bluuebunny/crossref_metadata_2025 huggingface dataset:
Thucydides, Procopius, and the Historians of the Later Roman Empire
Authors: Whately Conor
Published: March 2017

This chapter discusses Thucydides’ influence on the historians of late antiquity, with a particular emphasis on Procopius. Topics include an overview of history writing in late antiquity; a look at some basic Thucydidean borrowings, from subject matter to types of episodes; a discussion of rhetoric and education in late antiquity and its role in fostering Thucydides’ impact; the particular place that Thucydides’ description of the siege of Plataea had in later accounts of sieges; and a discussion of Procopius’ particular engagement with Thucydides. The chapter argues that Thucydides’ evident influence was not the result of a malaise among those late antique historians who chose to write classicizing, “old-fashioned” histories, but rather of the immediate usefulness of Thucydides’ approach for those interested in war and politics.
Thucydides on Early Greek History
Authors: van Wees Hans
Published: March 2017

This chapter studies Thucydides’ account of early Greek history in the “Archaeology” (1.1.2–1.21.2). It shows that Thucydides’ criteria of development and his reconstruction of history are heavily influenced by power relations in Greece during the early stages of the Peloponnesian War. Comparison with other sources for both the legendary and the historical past reveals the extent to which Thucydides, by means of omission, selective emphasis, and skewed interpretation, manipulates traditions that were well known to Athenian audiences, in order to create his distinctive vision of history as reaching a peak of military and economic development and “modernity” in the Greece of his own day. The chapter concludes by exploring the ways in which Thucydides’ influential model of Greek history fails to do justice to the historical realities of archaic Greece.
Thucydides on the Athenian Empire and Interstate Relations (431–404)
Authors: Low Polly
Published: March 2017

This chapter explores the nature of the Athenian Empire (or Delian League) during the Peloponnesian War, discussing its administration, its finances (particularly the tribute and the tax on trade that replaced it), and the changes in its scale and ideology during this period. The final part of the chapter outlines other aspects of interstate conduct, especially attitudes to treaties and diplomacy. The non-Thucydidean evidence, both literary and (especially) epigraphic, for all of these themes is discussed, partly because Thucydides is not always the most detailed (or objective) source for these questions, and partly to draw attention to distinctive features of Thucydides’ analysis.
Thucydides on the Causes and Outbreak of the Peloponnesian War
Authors: Robinson Eric
Published: March 2017

Thucydides repeatedly explains that the Peloponnesian War arose not simply from the specific grievances of this or that state but from a longer process of growing Athenian power that inspired fear among the Spartans, making the war inevitable. Thucydides’ balanced and richly detailed account has not convinced everyone, however. Many scholars investigating the war’s causes have disagreed with Thucydides’ thesis, typically using the historian’s own narrative to fix primary blame for the war on the Athenians or the Spartans, or more rarely casting the war’s outbreak in broader terms, with varying degrees of success. This chapter validates Thucydides’ explanation and shows that alternative modern explanations are unsatisfactory.
Speeches
Authors: Tsakmakis Antonis
Published: March 2017

The great number of set speeches in Thucydides’ work reflects the importance of the art of persuasion in his world, but also exhibits an awareness of the limitations of that art. Far from suggesting straightforward explanations, in their multifarious, dynamic relation to their narrative contexts, immediate or remote, Thucydides’ speeches create a dialectical historiography. Their diversity regarding a series of criteria (speakers, audiences, themes, communicative situations, impact, way of introduction, stylistic choices) is sometimes concealed by the uniformity of language and common ideological presuppositions. While indirect discourse allows for more authorial control, direct speeches combine particular points of view with considerations on general matters. The openness and ambiguity of Thucydides’ rhetorically formulated statement on his method of composing his speeches is in alignment with his effort to keep nothing more than is necessary or helpful (for his purposes) from the original speeches.
Repertoire as Pedagogy
Authors: Goetze Mary
Published: March 2017

Including music from a wide range of cultures calls for choral directors to rethink the common practices employed in most choral rehearsals, and to open themselves to a world of new procedures within rehearsals and performances. Since few directors are also ethnomusicologists, these new practices may also impact the role the director plays in the rehearsals. This chapter challenges directors to define their reasons for including vocal music from outside the western art tradition. Directors should consider alternative processes for finding repertory, presenting it to the ensemble, and sharing it. They need to address challenges singers meet when matching vocal timbres and movement that are concomitant with multicultural musical traditions. Finally they must blend consistent choices with repertory that reflects cultural diversity.
Choral Pedagogy and the Construction of Identity
Authors: Harrison Scott , Young Anthony
Published: March 2017

The chapter speaks to the creation of an encouraging environment in which singing is considered a natural part of male identity. The chapter begins by problematizing the issue of boys’ identity, and addresses some of the concerns raised in the literature and recent research regarding a reluctance of males to sing in the choral setting. After a brief overview of the physiological aspects of changing voice, the chapter moves to discuss the practical considerations. The chapter reflects on practitioners and scholars that have had positive experiences of singing, and issues are systematically addressed with reference to repertoire, technical work, rehearsal strategy and other non-musical concerns. The chapter concludes with a manifesto for male singing across the lifespan which seeks to address the critical point at which boys often stop singing in choirs: the moment they begin to reconstruct their identity at adolescence.
Choral Pedagogy and the Construction of Identity
Authors: Owens Matthew , Welch Graham F.
Published: March 2017

Following an initiative of the early 1990s, the majority of United Kingdom cathedrals now have girl as well as boy cathedral choristers, often alternating in the singing of the daily services. One of the original political challenges in this musico-cultural initiative was whether or not it was possible for girl choristers to attain the same vocal quality as their male counterparts. Empirical studies, however, suggest that there is considerable overlap between the psycho-acoustic vocal features of girls’ and boys’ singing, such that it is often difficult perceptually to distinguish between the two, particularly for the relatively naïve listener. Moreover, the music repertoire usually reaches across gender. The chapter provides an overview of these recent developments and explores how the musical director can best shape the vocal products of their choristers, while being sensitive to particular vocal production issues that relate to the development of girls’ voices.
Creativity
Authors: Simonton Dean Keith
Published: March 2017

This chapter begins by defining what “creativity” signifies, discussing both two- and three-criterion definitions and distinguishing between “little-c” and “Big-C” creativity. The article then turns to the main measurement approaches; namely, those that focus on the creative process, the creative person, and the creative product. Next follows an overview of some key empirical findings, especially concerning developmental adversity and psychopathology. This overview leads to a treatment of three major theoretical questions: the nature-versus-nurture issue, little-c versus Big-C creativity, and domain-specific versus generic processes. The following section concerns practical applications in both early development and adulthood encouragement. The article closes with a discussion of future directions in creativity research and practice.
Progress in the Science of Gratitude
Authors: Watkins Philip C. , McCurrach Duncan
Published: March 2017

This chapter reviews recent progress in the science of gratitude; its foundational issues; and its benefits. Research has shown that grateful people tend to be happy, and gratitude interventions enhance happiness. We review four types of gratitude interventions that have been described in the literature: grateful recounting, grateful reflection, grateful expression, and grateful reappraisal. We also discuss some of the unresolved issues in research regarding gratitude treatments, such as whether people can be trained to become more grateful. We go on to describe another area that is need of research: inhibitors of gratitude. Recent work has shown that narcissism and cynicism inhibit the growth of gratitude, but much more research is needed. Finally we turn to the issue of how gratitude enhances well-being. We argue that gratitude enhances well-being because it amplifies the good in one’s life. Gratitude might amplify the good in cognition, relationships, and in oneself.
World Council of Churches
Authors: Heller Dagmar
Published: March 2017

This chapter describes the World Council of Churches (WCC) from different angles, beginning with the description of it as ‘a fellowship of churches’ in its Basis, its purpose being to help the churches to call one other to visible unity, as formulated in its Constitution. Secondly, the chapter discusses the structural organization of the WCC, with its governing bodies and the working areas covering a variety of issues. That scope necessitates the use of a number of different methodologies, ranging from theological study of church-dividing issues and mission work to networking and advocacy with regard to environmental issues or questions of human rights. An outline of its history and main achievements leads to an evaluation of the significance of the WCC, highlighting its coordinating role for multilateral dialogue, and promotion of common action by the churches as of lasting importance.
Employer-Led In-Work Training and Skill Formation
Authors: Unwin Lorna
Published: March 2017

This chapter examines skill formation organized by employers in the workplace. Its starting point is that all types of work involve knowledge and skill and, therefore, all workplaces are potential learning environments. The chapter discusses developments in workplace learning theory as well as the international empirical evidence on employer attitudes to and investment in in-work training. Illustrations from case study research are provided. It argues that workplace learning is contingent on the level of interaction of individuals with the way work is organized and managed, the nature of the employment contract including reward and incentive structures, the level of discretion employees have to determine how they work, and the extent to which employees are involved in decision making. The chapter concludes with recommendations for policy and practice.
Measuring Skills Stock, Job Skills, and Skills Mismatch
Authors: Felstead Alan , Gallie Duncan , Green Francis
Published: March 2017

This chapter critically appraises the different types of international and national skills data currently available in terms of the underlying concepts of skill and the collection techniques used. It focuses on three ways of measuring skills using surveys. The first measures the skills held by a given group of individuals -- the skills stock. The second focuses on the skills required to do the job competently -- job skills, and the third uncovers mismatches between skills supply and skills demand. In doing so, the chapter reviews the strengths and weaknesses of the survey tools and concepts which have been developed, and pieces together some of main findings which have emerged. The chapter therefore equips readers with the necessary tools to navigate their own way through the myriad of datasets available and the measures they use.
Skill Ecosystems
Authors: Buchanan John , Anderson Pauline , Power Gail
Published: March 2017

Recent interest in skill ecosystems and initiatives associated with their reform represent the latest manifestation of a long-standing tradition of skills analysis which recognizes the importance of the context in which skills are developed and used. Whilst the original academic literature on the topic was primarily concerned with understanding and promoting high skill ecosystems, this chapter examines national approaches to policy and practice concerned with improving ecosystems associated with workers with low and middle-levels skills. Most of this chapter refers to developments in Australia, the UK and US. All the elements for successful skill ecosystem reform are in existence across these case study countries but they are not co-located. Enduring transformations to skill contexts required for effective change is therefore hard to achieve.
The Changing Meaning of Skill
Authors: Payne Jonathan
Published: March 2017

‘Skill’ has long been a contested concept within the social sciences. In recent decades, the use of the term by policy makers, employers and academics has broadened considerably, fuelling debate about what skill is and what constitutes skilled work. With ‘skill’ purportedly encompassing behaviours such as discipline and conformity, the concept is said to be in danger of losing its meaning or significance. The growth of interactive service work has also seen the emergence of new and controversial skill concepts such as emotional, aesthetic and articulation work. Are so-called ‘low skilled’ service jobs really low skilled and might recognition of these hidden skills help to achieve better pay, or is there a risk of exaggerating their skill content and raising unrealistic expectations? This chapter charts these controversies, and argues for placing skill in its societal and workplace context and taking seriously issues of power, job complexity and worker autonomy.
Egyptian—Ptolemaic (Hieroglyphs)
Authors: Kurth Dieter
Published: March 2017

After a concise introduction, the chapter considers texts of varying length as examples of the literature that was written in hieroglyphs during the period of Roman rule in Egypt. The translated texts belong to the sphere of religious literature: litanies, hymns to several deities, and myths of creation. Other texts, more secular ones, contain descriptions of buildings and festivals or deal with religious astronomy. The reader will also find two texts reporting extraordinary incidents. The sphere of funeral belief is represented by some texts that shed light on the realm of the dead as it was conceived by the Egyptians. One of these texts touches the reader’s heart and mind, since it is an imaginary letter written by a deceased Egyptian lady to her former husband telling him about her sad destiny in the netherworld.
Faith and Reason
Authors: Antognazza Maria Rosa
Published: March 2017

This chapter discusses Leibniz’s conception of faith and its relation to reason. It shows that, for Leibniz, faith embraces both cognitive and noncognitive dimensions: although faith must be grounded in reason, it is not merely reasonable belief. Moreover, for Leibniz, a truth of faith (like any truth) can never be contrary to reason but can be above the limits of comprehension of human reason. The latter is the epistemic status of the Christian mysteries. This view raises the problem of how it can be determined whether a doctrine above the full grasp of human reason does or does not imply contradiction. The notion of “presumption” and the “strategy of defense” are discussed as Leibniz’s way to tackle this issue. Finally, the chapter explores the “motives of credibility” that, according to Leibniz, can and should be produced to uphold the credibility of a putative divine revelation, including his account of miracles.
Philosophical Theology and Christian Doctrines
Authors: Antognazza Maria Rosa
Published: March 2017

This chapter discusses Leibniz’s views on key Christian doctrines that were surrounded, in the early modern period, by particularly lively debates. The first section delves into his defence of the Trinity and the Incarnation against the charge of contradiction, and his exploration of metaphysical models capacious enough to accommodate these mysteries. The second section focuses on the resurrection and the Eucharist, with special regard to their connections with Leibniz’s metaphysics of bodies. The third section investigates Leibniz’s position on predestination, grace, salvation, and damnation. It comes to the conclusion that salvation, for Leibniz, does not ultimately depend on believing a set of true doctrines, but on a practical attitude: the love of God above all things. Leibniz’s theology is thus fundamentally a theology of love that is ultimately practical and tries to be both universalist and Christian.
Ecclesiology, Ecumenism, and Toleration
Authors: Antognazza Maria Rosa
Published: March 2017

This chapter discusses Leibniz’s conception of the Christian church, his life-long ecumenical efforts, and his stance toward religious toleration. Leibniz regarded the main Christian denominations as particular churches constituting the only one truly catholic or universal church whose authority went back to apostolic times and whose theology was traceable back to the entire ecclesiastical tradition. This is the ecclesiology that underpins his ecumenism. The main phases and features of his work toward reunification of Protestants and Roman Catholics, and unification of Protestant churches, are briefly explored before turning to the issue of religious toleration. It is argued that a remarkably inclusive conception of toleration can be gleaned from a broad sample of Leibniz’s writings and correspondence. It is thanks to the philosophical and theological grounds of this conception that, for Leibniz, toleration can be extended in principle to all men and women of good will, including non-Christians, pagans, and atheists.
Agency in Plato’s Republic
Authors: Bobonich Christopher
Published: March 2017

This article discusses some of the most important recent controversies in the psychology of Plato’s Republic. These include its views on akratic action, the capacities of the parts of the soul, and the distinction between the rational part of the soul and the nonrational parts. It argues that the Republic accepts the possibility of synchronic akratic action, that is, action contrary to the agent’s belief about what is overall best at the time of action. It then considers some recent arguments that the lower parts of the soul, especially the Appetitive part, are cognitively primitive. Against these views, this article argues that the Appetitive part is capable of means-end reasoning and of forming a conception of its own good. Finally, this article argues that Plato’s distinction between the rational and the nonrational parts of the soul is to be understood in terms of the intelligible versus sensible distinction.
Patent Trolls and Patent Litigation Reform
Authors: Gugliuzza Paul R.
Published: March 2017

This chapter critically examines recent legislative proposals to reform patent litigation in the United States. It begins by providing background on the dynamics that are driving the calls for reform, including complaints about so-called patent trolls. It then reviews proposed bills that would, among other things, impose heightened pleading standards on plaintiffs, limit discovery, and create a presumption that the loser should pay the winner’s attorneys’ fees. After surveying many recent changes to patent law already made by the courts and by Congress in the America Invents Act, the chapter concludes by arguing that additional legislative reform is largely unnecessary. Rather, Congress should focus on discrete problems in patent litigation that the courts may be unable to solve on their own, such as the unusually heavy concentration of cases in the rural Eastern District of Texas.
The Archaeological Record of Indian Ocean Engagements in the Red Sea
Authors: Seland Eivind Heldaas
Published: March 2017

This chapter reviews the evidence, nature, and development of maritime contacts in the Red Sea and from the Red Sea into the western Indian Ocean from the Neolithic until the start of the Islamic period, c. 4000 BCE–700 CE. In addition to summarizing and highlighting recent archaeological research and ongoing scholarly debates, emphasis is placed on identifying and explaining periods of intensified as well as reduced interaction, and on the relationship between internal Red Sea dynamics and contacts with the Mediterranean and the Indian Ocean worlds in light of climate, natural environment, hinterland interest, and a changing geopolitical situation.
Confucianism, Moral Education, and Childhood Development
Authors: Cline Erin M.
Published: March 2017

This article discusses Confucian views on childhood moral development, focusing especially on accounts of moral cultivation in the classical and Han periods. Beginning very early, Confucians exhibited an understanding of the unique influence that parent–child relationships have on children’s moral development during the earliest stages of development, which led them to argue for the importance of moral cultivation and moral education not only during infancy and childhood, but even during the prenatal period. Through an examination of texts, including the Analects, Mengzi, Discourse on the States, Record of Ritual, Collected Biographies of Women and Protecting and Tutoring, as well as secondary literature on this topic, this article focuses on how we should understand Confucian accounts of the roles of parents, the family, ritual, and filial piety in the moral development of children.
OT J002656.6+284933 (CSS101212:002657+284933): an SU UMa-type dwarf nova with the longest superhump period
Authors: Kato Taichi , Tordai Tamás , Littlefield Colin , Kasai Kiyoshi , Shugarov Sergey Yu. , Katysheva Natalia , Zaostrojnykh Anna M. , Pickard Roger D. , de Miguel Enrique , Antonyuk Kirill , Antonyuk Oksana , Pavlenko Elena P. , Pit Nikolai , Itoh Hiroshi , Ruiz Javier , Isogai Keisuke , Kimura Mariko , Wakamatsu Yasuyuki , Vanmunster Tonny , Stone Geoff
Published: March 2017

We observed the 2016 outburst of OT J002656.6+284933 (CSS101212:002657+284933) and found that it has the longest recorded [0.13225(1) d on average] superhumps among SU UMa-type dwarf novae. The object is the third known SU UMa-type dwarf nova above the period gap. The outburst, however, was unlike ordinary long-period SU UMa-type dwarf novae in that it showed two post-outburst rebrightenings. It showed superhump evolution similar to short-period SU UMa-type dwarf novae. We could constrain the mass ratio to less than 0.15 (most likely between 0.10 and 0.15) by using superhump periods in the early and post-superoutburst stages. These results suggest the possibility that OT J002656.6+284933 has an anomalously undermassive secondary and it should have followed a different evolutionary track from the standard one.
Individual and Regional Determinants for Physical Therapy Utilization in Germany: Multilevel Analysis of National Survey Data
Authors: Rommel Alexander , Kroll Lars Eric
Published: March 2017

Background. Physical therapy is included in many clinical guidelines and is a commonly used health service. However, access to its benefits should not strongly depend on social or demographic factors.

Objective. The present study used the Andersen model to explain to what extent physical therapy utilization in Germany depends on factors beyond medical need.

Methods. The German Health Interview and Examination Survey for Adults (DEGS, 2008–2011; target population, 18–79 years) is part of the German health-monitoring system. Two-stage stratified cluster sampling resulted in a sample of 8152 participants. Data were matched with district-related information on social structures and service supply. Following Andersen's Behavioral Model of Health Services Use, this study identified predisposing, enabling, and need factors for physical therapy utilization using multilevel logistic regression analyses.

Results. Physical therapy was used by 23.4% (95% CI: 22.0–24.8) of the German population within one year, with a higher proportion of females (26.8%; 95% CI: 25.1–28.6) than males (19.9%; 95% CI: 18.1–21.8) and an increase with age. Beyond medical need, physical therapy utilization depended on higher education, migrant background, nonsmoking (predisposing), social support, higher income, private health insurance, and gatekeeping service contact (enabling). Variation among districts partly reflected regional supply.

Limitations. Because the present study was cross-sectional, its findings provide representative information on physical therapy use but do not establish final causal links or identify whether utilization or supply in certain districts or population groups is adequate.

Conclusions. Whether certain regions are under- or overserved and whether further regulations are needed is of political interest. Physicians and therapists should develop strategies to improve both adherence of hard-to-reach groups and supply in low-supply regions.
Validity and Reproducibility of the STarT Back Tool (Dutch Version) in Patients With Low Back Pain in Primary Care Settings
Authors: Bier Jasper D. , Ostelo Raymond W.J.G. , van Hooff Miranda L. , Koes Bart W. , Verhagen Arianne P.
Published: March 2017

Objective. The purpose of this study was to translate and to investigate the reliability and validity of the STarT Back screening tool (SBT) in the primary care setting among patients with nonspecific low back pain (LBP).

Design. The SBT was formally translated into Dutch following a multistep approach for forward and backward translation. General practitioners and physical therapists included patients with LBP.

Methods. Patients completed a baseline questionnaire and a follow-up at 3 days and 3 months. The construct validity was calculated with Pearson's correlation coefficient. The reproducibility was assessed using the quadratic weighted kappa and the specific agreement. Predictive validity was assessed using relative risk ratios for persisting disability at 3 months. Content validity was analyzed using floor and ceiling effects.

Results. In total, 184 patients were included; 52.2% were categorized in the “low-risk” subgroup, 38.0% “medium-risk,” and 9.8% “high-risk.” For the construct validity we found, as expected, a moderate to high Pearson's correlation for questions 3 to 9 and a low correlation for questions 1 and 2 with their respective reference questionnaires. The reproducibility had a quadratic weighted kappa of 0.65 and the specific agreement of 82.4% for “low-risk,” 53.3% for “medium-risk,” and 33.3% for “high-risk.” For the predictive validity for persisting disability we found a relative risk ratio for “medium-risk” of 1.8 (95% confidence interval [CI]: 1.0–3.1) and 2.7 (95% CI: 1.4–4.9) for “high-risk” compared with “low-risk.” For the content validity, we found that no floor and ceiling effects were present.

Limitations. There was a relatively small sample size for the retest reliability study. Patients were not compared between physical therapist and GP, as there were not enough patients in both groups. For practical reasons, the patients filled out the baseline questionnaire after receiving the first treatment/consultation; however, the questionnaire is intended to be filled in before the first consultation/treatment.

Conclusion. The SBT has been successfully translated into Dutch. The psychometric analysis showed acceptable results and, therefore, the SBT is a valid screening tool for patients with LBP in Dutch primary care.
Comparison of Robotic and Other Minimally-Invasive Routes of Hysterectomy for Benign Indications
Authors: Swenson Carolyn W. , Kamdar Neil S. , Harris John A. , Uppal Shitanshu , Campbell Darrell A. , Morgan Daniel M.
Published: March 2017

(Abstracted from Am J Obstet Gynecol 2016;215(5):650.e1–650.e8)

The popularization of robotic-assisted laparoscopic hysterectomy (RH) over the past decade has provided an alternative approach to performing minimally invasive hysterectomy.
Impaired Telomere Length and Telomerase Activity in Peripheral Blood Leukocytes and Granulosa Cells in Patients With Biochemical Primary Ovarian Insufficiency
Authors: Xu Xiaofei , Chen Xinxia , Zhang Xiruo , Liu Yixun , Wang Zhao , Wang Peng , Du Yanzhi , Qin Yingying , Chen Zi-Jiang
Published: March 2017

(Abstracted from Hum Reprod 2017:32:201–207)

The underlying cause of primary ovarian insufficiency (POI) is unknown in most cases, which generally are referred to as idiopathic. Primary ovarian insufficiency is associated with biological reproductive aging and encompasses 3 stages: occult, biochemical, and overt.
Neurodevelopmental Outcome at 2 Years in Offspring of Women Randomised to Metformin or Insulin Treatment for Gestational Diabetes
Authors: Wouldes Trecia A. , Battin Malcolm , Coat Suzette , Rush Elaine C. , Hague William M. , Rowan Janet A.
Published: March 2017

(Abstracted from Arch Dis Child Fetal Neonatal Ed 2016;101:F488–F493)

Gestational diabetes mellitus (GDM) is a common complication of pregnancy and is associated with deficits in motor, social, or linguistic development in offspring. Diet modification and insulin, which does not cross the placenta, have been the mainstay of treatment for GDM.
Third Trimester Brain Growth in Preterm Infants Compared With In Utero Healthy Fetuses
Authors: Bouyssi-Kobar Marine , du Plessis Adré J. , McCarter Robert , Brossard-Racine Marie , Murnick Jonathan , Tinkleman Laura , Robertson Richard L. , Limperopoulos Catherine
Published: March 2017

(Abstracted from Pediatrics 2016;138:e20161640)

Preterm birth is associated with lifelong neurodevelopmental disabilities even in the absence of destructive prematurity-related brain injury. The timing, progression, and functional impact of delayed brain maturation in the absence of structural brain injury remain unknown.
Sensitivity of Fetal RhD Screening for Safe Guidance of Targeted Anti–D Immunoglobulin Prophylaxis: Prospective Cohort Study of a Nationwide Programme in the Netherlands
Authors: de Haas Masja , Thurik Florentine F. , van der Ploeg Catharina P. B. , Veldhuisen Barbera , Hirschberg Hoang , Soussan Aicha Ait , Woortmeijer Heleen , Abbink Frithjofna , Page-Christiaens Godelieve C. M. L. , Scheffer Peter G. , van der Schoot C. Ellen
Published: March 2017

(Abstracted from BMJ 2016;355:i5789)

The risk of maternal alloimmunization due to RhD incompatibility has decreased with use of antenatal and postnatal anti–D immunoglobulin prophylaxis. The discovery of cell-free fetal (cff) DNA in maternal plasma during pregnancy and the feasibility of fetal RhD testing using this source of DNA make it possible to determine fetal RhD type and to restrict the use of antenatal anti–D immunoglobulin to only those RhD-negative women carrying an RhD-positive fetus.
Common Pediatric Pain Disorders and Their Clinical Associations
Authors: Donnelly Theresa J. , Bott Aneeka , Bui Minh , Goh Shuxiang , Jaaniste Tiina , Chapman Cindy , Crawford Matthew , Hopper John L. , Champion David
Published: March 2017

Background:

Common childhood pain conditions (nonmigraine headache, migraine, recurrent abdominal pain, growing pains, low back pain) and persistent pains are often associated with each other and have significant implications in later life. Emerging evidence suggests additional associations between these pain conditions and restless legs syndrome, iron deficiency, anxiety, and depression. The aim of this cross-sectional study in pediatric twin individuals and their siblings was to investigate these associations.

Materials and Methods:

Surveys were sent to Australian twin families via the Australian Twin Registry, yielding responses from 2530 pediatric individuals. The lifetime prevalence of the common pain disorders of childhood and of other persistent pains, restless legs syndrome and iron deficiency, and anxious/depressed score were determined by questionnaires. Random-effects logistic regression modeling was used to investigate univariate and multivariate associations between conditions.

Results:

Univariate associations were found between each of the pain conditions and persistent pain, and between the pain conditions with restless legs syndrome, iron deficiency, and anxious/depressed score. Derivative multivariate analyses retained statistically significant associations between each of the pain disorders included in the respective models (odds ratios [OR], 1.69-7.04) with the exception of growing pains with persistent pain. Of the nonpain conditions included in the multivariate analyses, restless legs syndrome remained associated with growing pains (OR, 8.50) and persistent pain (OR, 2.01). Iron deficiency remained significantly associated with migraine (OR, 2.38), persistent pain (OR, 3.70), and restless legs syndrome (OR, 5.10).

Conclusions:

In light of their extensive associations, the common pain conditions, persistent pain, restless legs syndrome, iron deficiency, anxiety and depression, are likely to involve common etiological mechanisms that warrant further investigation.
The Impact of Serum Drug Concentration on the Efficacy of Imipramine, Pregabalin, and their Combination in Painful Polyneuropathy
Authors: Sindrup Søren H. , Holbech Jakob V. , Bach Flemming W. , Finnerup Nanna B. , Brøsen Kim , Jensen Troels S.
Published: March 2017

Objective:

The aim of this study was to explore the serum concentration-effect relation for first-line drugs in neuropathic pain and to determine if efficacy could be increased.

Methods:

Data from a randomized, placebo-controlled, cross-over trial on imipramine, pregabalin, and their combination in painful polyneuropathy were used. Treatment periods were of 4 weeks’ duration, outcome was the weekly median of daily pain rated by a 0 to 10 numeric scale, and drug concentrations were determined by high-performance liquid chromatography.

Results:

In 47 patients, pain was reduced −1.0 (95% confidence interval [CI], −1.5 to −0.6) by imipramine, −0.4 (95% CI, −0.9 to 0.1) by pregabalin, and −1.6 (95% CI, −2.1 to −1.1) by combination therapy. On monotherapy, there was no difference between responders and nonresponders with respect to concentrations of imipramine (mean, 161 vs. 229 nmol/L,P=0.129) and pregabalin (mean, 9.8 vs. 11.7 μmol/L,P=0.178). There was no correlation between drug concentration and pain reduction for imipramine (r=0.17,P=0.247), whereas there was a marginally, positive correlation for pregabalin (r=0.28,P=0.057). There was no interaction between treatment and concentration classes (imipramine < or ≥100 nmol/L, pregabalin < or ≥10 μmol/L) either for monotherapy or for combination therapy (P=0.161 to 0.797). Isobolographic presentations of reponders with imipramine and pregabalin concentrations during combination therapy did not indicate synergistic interaction.

Discussion:

There were no important relations between drug concentrations and efficacy, or indication of synergistic interaction between the drugs. It was not concluded that treatment can be improved by measurement of drug concentration of pregabalin.
Postoperative Analgesia After Wound Infiltration With Tramadol and Dexmedetomidine as an Adjuvant to Ropivacaine for Lumbar Discectomies: A Randomized-controlled Clinical Trial
Authors: Mitra Saikat , Purohit Shobha , Sharma Mamta
Published: March 2017

Introduction:

Crippling postoperative pain linked with lumbar discectomies not only shackles patient’s normal daily activities but also lengthens their hospital stay. So, allaying postoperative pain in these patients has become a substantive component in neuroanesthesia to expedite neurological recovery. Wound infiltration with local anesthetics is widely used to optimize postoperative pain. Different adjuvants like dexmedetomidine and tramadol when added to local anesthetics prolongs postoperative analgesia. The aim of this trial was to evaluate the analgesic efficacy of tramadol and dexmedetomidine when added to ropivacaine for wound infiltration in lumbar discectomies.

Methodology:

This study was prospective, randomized, double-blind, controlled in nature conducted among 45 adult patients belonging to American Society of Anesthesiologists’ physical status 1 and 2, of either sex aged between 30 and 70 years undergoing elective lumbar discectomies. They were randomly allocated into 3 equal groups: group R received 100 mg of 0.5% ropivacaine (20 mL) and 2 mL normal saline, group RT received 100 mg of 0.5% ropivacaine (20 mL) and 2 mg/kg tramadol (2 mL), and group RD received 100 mg of 0.5% ropivacaine (20 mL) and 0.5 μg/kg dexmedetomidine (2 mL) (total volume, 22 mL). Visual analog scale at 0, 2, 4, 6, 12, 18, and 24 hours; time to first rescue analgesia, total supplemental analgesic consumption and side effects (if any) were assessed during first 24 hours postoperatively.

Results:

The median time to first rescue analgesia (median; 95% confidence interval [CI]) in group RD was 930 (854.3 to 1005.7) minutes. This was significantly longer (P=0.000) than group RT (420 [366.3 to 473.7] min) or group R (270 [243.2 to 296.8] min). Postoperative diclofenac consumed (median [interquartile range]) was 150 (150 to 200) mg in group R, 150 (75 to 150) mg in group RT and 75 (75 to 150) mg in group RD (P=0.008). Significant differences in mean visual analog scale scores were observed among the 3 groups at hours 0 (P=0.033), 2 (P=0.001), 4 (P=0.000), 6 (P=0.001), and 24 (P=0.013). No statistical significant side effects could be discerned among the groups.

Conclusions:

We concluded that wound infiltration with combined ropivacaine and dexmedetomidine found to be significantly superior for postoperative analgesia compared with either combined ropivacaine and tramadol or ropivacaine alone for lumbar discectomies.
Toward Relational Practices for Enabling Knowledge-to-Action in Health Systems
Authors: Plamondon Katrina , Caxaj Susana
Published: March 2017

Despite widespread emphasis on evidence-informed decision making in health care, there remain persistent challenges in actualizing this ideal. An integrated strategy to knowledge translation can help bridge perspectives across sectors, communities, and organizations, and bridge the “knowledge-to-action” gap. One such strategy is a deliberative dialogue method. Deliberative dialogue has unique potential to mobilize partnered changes and improvements across health care, and we believe, is most salient when enacted relationally through practices of relational engagement and relational accountability. Drawing from our own scholarship, we reflect on how these practices can help establish both processes and outcomes that can affect meaningful change.
Occurrence, Predictors, and Prognosis of Alcohol Withdrawal Syndrome and Delirium Tremens Following Traumatic Injury
Authors: Salottolo Kristin , McGuire Emmett , Mains Charles W. , van Doorn Erika C. , Bar-Or David
Published: March 2017

Objectives:

We sought to determine occurrence, predictors, and prognosis of alcohol withdrawal syndrome and delirium tremens in patients with traumatic injury.

Design:

Retrospective multicenter cohort study.

Setting:

Three U.S. trauma centers.

Patients:

Twenty-eight thousand one hundred one trauma patients admitted from 2010-2014.

Interventions:

None.

Measurements and Main Results:

Measures included occurrence of alcohol withdrawal syndrome and delirium tremens, injury characteristics, risk factors for alcohol withdrawal syndrome, clinical outcomes, pharmacologic treatment for alcohol withdrawal syndrome, and Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) scores. Alcohol withdrawal syndrome severity was defined by CIWA-Ar score as minimal (< 10), moderate (10–20), and severe (> 20). Alcohol withdrawal syndrome developed in 0.88% (n = 246), including 12% minimal, 36% moderate, and 53% severe. Alcohol withdrawal syndrome progressed to delirium tremens in 11%. Before adjustment, alcohol withdrawal syndrome severity was associated with injury severity, hypokalemia, baseline CIWA-Ar score, and established alcohol withdrawal syndrome risk factors. Logistic regression identified the following predictors of delirium tremens: baseline CIWA-Ar score greater than or equal to 10 (odds ratio, 6.05; p = 0.02) and age greater than or equal to 55 (odds ratio, 3.24; p = 0.03). In patients with severe alcohol withdrawal syndrome, severe head injury also predicted progression to delirium tremens (odds ratio, 6.08; p = 0.01), and hypokalemia was borderline significant (odds ratio, 3.23; p = 0.07). Clinical outcomes of hospital length of stay, ICU length of stay, and alcohol withdrawal syndrome complications differed significantly by alcohol withdrawal syndrome severity and were worse with more severe manifestations of alcohol withdrawal syndrome. Mortality also significantly differed by alcohol withdrawal syndrome severity but was only greater in patients who progressed to delirium tremens (11.1%; p = 0.02); otherwise, there were no differences in mortality by severity (4%, 4%, and 0% by minimal, moderate, and severe alcohol withdrawal syndrome).

Conclusions:

Trauma patients with alcohol withdrawal syndrome experience a high occurrence of delirium tremens that is associated with significant mortality. These data demonstrate the predictive ability of baseline CIWA-Ar score, age, and severe head injury for developing delirium tremens.
Perspectives From Patients and Care Providers on the Management of Fecal Incontinence: A Needs Assessment
Authors: Helewa Ramzi M. , Moloo Husein , Williams Lara , Foss Kristine M. , Baksh-Thomas Waheeda , Raiche Isabelle
Published: March 2017

BACKGROUND:

A large proportion of Canadians experience fecal incontinence, with no avenue for effective treatments. The Ottawa Hospital has recently started a percutaneous tibial nerve stimulation program for patients who have not improved with conservative efforts.

OBJECTIVE:

As part of this program implementation, a qualitative needs assessment was undertaken to better define successful outcomes and to identify barriers for program sustainability.

DESIGN:

This was a cross-sectional, qualitative study involving standardized, semistructured interviews.

SETTINGS:

The study was conducted at a single tertiary care center.

PATIENTS:

Patients experiencing fecal incontinence, as well as nurses, physical therapists, and physicians, were enrolled in the study.

MAIN OUTCOME MEASURES:

Interview questions revolved around success definitions, barriers, and promoters of fecal incontinence care. Transcripts were analyzed to develop themes surrounding fecal incontinence care.

RESULTS:

Twelve interviews were undertaken raising a total of 17 different themes. Barriers to fecal incontinence care included education for both the care provider and patients. Access issues for treatments were also highlighted. Promoters of fecal incontinence care were reflected by the impact that it has on quality of life, personal hygiene, psychological burden, and activity and productivity. The definition of fecal incontinence success was focused on improvements in quality of life rather than a numerical reduction of incontinence episodes.

LIMITATIONS:

This study was limited in its small number of interviews conducted. We were unable to identify patients who were unable to seek out care for fecal incontinence.

CONCLUSIONS:

Patient and care provider education surrounding fecal incontinence is lacking. Furthermore, access for effective treatments is a real barrier for Canadians experiencing fecal incontinence. Programs should focus on improvement of overall quality of life rather than a reduction of incontinence episodes.
Endoscopic Pilonidal Sinus Treatment Combined With Crystalized Phenol Application May Prevent Recurrence
Authors: Gecim Ibrahim Ethem , Goktug Utku Ufuk , Celasin Haydar
Published: March 2017

BACKGROUND:

No single treatment yet exists for pilonidal disease that has a short healing time, good cosmetic results, and a low rate of recurrence. Phenol crystal application and diathermy ablation through an endoscope have been used for the treatment of pilonidal disease, but this cohort is the first one to combine them.

OBJECTIVE:

The purpose of this study was to examine the safety, effectiveness, and short- and long-term outcomes of crystalized phenol treatment combined with endoscopic pilonidal sinus treatment for pilonidal disease.

DESIGN:

This was a prospective cohort study.

SETTINGS:

Procedures were performed in 2 hospitals by the same surgeon between February and July 2014.

PATIENTS:

Twenty-three patients underwent surgical treatment for pilonidal disease.

INTERVENTIONS:

Under local anesthesia and sedation, all of the patients underwent a video-assisted diathermy ablation of the sinus cavity and the application of phenol crystals.

MAIN OUTCOME MEASURES:

Adverse events were recorded as a measure of safety and tolerability. Failure to heal and recurrence rate were documented and evaluated.

RESULTS:

Patients were discharged on the same day as surgery. There was no or minimal postoperative pain (mean visual analog scale score, 1.40 ± 0.95). Mean operation time was 20.43 ± 6.19 minutes, and the median return-to-work duration was 2.00 days (mean, 3.03 ± 2.95 d). Patients were followed-up for 18 to 24 months (mean, 22.00 ± 1.88 mo). No serious complications or rehospitalization were observed. No primary failure to heal or recurrence was observed.

LIMITATIONS:

This study did not include a control group with which to compare and consisted of a relatively small number of patients.

CONCLUSIONS:

Crystalized phenol treatment combined with endoscopic pilonidal sinus treatment was safe, tolerable, and achieved fast and durable healing with no recurrence over an average of 22 months of follow-up.