive addressees. The dating of Epistles 2 presents a more difficult puzzle, although scholars generally date the poems to the period between 13 bce and Horace’s death in 8 bce. This book contains two poems, the first addressed to Augustus and the second to Julius Florus. The 476-line Ars Poetica is addressed to a Piso and his two sons and has been variously dated, with some estimates as early as 24 bce and some as late as 8 bce. Debate persists as to whether the poems of Epistles 2 should be treated singly or as a unified book. Sometimes treated as “Epistles 2.3,” the Ars Poetica was nevertheless thought of as a discrete work already in Quintilian, Institutio Oratoria 8.3.60. Produced in the wake of Horace’s monumental Odes 1–3, Horace’s epistolary poems are the product of a mature poetic voice, and the persona constructed in them belongs to a man with the success and experience that allows him to address with authority not only younger colleagues and protégés but also his social superiors. In keeping with this experienced persona, the poems turn away from the erotic and sympotic themes prevalent in the Odes and focus instead on the ethical (Epistles 1) and literary (Epistles 2 and Ars Poetica) topics befitting his changed age and mentality (Epist. 1.1.4). The poet shifts away from the role of public vates adopted, for example, in the Roman Odes and instead occupies a secluded retreat from which he addresses men occupying a range of public and private positions. Horace ironically claims (Epist. 1.1.10, 2.2.52–57, and Ars 306) that these letters are something less than formal poetry, which, along with their short hexameter form and moral focus, connects the Epistles with his earlier Satires (cf. esp. 1.4.39–42), themselves the product of a “pedestrian muse” (Sat. 2.6.17). While the Epistles share strong thematic links to the Satires, Horace develops these themes anew in keeping not only with his own changed voice but also with the social and political transformations of Augustan Rome. Often viewed in the shadow of his more widely read Satires and Odes, the Epistles and Ars Poetica have nevertheless received an impressive amount of scholarly attention.
Greek Literary Letters
Authors: Rosenmeyer Patricia
Published: April 2017

What do we mean by Greek literary letters. Letters in literature? Literature in letter form? Do we include “private” letters (e.g., Plutarch to his wife) if they are later published? The earliest reference to a (proto-) letter in Greek occurs in an epic that otherwise betrays no knowledge of writing (Homer Iliad 6: Bellerophon’s tablet). Yet fictive epistolography as an independent genre flourished only later, in the imperial period (second through third centuries ce). Hundreds of literary letters are printed in Hercher 1873 (cited in Texts and Commentaries): letters from dramas, letters from historians, letters from novels, epistolary novels, collections of love letters, and pseudohistorical or philosophical letters, among others. Yet many remain without modern editions or translations. Studies of epistolography generally explore one of three topics: Authenticity and Classification, sources and receptions, and narrative. The concern with authenticity emerged in Bentley 1697 (cited in Authenticity), and its influential declaration that most letters attributed to classical authors were actually later “forgeries.” This term was then wisely replaced by “fictive” or “pseudepigraphical,” since the letters displayed no evidence of intentional deceit, and some collections included what were accepted as authentic (e.g., Plato Letter 7) as well as spurious texts. As readers became more sensitive to issues of voice and authority, the question of authenticity was replaced by that of classification: were these letters private or public, real or imaginary? Did it matter if they were free-standing or embedded? Classical scholars in the early twentieth century, in particular Deissmann 1927 (cited in Classification), engaged with their Biblical colleagues, seeking ways to identify both letters and epistles, the latter being considered more self-consciously constructed. Two other main paths of study slowly emerged. Some scholars focused on origins and influences, looking to pseudonymous letters as nontraditional sources for information on authors’ lives and teachings. Others connected Greek epistolography to the rise of the European epistolary novel. Yet others located the impulse for pseudepigraphy in rhetorical exercises. The early twenty-first century has turned out to be a golden era for Greek literary letters, as numerous monographs, conference proceedings, translations, and articles tapped into contemporary critical theory and became ever more sophisticated in their approaches to the field. How do literary letters work within or as part of a larger narrative context? What was so appealing to ancient authors about epistolarity as a narrative strategy? Greek literary letters have finally become (again) a legitimate and fruitful object of study.
Gender and International Relations
Authors: Brown Karen
Published: April 2017

Gender analysis offers a distinct perspective on international relations in provoking a new set of questions. Early feminist international relations (IR) theorists joined other critical approaches to the field in interrogating the traditional conceptual terrain of IR scholarship in the 1980s, including states and sovereignty, national security, war, economic development and trade, globalization. Feminist scholarship represented an integral element of the critical foment of the “fourth debate” and its examination of international relations through a post-positivist lens. Scholars who focused on questions of gender and international relations brought a common commitment to understanding how social relations of masculinity and femininity, of gender identities and sexualities, of gender difference, are implicated in international politics. What “work” does gender do in international relations? Gender analysis provides a counterpoint to mainstream (or “malestream”) IR by asking two separate but closely interrelated questions: where are the women? how do gendered power relations undergird and shape the substance of international politics? These questions have led to a broad and diverse body of feminist IR scholarship that offers a reformulation of traditional IR topics as well as a new range of research subjects previously regarded as outside the scope of IR. One of the early tasks of feminist IR scholars was the establishment of a body of research on women, a necessary corrective to a field focused almost exclusively on the experiences of men and masculinist/male-dominated institutions and practices. This work helped to make a case for hegemonic masculinity. In addition, these scholars have demonstrated that investigation of gender as a means of social differentiation linked to power hierarchies in international relations reveals a more complex and varied conceptual and empirical terrain. From the early interventions when “adding women” represented a radical move in international relations scholarship, an interdisciplinary and extensive body of work now addresses analyses of gender and sexualities in international relations across subject areas, methodologies, and theoretical frameworks. Gender analyses include not only feminist theory, but also queer theory and a recent emphasis on masculinities and IR.
The nurse who could lift
Authors: Jones Sherry
Published: April 2017

This month, we celebrate nurses for their dedication to patient well-being and safety. The American Nurses Association has declared National Nurses Week 2017, May 6-12, the “Year of the Healthy Nurse.” This special Nurses Week tribute reminds us that although patient health and safety is the goal of every nurse, it's important to remember our own health as well.
Vulnerability to Psychopathology and Dimensions of Personality in Patients With Fibromyalgia
Authors: Garcia-Fontanals Alba , Portell Mariona , García-Blanco Susanna , Poca-Dias Violant , García-Fructuoso Ferran , López-Ruiz Marina , Gutiérrez-Rosado Teresa , Gomà-i-Freixanet Montserrat , Deus Joan
Published: April 2017

Objective:

Fibromyalgia (FM) patients may present psychopathology and some characteristic personality traits that may affect their adaptation to the disease. The aim of this paper was to study the relationship between personality dimensions according to the psychobiological model of Cloninger and the presence of psychopathology.

Materials and Methods:

The study sample consisted of 42 patients with FM and 38 pain-free controls. The assessment instruments administered were the Temperament and Character Inventory-Revised and the Millon Clinical Multiaxial Inventory.

Results:

A higher proportion of clinical psychopathologic syndromes (CPS) was observed in the FM group than in the control group, the most prevalent being anxiety disorder and dysthymia. Patients with FM (with CPS or without CPS) presented higher Harm Avoidance than the control group, and the presence of a CPS also increased Harm Avoidance scores. FM patients with CPS had low Self-directedness (SD) compared with both the control group and with their FM peers without CPS. Purposefulness and Anticipatory worry-Pessimism explained 38% of the variance of dysthymia, and anticipatory worry-Pessimism explained 18% of the variance of anxiety disorders.

Conclusions:

Patients with FM have a high probability of anxious-depressive-type psychopathologic alterations. Their vulnerability to these conditions may be determined by personality traits. The SD character dimension may have implications for therapy, as low SD is associated with the presence of psychopathology and with a low capacity to cope with the disease.
Open Glenohumeral Joint Reduction and Latissimus Dorsi and Teres Major Tendon Transfers for Infants and Children Following Brachial Plexus Birth Palsy
Authors: Abzug Joshua M. , Kozin Scott H. , Waters Peter M.
Published: April 2017

Glenohumeral dysplasia can occur in brachial plexus birth palsy due to an imbalance of muscle forces. Most commonly this occurs in C5-C6 injuries where the shoulder external rotators are weak compared with the shoulder internal rotators. Treatment of the dysplasia with open reduction of the glenohumeral joint in combination with rebalancing the muscles can improve the development of the joint. Furthermore, the tendon transfer can improve shoulder function by decreasing the internal rotation forces about the shoulder while increasing the external rotation forces. This paper describes the indications, contraindications, and technique of performing an open glenohumeral joint reduction and latissimus dorsi and teres major tendon transfers for brachial plexus birth palsy.
Repeated Critical Illness and Unplanned Readmissions Within 1 Year to PICUs*
Authors: Edwards Jeffrey D. , Lucas Adam R. , Boscardin W. John , Dudley R. Adams
Published: April 2017

Objectives:

To determine the occurrence rate of unplanned readmissions to PICUs within 1 year and examine risk factors associated with repeated readmission.

Design:

Retrospective cohort analysis.

Setting:

Seventy-six North American PICUs that participated in the Virtual Pediatric Systems, LLC (VPS, LLC, Los Angeles, CA).

Patients:

Ninety-three thousand three hundred seventy-nine PICU patients discharged between 2009 and 2010.

Interventions:

None.

Measurements and Main Results:

Index admissions and unplanned readmissions were characterized and their outcomes compared. Time-to-event analyses were performed to examine factors associated with readmission within 1 year. Eleven percent (10,233) of patients had 15,625 unplanned readmissions within 1 year to the same PICU; 3.4% had two or more readmissions. Readmissions had significantly higher PICU mortality and longer PICU length of stay, compared with index admissions (4.0% vs 2.5% and 2.5 vs 1.6 d; all p < 0.001). Median time to readmission was 30 days for all readmissions, 3.5 days for readmissions during the same hospitalization, and 66 days for different hospitalizations. Having more complex chronic conditions was associated with earlier readmission (adjusted hazard ratio, 2.9 for one complex chronic condition; hazard ratio, 4.8 for two complex chronic conditions; hazard ratio, 9.6 for three or more complex chronic conditions; all p < 0.001 compared no complex chronic condition). Most specific complex chronic condition conferred a greater risk of readmission, and some had considerably higher risk than others.

Conclusions:

Unplanned readmissions occurred in a sizable minority of PICU patients. Patients with complex chronic conditions and particular conditions were at much higher risk for readmission.
A Mixed Method Review of Tobacco Cessation for the Cardiopulmonary Rehabilitation Clinician
Authors: Mola Ana , Lloyd Madeleine M. , Villegas-Pantoja Miguel A.
Published: April 2017

PURPOSE:

To systematically survey the literature, describe the current tobacco science, and perform a mixed method review of randomized control trials of tobacco research in the cardiopulmonary population.

METHODS:

Mixed method review was conducted on major resource databases. Inclusion criteria were English language with a minimum follow-up of 6 months, published between January 1, 2007, and June 30, 2016; adult smokers ≥18 years of age with cardiovascular and/or pulmonary disease; initiation of subject recruitment from hospital or community; tobacco cessation (TC) as the main aim of the study; biometric validation of smoking status; first-line TC medications; and nonpharmacological treatments.

RESULTS:

The pooling of the 10 studies through forest plot analysis revealed the effect of tobacco continuous abstinence rates significant at 3, 6, and 12 months (total OR = 3.73; 95% CI, 2.58-5.38). Also, tobacco point prevalence rates of TC treatments demonstrated overall effects that were significant at the different end points (total OR = 2.63; 95% CI, 1.90-3.64). In both cases, the higher ORs were found in the 3 months end point. Most successful interventions consisted of a combination of pharmacological and nonpharmacological therapy (predominantly counseling).

CONCLUSIONS:

The evidence continues to support the recommended first-line TC pharmacotherapy and nonpharmacological practices published in the 2008 national guidelines. Implications for cardiopulmonary rehabilitation clinicians are discussed.
The effect of a lay-led, group-based self-management program for patients with chronic pain: a randomized controlled trial of the Danish version of the Chronic Pain Self-Management Programme
Authors: Mehlsen Mimi , Hegaard Lea , Ørnbøl Eva , Jensen Jens Søndergaard , Fink Per , Frostholm Lisbeth
Published: April 2017

The Stanford Chronic Pain Self-Management Programme (CPSMP) consists of 6 2½-hour weekly workshops focusing on how to manage pain in daily life. The workshops are facilitated by 2 workshop leaders of whom at least 1 must suffer from a long-term pain condition. The program is highly structured and manualized. Only few controlled trials testing the effect of CPSMP exist. Enrolled in the study were 424 adults from 19 Danish municipalities, (72% women; age: 25-93 years) with pain of any etiology and great variation in pain history (0-50 yrs). Of these, 216 were randomized to a lay-led version of the CPSMP. The primary outcome was pain-related disability. Secondary outcomes were pain, pain catastrophizing, self-efficacy, emotional distress, physical symptoms, and illness worry. Outcomes were measured before randomization, immediately after the CPSMP (response rate: 94%), and at 3-month follow-up (response rate: 92%). National register data on health expenditure were obtained to examine effects on health care use. ClinicalTrials.gov Identifier: NCT01306747. The CPSMP had no effect on the primary outcome pain-related disability or on health expenditure during intervention and follow-up period. Small positive effects on emotional distress and illness worry 3 months after CPSMP were observed. Lay-led CPSMP is not recommended as treatment for chronic pain-related disability. This heterogeneous group of patients with pain did not benefit from the CPSMP except for a small, but clinically insignificant improvement in psychological well-being.
Sensitivity and Specificity of the Modified Balance Error Scoring System in Concussed Collegiate Student Athletes
Authors: Buckley Thomas A. , Munkasy Barry A. , Clouse Brandy P.
Published: April 2017

Objective:

To assess the efficacy of the modified Balance Error Scoring System (mBESS) compared with the Balance Error Scoring System (BESS) in an acutely concussed population.

Design:

Prospective observational study.

Setting:

University athletic training room.

Patients:

Thirty-five collegiate student-athletes (18 Female, 18.9 ± 0.8 year old, height: 1.71 ± 0.12 m, weight: 76.3 ± 24.1 kg) with diagnosed concussions and baseline BESS/mBESS tests.

Interventions:

All participants completed the BESS and mBESS on the day after the concussion (acute) and were retested daily until their BESS score achieved baseline value (recovery).

Main Outcome Measures:

The number of errors committed during the BESS and mBESS at each time point were recorded. The sensitivity and specificity of the BESS and mBESS compared with the baseline test was calculated for acute and recovery as well as the mBESS compared with the BESS.

Results:

At acute, the sensitivity of the BESS and mBESS were 60.0% and 71.4%, respectively. Relative to mBESS baseline, 60% of participants were misclassified at either acute or recovery.

Conclusions:

The mBESS had higher sensitivity at acute and identified lingering deficits at BESS recovery. Use of the mBESS is likely to produce different results than the BESS; however, the clinical implications of this warrant further investigation.
Sleep Quality and Quantity in Low-Income Postpartum Women
Authors: Doering Jennifer J. , Szabo Aniko , Goyal Deepika , Babler Elizabeth
Published: April 2017

Purpose:

To describe and explore patterns of postpartum sleep, fatigue, and depressive symptoms in low-income urban women.

Study Design and Methods:

In this descriptive, exploratory, nonexperimental study, participants were recruited from an inpatient postpartum unit. Subjective measures were completed by 132 participants across five time points. Objective sleep/wake patterns were measured by 72-hour wrist actigraphy at 4 and 8 weeks. Mean sample age was 25 years, high school educated with 3.1 children. Over half the sample reported an annual income less than 50% of the federal poverty level.

Results:

Objectively, total nighttime sleep was 5.5 hours (week 4) and 5.4 hours (week 8). Subjectively, 85% met criteria for “poor sleep quality” at week 4, and nearly half were persistently and severely fatigued through 8 weeks postpartum.

Clinical Implications:

The majority (65%) of women in this study met the definition of “short sleep duration,” defined as sleeping ≤ 6 hours per night. Adverse effects of this short sleep on physical and mental health as well as safety and functioning, especially within the context of poverty, may be profound. There is an urgent need for further research on sleep in low-income underrepresented women to identify interventions that can improve sleep and fatigue as well as discern the implications of sleep deprivation on the safety and physical and mental health of this population.
The Impact of Body Mass Index on Abdominal Wall Reconstruction Outcomes: A Comparative Study
Authors: Giordano Salvatore A. , Garvey Patrick B. , Baumann Donald P. , Liu Jun , Butler Charles E.
Published: April 2017

Background:

Obesity and higher body mass index may be associated with higher rates of wound healing complications and hernia recurrence rates following complex abdominal wall reconstruction. The authors hypothesized that higher body mass indexes result in higher rates of postoperative wound healing complications but similar rates of hernia recurrence in abdominal wall reconstruction patients.

Methods:

The authors included 511 consecutive patients who underwent abdominal wall reconstruction with underlay mesh. Patients were divided into three groups on the basis of preoperative body mass index: less than 30 kg/m2 (nonobese), 30 to 34.9 kg/m2 (class I obesity), and 35 kg/m2 or greater (class II/III obesity). The authors compared postoperative outcomes among these groups.

Results:

Class I and class II/III obesity patients had higher surgical-site occurrence rates than nonobese patients (26.4 percent versus 14.9 percent, p = 0.006; and 36.8 percent versus 14.9 percent, p < 0.001, respectively) and higher overall complication rates (37.9 percent versus 24.7 percent, p = 0.007; and 43.4 percent versus 24.7 percent, p < 0.001, respectively). Similarly, obese patients had significantly higher skin dehiscence (19.3 percent versus 7.2 percent, p < 0.001; and 26.5 percent versus 7.2 percent, p < 0.001, respectively) and fat necrosis rates (10.0 percent versus 2.1 percent, p = 0.001; and 11.8 percent versus 2.1 percent, p < 0.001, respectively) than nonobese patients. Obesity class II/III patients had higher infection and seroma rates than nonobese patients (9.6 percent versus 4.3 percent, p = 0.041; and 8.1 percent versus 2.1 percent, p = 0.006, respectively). However, class I and class II/III obesity patients experienced hernia recurrence rates (11.4 percent versus 7.7 percent, p = 0.204; and 10.3 percent versus 7.7 percent, p = 0.381, respectively) and freedom from hernia recurrence (overall log-rank, p = 0.41) similar to those of nonobese patients.

Conclusion:

Hernia recurrence rates do not appear to be affected by obesity on long-term follow-up in abdominal wall reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, II.
Facial Danger Zones: Techniques to Maximize Safety during Soft-Tissue Filler Injections
Authors: Scheuer Jack F. , Sieber David A. , Pezeshk Ronnie A. , Gassman Andrew A. , Campbell Carey F. , Rohrich Rod J.
Published: April 2017

Given the short recovery and immediate results, facial fillers have become a popular alternative to surgical rejuvenation of the face. Reported complications arising from facial filler injections include erythema, tissue loss, blindness, stroke, and even death. In this article, the authors describe their anatomically based techniques to minimize risk and maximize safety when injecting in the facial danger zones, including the glabella/brow, temporal region, perioral region, nasolabial fold, nose, and infraorbital region. Complications generally arise secondary to vasculature injury and/or cannulation with filler. The authors have outlined their preferred injection techniques in the facial danger zones with respect to the pertinent anatomy in an attempt to minimize risk and maximize results. Most importantly, the practitioner should be able to recognize complications and address them immediately.