bluuebunny/crossref_metadata_2025 huggingface dataset:
Texture
Authors: De Souza Jonathan
Published: July 2016

This chapter considers musical texture as an emergent property. The first section shows how the interplay of rhythm and pitch—specifically, degrees of synchrony and similar motion—produces basic textural categories (monophony, homophony, polyphony, and heterophony). These textural types may be transformed or hierarchically combined. The second section further argues that such textural structures are supplemented by textural materials, involving timbre, articulation, dynamics, and so forth. This focus on sound quality suggests a more “tactile” approach, imagining musical texture in terms of embodied performance and instrumental materiality. The third section explores texture’s interaction with large-scale form, musical metaphor, dramatic meaning, and social values. Throughout, the chapter mixes perceptual principles and theoretical formalization with analytical comments on diverse repertoire.
Muscovite Political Culture
Authors: Kollmann Nancy
Published: July 2016

This chapter reveals the deep structures of Muscovite politics by explaining first its theoretical foundations (in which written texts and symbolic representations combined to present a consistent worldview) and then its practical operations (heavily dependent on kinship, marriage and patronage networks). Though it focuses on the period from Ivan III (r. 1462–1505) to the end of the seventeenth century, the chapter ends by considering the impact of Peter I (r. 1682–1725). Change trumped continuity with regard to political culture. Yet, even as they constructed a political rhetoric and elite culture on Western models, Peter and his successors echoed traditional Muscovy in their evocations of Orthodoxy, their patronage and largesse, and their patrimonial claims to power. And they achieved time-honoured Muscovite goals by maintaining stability among factional groups, enriching their elites, expanding the Empire and presiding over dynamic economic growth.
What Do We Think We Know?
Authors: Benedict Cathy
Published: July 2016

This chapter argues for a pedagogy of recognition and against a simplistic, didactic educative stance of “preparing students for social justice.” The question this chapter pursues is not how to best prepare or produce a student to be socially just, but rather how educators can facilitate moments of freedom, or “acting out with others” (Arendt, 1958, p. 198). Pedagogical engagements that disconnect individuals from acts of humanity and grace and the development of self-fueled ideological aims ensure competition, domination, and superiority. This suggests an interrogation of those engagements that have been, as Arendt (1998) suggests, “uncritically and slavishly accepted” (p. 179). The chapter examines concepts and constructs that are taken for granted—furthering individual pride, creating and posting class rules, and building upon “what is known”—revealing that social justice or socially just actions are neither the reproduction of an existing discourse nor preparation for future goal-oriented behaviors.
Multiculturalism and Social Justice
Authors: Campbell Patricia Shehan , Roberts J. Christopher
Published: July 2016

Social justice, with its emphasis on identifying and rectifying inequalities that exist in society, is a concept that in many ways parallels multiculturalism. This chapter argues that multiculturalizing the curriculum is an essential means by which to move toward more socially just educational experiences. It turns to the work of pioneering educationist James Banks, applying his Levels of Curriculum Reform to learning experiences in music education. These tiered levels—contributions, additive, transformative, and social action—provide a sequential pathway by which educators unversed in working with multicultural content can create curricula that lead to a more multicultural and socially just educational enterprise.
The Ethics of Policy
Authors: Schmidt Patrick
Published: July 2016

This chapter delineates the need for policy thought as a key element of the education and professional life of any teacher, and in particular of those charged to educate in and through music. This argument is built upon the ethical imperative of bringing music educators and policy together, the positive implications such approximation may have, and how it can impact social justice work in music education. The policy realm is commonly seen as “above our pay grade,” beyond our duties and responsibilities, and outside the reach of our capacities. But nothing could be further from the truth. This chapter offers a framework and rationale that show how social justice and policy are entwined, while arguing that both areas are integral parts of the political lives of teachers.
Music Education and Social Reproduction
Authors: Wright Ruth
Published: July 2016

This chapter discusses the role of music education in the perpetuation of cycles of unjust hegemonic social reproduction, using Bourdieu’s theory of social reproduction and the roles of education and culture therein. Alternative music pedagogies, such as informal learning, are examined as offering potential to break such cycles by allowing accumulation of two forms of cultural capital—pedagogical and musical capital—by diverse students. An empirical example is used to demonstrate how perceptions of the knowledge legimitation code within which music education operates may be shifted, allowing fewer students to self-identify as “non-elite” and therefore not suited to studying music. Some principles are suggested by which music education might act to break cycles of injustice and in whatever small way act to disrupt the social status quo.
Music First and Last
Authors: Savage Jonathan
Published: July 2016

This chapter explores issues of social justice in music education with technology in two key settings. The first of these relates to the provision of examinations in music and music technology within the United Kingdom. The second recounts a project conducted in Manchester, northwest England, that drew together two groups of students from very different musical and social backgrounds. These settings illustrate and highlight a number of issues relating to themes of social justice, technology, and music education. An alternative, more socially just, vision of music education with technology is envisaged, with key characteristics drawn from the work of other theorists, practitioners, and the research.
Can Music Teaching Be a Powerful Tool for Social Justice?
Authors: Sloboda John
Published: July 2016

This chapter reflects on how practitioners may differently relate to social justice issues in music education according to their personal and professional priorities. The relative merits of micro- and macro-approaches to social justice in music are discussed. It is argued that social justice goals are particularly strongly linked to the development and support of musical cultures that are sustainable beyond specific educational contexts, and that are embedded in the wider society. Music may not always be a very effective means of promoting social justice, as exemplified by the experience of using musical activities for conflict resolution and inter-group reconciliation. For greater understanding, long-term evaluation of social justice outcomes is required, measured by explicit and agreed metrics.
Gender and Sexual Diversity Challenges (for Socially Just) Music Education
Authors: Bergonzi Louis
Published: July 2016

This chapter explores music education’s relationship to social justice for sexual-diverse and gender-diverse persons and communities. It focuses on music education in the context of public schooling as both a critical site for social justice and social justice education, particularly as related to gender and sexual diversity, and a robustly heteronormative enterprise that receives and sustains oppressive ideologies with regard to gender-sexual diversity. To bring together ideas, Kumashiro’s work in social justice education is drawn upon, specifically his four-part activist theory of anti-oppressive education, as well as recent, emerging research in music education regarding gender-sexual diversity and discussion of music education students and practice. Whether acknowledged or not, social justice intentions and actions with regard to gender and sexual minorities are precast and limited by our awareness of and readiness to identify and act against the multiplicity of ways we benefit from the gender and sexual status quo.
You Gotta Fight the Power
Authors: Ladson-Billings Gloria
Published: July 2016

The tradition of music and song in freedom and liberation movements is a long one. However, each generation begins to craft new songs and new music to address its own social context and stylistic tastes. From the slave chants of the eighteenth and nineteenth centuries to the protest songs of the 1960s, there has been a thread of resistance and freedom in the music of African Americans. However, one of the most generative and creative forces—hip-hop music and culture—has been popularized to represent depravity, misogyny, racism, and homophobia. This chapter explores the revolutionary and resistance roots of hip-hop and describes how teachers might leverage the genre’s attraction to engage youth in social justice teaching and learning.
Social Justice and Urban Music Education
Authors: Gaztambide-Fernandez Ruben , Stewart Rose Leslie
Published: July 2016

Music education has had an ambiguous and fraught relationship with urban schools. This chapter seeks to address this tension through an elucidation of two related problems: how to understand the notion of “urban music education,” and how to approach the intersection between the former and various commitments to social justice. To do this, the authors challenge the taken-for-granted definition of urban music, suggesting that social justice commitments require a more nuanced understanding of what constitutes “the urban,” which highlights social inequalities. The authors provide an introduction to various understandings of social justice and summarize four different approaches to anti-oppressive pedagogy in music education, focusing on access, representation, pedagogy, and ideology. The chapter concludes with a discussion of the implications of a cultural production approach to social justice in urban music education.
The Diversity of Religious Systems Across History
Authors: Boyer Pascal , Baumard Nicolas
Published: July 2016

The mental representations and behaviors we commonly call “religious”—everyday supernatural imagination, tribal cults, archaic religions, modern world religions—are amenable to explanation both in terms of computational, information-processing systems and in terms of adaptations that emerged during human evolution. These two research programs, focused on proximate and ultimate aspects of cultural representations respectively, have been particularly fruitful in the last 30 years. Early developments in cognitive approaches ushered in a whole new field in the study of religion. More recently, evolutionary psychology has provided new tools for explaining the emergence and transmission of religious ideas. This chapter aims to show how this cognitive and evolutionary approach can provide a better understanding of the historical diversity of religious systems.
Business of Fiction
Authors: Suarez Michael F.
Published: July 2016

The eighteenth century witnessed a remarkable proliferation of print, with annual publications in England, Scotland, Wales, and Ireland increasing by more than 350 per cent from the first decade to the last. This chapter relates the growth in novel publishing between 1695 and 1774 to population growth and the growth in literacy. Recent research links the book trade keeping prices artificially high to readers’ consumption of novels as luxury products and evidence of social status. This trend is considered, along with remuneration for authors; the market for fiction; Irish reprints; continuations and spin-offs; abridgements and serializations; translations; circulating libraries; and the significance of book history to understanding the emergence and development of the novel.
Sterne’s Fiction and the Mid-Century Novel
Authors: Parnell Tim
Published: July 2016

This chapter offers a detailed reassessment of the relationship between Sterne’s fiction and the mid-century novel. Tristram Shandy, it argues, is best understood in the context of the ‘new species of fiction’ as it developed in the wake of Fielding’s and Richardson’s seminal successes. Sterne’s masterpiece is, in part, a burlesque of conventions of the tradition of comic ‘Biography’ inaugurated by Joseph Andrews. It is also a comic novel in its own right in which Sterne draws on and develops germs of ideas, situations, and narrative strategies that he found in novels of the 1750s. The chapter concludes with a discussion of Sterne’s much-debated ‘sentimentalism’, arguing that while he engages with contemporary debates about the social virtues and the ethical dimension of feeling, A Sentimental Journey stands out from other novels of the 1760s in ways which support his sense of it as ‘something new, quite out of the beaten track’.
Focus Projection Theories
Authors: Arregi Karlos
Published: July 2016

This chapter examines the phenomenon of focus projection: a sentence with prosodic marking of focus on a word can lead to ambiguity, in that different constituents containing the word can be interpreted as focused. Two general approaches to focus projection are compared. In Default Prosody analyses, focus projection is epiphenomenal, a consequence of general principles requiring that focus be prosodically prominent, coupled with default principles of default prominence. In the F-projection approach, focus projection is encoded more directly, in terms of licensing rules for F-marking on constituents. Overall, the evidence in the literature favors the Default Prosody approach, and this chapter concentrates on comparing these two general approaches, as well as briefly summarizing other aspects of focus projection. The chapter ends with discussion of Basque data that are problematic for widely assumed generalizations about focus projection, and a possible way of understanding the data in the Default Prosody approach.
Towards a Neurobiology of Information Structure
Authors: Bornkessel-Schlesewsky Ina , Schumacher Petra B.
Published: July 2016

This chapter reviews neurophysiological and neuroanatomical investigations of information structural notions, with a view to working towards a neurobiologically grounded perspective. It first considers components of a neurobiologically plausible theory of information structure and outlines candidate mechanisms for higher-order cognitive processing, namely prediction and mental modelling, attention orientation, memory, and inferencing. The chapter then proceeds to neuroscientific investigations of information structure, highlighting differences between sentence- and text-level processing and discussing findings for the information structural notions of givenness, focus, and topic, before presenting further insights from syntax-induced information structural effects. The chapter concludes with a discussion of neurobiological models of information structure processing.
Quantification and Information Structure
Authors: Krifka Manfred
Published: July 2016

The chapter provides an overview of the interaction between quantification and information-structural properties, especially focus, givenness, and topic. While quantification affects truth conditions, information-structuring devices can have an effect on the interpretation of quantificational expressions. After a short introduction to the nature of quantification, the chapter covers the main areas where such effects have been identified, in particular in adverbial quantification, in generic clauses, in conditional sentences, and in sentences with nominal (or determiner) quantification, including intersective determiners and comparative determiners like most. It reviews different theoretical proposals how this sensitivity to information-structural categories arises, in particular whether they are related to focus or givenness. It also discusses cases in which the quantifier itself is topical, given, or focused.
Citizenship and Race
Authors: Frymer Paul
Published: July 2016

Contrary to a view that sees racism as an aberration within American liberalism or largely outside the broader dynamics of American politics, historical institutional scholars often emphasize the central place of racial conflict in American politics and especially in the development of the American state. Although racial conflict has been an obstacle to state-building, struggles over race also enhanced state authority in ways that defy conceptions of a weak American state. Approaching American politics through an historical institutional lens helps underscore the way efforts to confront long standing racial divisions and conflict helped to institutionalize key political and social rights.
Institutions and the Consolidation of Democracy in Western Europe
Authors: Berman Sheri
Published: July 2016

During the nineteenth and the first half of the twentieth century, Europe was the most turbulent region on earth, convulsed by war, economic crises, and social and political conflict. Yet after 1945 Western Europe became among the most stable, a study in democracy, social harmony, and prosperity. How can we understand this remarkable transformation? This chapter shows how an historical institutionalist analysis of the continent’s political development that focuses on the role played by institutions in shaping political outcomes and analyzes institutions as products of the historical contexts within which they evolve, can help explain the puzzle of successful democratic consolidation in Western Europe.
Critical Junctures
Authors: Capoccia Giovanni
Published: July 2016

In the analysis of path-dependent institutions, the concept of critical juncture refers to situations of uncertainty in which decisions of important actors are causally decisive for the selection of one path of institutional development over other possible paths. The chapter parses the potentialities and the limitations of the concept in comparative-historical analysis, and proposes analytical tools for the comparative analysis of the smaller-scale and temporally proximate causes that shape decision-making on institutional innovation during critical junctures. In particular, the chapter discusses several patterns of short-term politics of institutional formation --innovative coalition-building for reform; “out-of-winset” outcomes; ideational battles; and near-missed institutional change—that can have a long-term impact on the development of policies and institutions.
The Never-Ending Story of Class Voting in Sweden
Authors: Oskarson Maria
Published: July 2016

This chapter presents a broad description of the development of class voting in Sweden. The aim of the study goes beyond simple description, however, in that it presents and applies a wider frame for understanding the development of the relationship between class position and party choice. The chapter begins with a reflection on the theoretical basis for class voting as representing the relation between a social and a political cleavage. It then examines developments in voting patterns in constituencies of different social and political composition and as an expression of class identification, and concludes that the class cleavage is still a viable characteristic of the Swedish political system.
The Swedish Administrative Model
Authors: Hall Patrik
Published: July 2016

This chapter discusses four features which together form the backbone of what is called the Swedish administrative model. These four features are the “dualism” (i.e. the relatively high degree of autonomy that Swedish state agencies enjoy in relation to the government), openness, decentralization, and corporatism. Each feature’s historical and constitutional foundation is discussed, as well as various tensions surrounding them. It is argued that the oldest features (the dualism and the openness) are still highly institutionalized while the younger ones (decentralization and corporatism) have weakened in recent decades. However, it is also argued that administrative practices linked to the dualism and the openness have changed quite rapidly in recent decades, giving these features the appearance of façades. In other words, government “talk” remains intact while actual government changes.
Globalization, Capabilities, and Distance
Authors: Ghemawat Pankaj , Hout Thomas M.
Published: July 2016

This article examines how firm-level capabilities relate to competitive outcomes between multinational companies (MNCs) from advanced economies and challengers from emerging economies. It examines John Sutton’s theory of the “capability window” in light of new empirical evidence on competition in particular between MNCs and Chinese firms inside China. Market share leadership by MNCs in China is found to be positively related to industry R and D- and advertising-intensities; and where leadership varies by segment, MNCs tend to lead in high-end segments and Chinese firms in low-end segments. The empirical research provides support for Sutton’s model but also suggests a set of extensions to it—most significantly, the incorporation of horizontal distance alongside the vertical distance emphasized in his baseline model. And since dealing with both kinds of distance requires firms to do things that they have not done before, dynamic capabilities are essential to success in this context.
Scientific Organizations and Learned Societies
Authors: Rudolph Hartmut
Published: July 2016

This chapter discusses Leibniz’s life-long efforts to create societies or academies of science. He was convinced that by collecting the knowledge available to humankind and by improving upon it through innovations in science and technology, rulers could ameliorate conditions in their territories, benefitting both themselves and their subjects, and thereby increasing their welfare and happiness. In Leibniz’s view, all this would be achieved if the work of scientists were motivated not by pure curiosity but by aiming at utility. In other words, scientists should work as subjects of God’s universal monarchy who contribute to the common good by combining theoria cum praxi. Leibniz’s plans comprised far-reaching economic, administrative, and educational reforms, as well as concrete proposals for financing them. At the same time, Leibniz also sought the directorship of the proposed institutions in order to secure cooperation among European societies.
Opportunity to Learn
Authors: Elliott Stephen N. , Bartlett Brendan J.
Published: July 2016

Opportunity to learn (OTL) is an evolving construct from which to better understand and use the intricacy of the schooling process. Progress to date includes considerations of how it might serve as an index of key factors of teachers’ and students’ contributions to learning and as a tool to guide fair and productive measurement of its operation. In this chapter, we provide an account of OTL measurement where classrooms have been the unit of analysis and where concentrations of focus have moved to include calibration of the quality of instruction alongside considerations of time and content elements of a learning opportunity. The account highlights the significance of this inclusion and presents current developments in creating feasible, reliable measurement and ongoing challenges where additional research is needed to further refine our conceptualization and current tooling for measuring OTL.
Modern Deterrence Theory
Authors: Quackenbush Stephen L. , Zagare Frank C.
Published: July 2016

Modern deterrence theories were conceived in the aftermath of World War I. Given the human and political carnage associated with the Great War, it was natural for historians, military strategists, policy analysts, diplomats, and politicians to try to understand why the breakdown occurred. The standard interpretation of the coming of World War I provided the intellectual foundation for classical deterrence theory and its variants. This article traces these developments in the literature of war and conflict initiation and evaluates recent theoretical, empirical, and policy challenges to mainstream realist theory. It summarizes two synergistic variants of the classical specification of deterrence and contrasts them with competing explanatory frameworks, then examines the empirical literature on deterrence, recent theoretical developments in deterrence theory, and debates about deterrence policies. It concludes with a discussion of how the study of deterrence fits into the study of international conflict more broadly.
Ontological Dependence and Grounding in Aristotle
Authors: Corkum Phil
Published: July 2016

The relation of ontological dependence or grounding, expressed by the terminology of separation and priority in substance, plays a central role in Aristotle’sCategories, Metaphysics, De Animaand elsewhere. The article discusses three current interpretations of this terminology. These are drawn along the lines of, respectively, modal-existential ontological dependence, essential ontological dependence, and grounding or metaphysical explanation. I provide an opinionated introduction to the topic, raising the main interpretative questions, laying out a few of the exegetical and philosophical options that influence one’s reading, and locating questions of Aristotle scholarship within the discussion of ontological dependence and grounding in contemporary metaphysics.
Mary and Mariology
Authors: Llywelyn Dorian
Published: July 2016

The mother of Jesus is the most important female figure of Christianity. Mary appears in a small number of biblical passages, but the vast Marian phenomenon includes Christian doctrine and a range of cultural expressions. Interest in Mary emerged early in the Eastern Mediterranean, and spread into the West. With slightly different emphases, Catholics and Orthodox Christians share a number of beliefs concerning Mary and pray to her, but most forms of Protestantism reject Marian devotion. While Catholic attention to Mary diminished in the global North following the changes wrought by the Second Vatican Council, it has remained strong in other parts of the world, especially in Latin America. Shrines such as sites where Mary is believed to have appeared draw millions of devotees annually. Contemporary Mariology, the academic study of the figure of Mary, includes considerations from almost all the liberal arts.
Human Shields
Authors: Haque Adil Ahmad
Published: July 2016

This chapter defends three claims. First, it is morally impermissible for combatants fighting for a just cause to use civilians supporting an unjust war effort as involuntary human shields. Second, civilians who are forced to serve as involuntary shields by combatants fighting for an unjust cause retain their basic rights; they are not morally liable to intentional harm, and the proportionality of collaterally harming them is not affected by the wrongful conduct of the unjust combatants. Finally, civilians who voluntarily serve as human shields for unjust combatants compromise but do not lose their basic rights. Such voluntary shields are not morally liable to collateral harm, though less is required to justify collateral harm to them than to justify collateral harm to involuntary shields or to civilians who are merely in the wrong place at the wrong time.
Method in the Morality of War
Authors: Lazar Seth
Published: July 2016

This chapter introduces the two main ways to think about the ethics of war. The first is to start by thinking about war. The second is to think about the ethics of killing outside of war, then apply those principles to the case of war. In contemporary just war theory, the first approach has most commonly been associated with those who broadly aim to vindicate international law, such as Michael Walzer and his contemporary defenders. The second approach is more frequently linked to the work of Jeff McMahan, and Walzer’s other revisionist critics. I show that this conflation is mere accident. Indeed, perhaps the richest terrain to be ploughed is in the combinations that have been relatively neglected—vindications of international law that start from cases based outside of war; critiques of international law based on the distinctive nature of war.
The Past and Future of Network Analysis in Economics
Authors: Jackson Matthew O.
Published: July 2016

This is a short essay that highlights a few of the areas in which the literature has made substantial progress, discusses what enabled this progress, as well as where current tools are poised to make further contributions, and points out some of the most important open problems.
Econometrics of Network Formation
Authors: Chandrasekhar Arun G.
Published: July 2016

This chapter surveys econometric network formation models. Its goal is to acquaint the readers, in a self-contained manner, with a number of network formation models used in the graph theory, statistics, sociology, and econometrics literature, with a view to how well they map to real-world data, the sorts of economic microfoundations they implicitly assume, and their econometric properties. A major difficulty in the study of network formation is that the researcher typically has a data set consisting of a single network observed in a single period. Key questions include whether a researcher can identify, and develop consistent estimators of, the parameters driving network formation when observing a single large network. Estimation involves a number of challenges, including but not limited to the degree of correlation between linking decisions, the ability to reproduce realistic patterns of network structure, concerns about multiple equilibria, and missing data.
Networks in the Laboratory
Authors: Choi Syngjoo , Gallo Edoardo , Kariv Shachar
Published: July 2016

There is a large body of empirical work which studies the influence of network structure on economic outcomes, but these observational studies are subject to identification problems. In the laboratory, by contrast, we can control subjects’ position in the network and their information. This provides an opportunity to test the predictions of network theories and study the effects of variables about which our models have little to say. This chapter surveys network research in experimental economics. The first part discusses experiments of games played on networks, focusing on how different architectures lead to different outcomes. The second part discusses trading in networks where connections represent potential trading relations. The aim of these experiments is to investigate the role of network architecture in determining the efficiency of markets. Overall, the results show that the clarity that is achieved by putting behavior “under the microscope” is well worth the necessary simplification.
Networks in Economics
Authors: Goyal Sanjeev
Published: July 2016

The study of networks is a dynamic and exciting field of research in contemporary economics. This chapter traces its origins and illustrates its reach. Social and economic life occurs at the intersection of the global (large firms, international markets) and the local (small overlapping neighborhoods). Game theory is well suited for the study of behavior in small exclusive groups; general equilibrium theory helps to understand large anonymous systems. Networks offer a language that spans the large and the details of the small within a common framework, filling an important gap in the tool kit of economists. The key methodological innovation of early research was the introduction of graph theory alongside purposeful agents, offering two overarching themes: first, the study of how network architecture shapes human behavior, and second, the study of how purposeful individuals form links thereby creating networks. The chapter discusses a number of applications to illustrate the scope of these two themes.
Information Processing in Mood Disorders
Authors: Roiser Jonathan , Sahakian Barbara J.
Published: July 2016

This article discusses the central role of information processing in mood disorders, distinguishing “cold” (emotion-independent) from “hot” (emotional-dependent) cognition. Impaired cold cognition, which appears in the core diagnostic criteria for both depressive and manic episodes, is a reliable finding in mood disorders. There is good evidence that cold cognitive abnormalities remain in remission, predict poor response to treatment, and are present in unaffected first-degree relatives of patients with mood disorders, suggesting that they are not simply epiphenomena of extreme mood states. Abnormal hot cognition is also a consistent finding in mood disorders. Mood-congruent affective biases and disrupted reward-processing have commonly been reported; the latter is especially relevant for understanding anhedonia. This pattern of disrupted hot and cold cognition is consistent with a cognitive neuropsychological model of depression, which proposes a central role for fundamental information-processing abnormalities in generating symptoms.
A Patient-Centered Approach to Postgraduate Trainee Health and Wellness: An Applied Review and Health Care Delivery Model
Authors: Carvour Martha L. , Ayyar Balaji K. , Chien Kelly S. , Ramirez Natalie C. , Yamamoto Haru
Published: July 2016

Attention to the health and wellness of postgraduate medical trainees has increased considerably in recent years, yet the scholarly literature consistently indicates that, in many instances, the medical and mental health care needs of this population remain unmet or only partially met. As a result, trainee health care often falls short of the current standards of the medical profession. Combined with the prevalence of burnout and other mental health conditions among trainees, inadequate health care for this patient population may result in significant negative consequences for trainees’ health, safety, and performance.

Here, the authors review the scholarly literature explicating the health care needs of postgraduate trainees. They explore the patient-centered medical home model as a potentially effective solution to address the unmet and partially met health care needs of trainees. The authors describe several practical interventions to improve access to care. These include care coordination and referral support, confidential care without perceived conflicts of interest in the training environment, co-location of medical and mental health care, and accommodations for schedule constraints. Finally, the authors explore the role of the medical home in developing and supporting broader institutional efforts to promote wellness.
Blueprint for an Undergraduate Primary Care Curriculum
Authors: Fazio Sara B. , Demasi Monica , Farren Erin , Frankl Susan , Gottlieb Barbara , Hoy Jessica , Johnson Amanda , Kasper Jill , Lee Patrick , McCarthy Claire , Miller Kathe , Morris Juliana , O’Hare Kitty , Rosales Rachael , Simmons Leigh , Smith Benjamin , Treadway Katherine , Goodell Kristen , Ogur Barbara
Published: July 2016

In light of the increasing demand for primary care services and the changing scope of health care, it is important to consider how the principles of primary care are taught in medical school. While the majority of schools have increased students’ exposure to primary care, they have not developed a standardized primary care curriculum for undergraduate medical education. In 2013, the authors convened a group of educators from primary care internal medicine, pediatrics, family medicine, and medicine–pediatrics, as well as five medical students to create a blueprint for a primary care curriculum that could be integrated into a longitudinal primary care experience spanning undergraduate medical education and delivered to all students regardless of their eventual career choice.

The authors organized this blueprint into three domains: care management, specific areas of content expertise, and understanding the role of primary care in the health care system. Within each domain, they described specific curriculum content, including longitudinality, generalism, central responsibility for managing care, therapeutic alliance/communication, approach to acute and chronic care, wellness and prevention, mental and behavioral health, systems improvement, interprofessional training, and population health, as well as competencies that all medical students should attain by graduation.

The proposed curriculum incorporates important core features of doctoring, which are often affirmed by all disciplines but owned by none. The authors argue that primary care educators are natural stewards of this curriculum content and can ensure that it complements and strengthens all aspects of undergraduate medical education.
A Multicenter, Randomized, Controlled Phase IIb Trial of Avoidance of Hyperoxemia during Cardiopulmonary Bypass
Authors: McGuinness Shay P. , Parke Rachael L. , Drummond Kate , Willcox Tim , Bailey Michael ,   on behalf of the SO-COOL investigators
Published: July 2016

Background

Cardiac surgery utilizing cardiopulmonary bypass (CPB) is one of the most common forms of major surgery. Cardiac surgery–associated multiorgan dysfunction (CSA-MOD) is well recognized and includes acute kidney injury (AKI), hepatic impairment, myocardial damage, and postoperative neurologic deficit. Pathophysiology of CSA-MOD involves numerous injurious pathways linked to the use of CPB including oxidative stress and formation of reactive iron species. During cardiac surgery with CPB, arterial return blood is oxygenated to supranormal levels. This study aimed to determine whether the avoidance of arterial hyperoxemia decreased oxidative stress and reduced the severity of the multiorgan dysfunction in patients undergoing cardiac surgery utilizing CPB.

Methods

The study was a multicenter, open-label, parallel-group, randomized controlled study of the avoidance of arterial hyperoxemia versus usual care in patients undergoing cardiac surgery involving CPB. Primary outcome was the incidence and severity of AKI. Secondary outcomes included serum biomarkers for CSA-MOD, duration of mechanical ventilation, and length of intensive care and hospital stay.

Results

A total of 298 patients were randomized and analyzed at two hospitals in New Zealand and Australia. Mean Pao
2 was significantly different between groups during CPB. There was no difference in the development of AKI (intervention arm 72.0% vs. usual care 66.2%; difference, −5.8% [95% CI, −16.1 to 4.7%]; P = 0.28), other markers of organ damage, or intensive care unit and hospital length of stay.

Conclusions

Avoiding modest hyperoxemia during CPB failed to demonstrate any difference in AKI, markers of organ damage, or length of stay.
Effect of Intralipid® on the Dose of Ropivacaine or Levobupivacaine Tolerated by Volunteers
Authors: Dureau Pauline , Charbit Beny , Nicolas Nathalie , Benhamou Dan , Mazoit Jean-Xavier
Published: July 2016

Background

Rapid intravenous administration of lipid emulsion has become the standard treatment of severe local anesthetic systemic toxicity. This experiment in volunteers aimed at determining the effect of Intralipid® administration on the time to neurologic symptoms.

Methods

Ropivacaine or levobupivacaine was infused intravenously in 16 volunteers (8 mg/min up to 120 mg) with 120 ml Intralipid® 20% (Fresenius, Paris France) or placebo infused at T + 2 min). Each subject received all four treatments in a crossover manner. The infusion was stopped after the intended dose had been administered or on occurrence of incipient neurologic signs of toxicity. The primary outcome was time-to-event. In addition, blood ropivacaine and levobupivacaine concentrations were measured.

Results

The dose infused was not different whether volunteers received placebo (81.7 ± 22.3 vs. 80.8 ± 31.7 mg, ropivacaine vs. levobupivacaine) or Intralipid® (75.7 ± 29.1 vs. 69.4 ± 26.2 mg, ropivacaine vs. levobupivacaine), P = 0.755, Intralipid® versus placebo groups. Plasma concentrations were best modeled with an additional volume of distribution associated with Intralipid®. Simulations suggested that decreased peak concentrations would be seen if Intralipid® was given during a period of increasing concentrations after extravascular administration.

Conclusions

At modestly toxic doses of ropivacaine or levobupivacaine, we were unable to find any effect of the infusion of Intralipid® on the time to early signs of neurologic toxicity in volunteers. Peak concentration was decreased by 26 to 30% in the subjects receiving Intralipid®. Simulations showed that Intralipid® might prevent the rapid increase of local anesthetic concentration after extravascular administration.
Adenosine Receptor Adora2b Plays a Mechanistic Role in the Protective Effect of the Volatile Anesthetic Sevoflurane during Liver Ischemia/Reperfusion
Authors: Granja Tiago F. , Köhler David , Schad Jessica , de Oliveira Franz Claudia Bernardo , Konrad Franziska , Hoch-Gutbrod Michaela , Streißenberger Ariane , Rosenberger Peter , Straub Andreas
Published: July 2016

Background

Liver ischemia/reperfusion (IR) injury is characterized by hepatic tissue damage and an inflammatory response. This is accompanied by the formation and vascular sequestration of platelet–neutrophil conjugates (PNCs). Signaling through Adora2b adenosine receptors can provide liver protection. Volatile anesthetics may interact with adenosine receptors. This study investigates potential antiinflammatory effects of the volatile anesthetic sevoflurane during liver IR.

Methods

Experiments were performed ex vivo with human blood and in a liver IR model with wild-type, Adora2a−/−, and Adora2b−/− mice. The effect of sevoflurane on platelet activation, PNC formation and sequestration, cytokine release, and liver damage (alanine aminotransferase release) was analyzed using flow cytometry, luminometry, and immunofluorescence. Adenosine receptor expression in liver tissue was analyzed using immunohistochemistry and real-time polymerase chain reaction.

Results

Ex vivo experiments indicate that sevoflurane inhibits platelet and leukocyte activation (n = 5). During liver IR, sevoflurane (2 Vol%) decreased PNC formation 2.4-fold in wild-type (P < 0.05) but not in Adora2b−/− mice (n ≥ 5). Sevoflurane reduced PNC sequestration 1.9-fold (P < 0.05) and alanine aminotransferase release 3.5-fold (P < 0.05) in wild-type but not in Adora2b−/− mice (n = 5). In Adora2a−/− mice, sevoflurane also inhibited PNC formation and cytokine release. Sevoflurane diminished cytokine release (n ≥ 3) and increased Adora2b transcription and expression in liver tissue of wild-types (n = 4).

Conclusions

Our experiments highlight antiinflammatory and tissue-protective properties of sevoflurane during liver IR and reveal a mechanistic role of Adora2b in sevoflurane-associated effects. The targeted use of sevoflurane not only as an anesthetic but also to prevent IR damage is a promising approach in the treatment of critically ill patients.
Alleviating Bone Cancer–induced Mechanical Hypersensitivity by Inhibiting Neuronal Activity in the Anterior Cingulate Cortex
Authors: Chiou Chiuan-Shiou , Chen Chien-Chung , Tsai Tsung-Chih , Huang Chiung-Chun , Chou Dylan , Hsu Kuei-Sen
Published: July 2016

Background

The anterior cingulate cortex (ACC) is a brain region that has been critically implicated in the processing of pain perception and modulation. While much evidence has pointed to an increased activity of the ACC under chronic pain states, less is known about whether pain can be alleviated by inhibiting ACC neuronal activity.

Methods

The authors used pharmacologic, chemogenetic, and optogenetic approaches in concert with viral tracing technique to address this issue in a mouse model of bone cancer–induced mechanical hypersensitivity by intratibia implantation of osteolytic fibrosarcoma cells.

Results

Bilateral intra-ACC microinjections of γ-aminobutyric acid receptor type A receptor agonist muscimol decreased mechanical hypersensitivity in tumor-bearing mice (n =10). Using adenoviral-mediated expression of engineered Gi/o-coupled human M4 (hM4Di) receptors, we observed that activation of Gi/o-coupled human M4 receptors with clozapine-N-oxide reduced ACC neuronal activity and mechanical hypersensitivity in tumor-bearing mice (n = 11). In addition, unilateral optogenetic silencing of ACC excitatory neurons with halorhodopsin significantly decreased mechanical hypersensitivity in tumor-bearing mice (n = 4 to 9), and conversely, optogenetic activation of these neurons with channelrhodopsin-2 was sufficient to provoke mechanical hypersensitivity in sham-operated mice (n = 5 to 9). Furthermore, we found that excitatory neurons in the ACC send direct descending projections to the contralateral dorsal horn of the lumbar spinal cord via the dorsal corticospinal tract.

Conclusions

The findings of this study indicate that enhanced neuronal activity in the ACC contributes to maintain bone cancer–induced mechanical hypersensitivity and suggest that the ACC may serve as a potential therapeutic target for treating bone cancer pain.
Randomized Trial of Video Laryngoscopy for Endotracheal Intubation of Critically Ill Adults*
Authors: Janz David R. , Semler Matthew W. , Lentz Robert J. , Matthews Daniel T. , Assad Tufik R. , Norman Brett C. , Keriwala Raj D. , Ferrell Benjamin A. , Noto Michael J. , Shaver Ciara M. , Richmond Bradley W. , Zinggeler Berg Jeannette , Rice Todd W.
Published: July 2016

Objective:

To evaluate the effect of video laryngoscopy on the rate of endotracheal intubation on first laryngoscopy attempt among critically ill adults.

Design:

A randomized, parallel-group, pragmatic trial of video compared with direct laryngoscopy for 150 adults undergoing endotracheal intubation by Pulmonary and Critical Care Medicine fellows.

Setting:

Medical ICU in a tertiary, academic medical center.

Patients:

Critically ill patients 18 years old or older.

Interventions:

Patients were randomized 1:1 to video or direct laryngoscopy for the first attempt at endotracheal intubation.

Measurements and Main Results:

Patients assigned to video (n = 74) and direct (n = 76) laryngoscopy were similar at baseline. Despite better glottic visualization with video laryngoscopy, there was no difference in the primary outcome of intubation on the first laryngoscopy attempt (video 68.9% vs direct 65.8%; p = 0.68) in unadjusted analyses or after adjustment for the operator’s previous experience with the assigned device (odds ratio for video laryngoscopy on intubation on first attempt 2.02; 95% CI, 0.82–5.02, p = 0.12). Secondary outcomes of time to intubation, lowest arterial oxygen saturation, complications, and in-hospital mortality were not different between video and direct laryngoscopy.

Conclusions:

In critically ill adults undergoing endotracheal intubation, video laryngoscopy improves glottic visualization but does not appear to increase procedural success or decrease complications.