bluuebunny/crossref_metadata_2025 huggingface dataset:
Interacting in the Open
Authors: Lamb Maurice , Chemero Anthony
Published: October 2018

Dynamical systems theories describe a wide range of theoretical orientations in cognitive science. In this chapter we focus on a particular formulation of dynamical systems theory that provides a strong theoretical basis for some of the claims made by 4E approaches to cognition. In particular, the target dynamical systems approaches depend on two hypotheses. First, the interaction hypothesis states that the states and behaviors of any entity in a cognitive system are highly dependent on the states and behaviors of some other entity or set of entities. Second, the openness hypothesis states that cognitive systems only persist in the context of other systems. Taken together, these hypotheses entail that the boundaries of cognitive systems should not be taken for granted, and that there are both metrics and reasons for empirically investigating how cognitive systems may be bounded and how those boundaries might change.
Dombey and Son and the Question of Reproduction
Authors: Ginsburg Michal P.
Published: October 2018

This chapter examines the role of reproduction, labour, and maintenance in Dombey and Son as it pertains to both the domestic sphere and the public sphere of economic and social relations. It shows that the reproduction and maintenance of the material home are represented in the novel mostly by the effects of their absence. It analyses both the ideological stakes of such representation and the way it ends up conflicting with claims about the naturalness of family and home that support domestic ideology. The chapter further argues that the way Dickens represents the firm of Dombey and Son also shows the need for, and the lack or failure of, the labour of reproduction and maintenance. It then discusses how ‘management’ is introduced to cure the ills of both the socio-economic and the domestic sphere.
A Tale of Two Cities
Authors: Vanfasse Nathalie
Published: October 2018

A Tale of Two Cities is one of Dickens’s shortest and possibly one of his most atypical and puzzling novels. For French readers in particular—whose history this novel purports to reinterpret—the novel proves especially challenging. This chapter provides new insights into the understanding of this perplexing work. It argues that the complexity of the novel stems from its interculturality—especially in relation to translation—as well as from the historical, political, philosophical, and sociological perspectives it engages with, and the interdisciplinary connections it thus establishes. The novel’s puzzling quality also derives from its intricate handling of the concept of identity and its multifarious ramifications that involve gender but also revolutionary crowds. Moreover, the elaborate combination of strong visual elements, added to an as yet underexplored but just as intense and multi-faceted kinaesthetic dimension, enhance our reading of A Tale of Two Cities, and open up new possibilities for performing and adapting the novel.
‘Milestones on the Dover Road’
Authors: Hollington Michael
Published: October 2018

This chapter takes as its starting point Dickens’s proximity—first, in childhood, and later, from 1856 onwards—to the Dover Road, arguing that this thoroughfare governs his thinking about travel and motion. Besides serving as the major vehicle of traffic between London and Europe, it was also a route of pilgrimage to Canterbury. Steeped in Bunyan, Dickens thus tended to think of the journey along it as an allegory of the progress of human life towards death. But his travels and travel writing should not be thought of solely in terms of a teleology. He himself distinguishes between purposeful travel and strolling or ‘flânerie’, and his two major travel books, on America and Italy respectively, explore both interconnectedly. Equally, his novels oscillate between picaresque linearity and an emphasis on circularity and stasis, these latter foremost in his last work.
Charles Dickens and the ‘Dark Corners’ of Children’s Literature
Authors: Hillard Molly Clark
Published: October 2018

The time is right to consider anew the ways in which Dickens anticipated, participated in, and critiqued the vast mediascape of Victorian children’s literature. In order to do so, we must continue to challenge our enduring bias that children’s literature does not possess the dialogic register of other genres. Dickens, for one, knew better: though he often tells his readers that children’s literature is a ‘nursery of fancy’ that socializes and humanizes through its ‘bright little books’, he shows a world in which children’s literature is an amorphous network of ‘dark corners’, often governed by ruthless, working-class bodies. Dickens’s fiction and journalism reveal his awareness of children’s literature’s growing currency in economic, cultural, and aesthetic terms. This chapter focuses on the years 1849–54, when Dickens’s child production matched his literary production, and when he was sharply attuned to children’s reading materials.
Material Culture
Authors: Wood Claire
Published: October 2018

This chapter discusses Dickens’s playful engagement with material culture, noting key stylistic features and the implications for subject–object relations. It distinguishes between objects that the narrative marks as significant and others that remain part of the mise-en-scène and examines how commodity criticism and thing theory have raised different types of objects to prominence. Subsequent discussion of a talking antique chair in The Pickwick Papers, bottles of Madeira wine in Dombey and Son, and gifts sent to the author by an admirer explores the importance of long-lived objects to Dickens’s material imagination. Entwining the endurance of things with the impermanence of human life, Dickens’s persistent objects offer further ways to think about the relationship between people and things, and the stories they might tell about one another.
Class and its Distinctions
Authors: Vanden Bossche Chris
Published: October 2018

Dickens employs a range of class discourses to imagine possibilities of social being defined in terms of middle-class selfhood. This self seeks social inclusion represented as the achievement of the status of the gentleman or gentlewoman. The nineteenth-century shift of gentility from inborn quality to a quality of character that is earned through self-making in turn raises the possibility of mere self-invention and along with it the pursuit of self-interest at the expense of others. This problematic accounts for the repeated plot structure in which a protagonist is excluded from genteel society and can only re-enter it through earning his or her way in the world. In the late novels, Dickens focuses in particular on the way in which the desire for social inclusion is generated by gestures of exclusion and thus questions gentility as a viable category for defining social being.
Cognitive Dickens
Authors: Badley Chip , Young Kay
Published: October 2018

Recent research in cognitive science and attachment theory on the relationship between the quality of mother–infant attachment and cognitive development helps make sense of the sometimes dissociated mind states of the Dickensian narrative universe. This chapter offers a critical genealogy of ‘minding Dickens’, with its particular attention to the cognitive disturbances of Dickens’s orphan child. Further, it explores how Dickens’s narrative art embodies those disturbances through metonymy, repetition, forms of occluded vision, conflated descriptions of life and death. Finally, it makes two fundamental claims: (1) How we mind depends in part on how we feel attached; and (2) How Charles Dickens ‘minds’ David Copperfield, Bleak House, and Great Expectations—through dissociation, faulty Theory of Mind, faulty problem solving, moments of amnesia or of traumatic repetition, and experiences of a ‘false self’—embodies the relation of ‘broken brains’ to ‘broken attachments’ that so often distinguish the psychology and technique of Dickens’s narrative art.
Dickens’s World-System
Authors: Young Paul
Published: October 2018

This chapter reads Dickens as ‘world literature’, in the sense that his writing constitutes ‘literature of the world-system—of the modern capitalist world-system’. Perhaps more than any other English writer of the period, it argues, Dickens captured the wide-ranging, empowered, profitable yet inherently uneven, unequal way that Britain in general, and London in particular, worked at the heart of nineteenth-century globalized modernity. It comprises three sections: first, it examines how Dickens’s fiction refuted the idea of British-led globalization as a free-flowing, fast-acting, all-encompassing phenomenon; second, it shows that at the same time Dickens’s novels revealed frictionally forceful, historically dynamic, materially significant global connections within the metropolitan topographies he represented; third, it draws on the theory of combined and uneven development as it considers how Dickens’s writing can be understood with regard to the socially divisive, violent impact of globalizing industrial capitalism—upon his own nation as well as the world beyond its shores.
Taking Everyday Political Talk Seriously
Authors: Conover Pamela Johnston , Miller Patrick R.
Published: October 2018

Though it is often a casual byproduct of social interactions, everyday political talk is nonetheless vital to deliberative democracy. In this chapter, we review current empirical research establishing the importance of everyday political talk. We also explore the psychology of everyday talk, explaining how over time everyday political talk encourages citizens to clarify their preferences, and develop understandings of politics that reflect their interests and identities. Finally, we probe the links between everyday talk, the media, and the formation of public opinion. Overall, we argue that by developing in citizens both a broad understanding of politics and a language to discuss it, everyday political talk prepares them for political action, including deliberation in more formal settings.
Democratic Deliberation and Social Choice
Authors: List Christian
Published: October 2018

In normative political theory, it is widely accepted that democracy cannot be reduced to voting alone, but that it requires deliberation. In formal social choice theory, by contrast, the study of democracy has focused primarily on the aggregation of individual opinions into collective decisions, typically through voting. While the literature on deliberation has an optimistic flavour, the literature on social choice is more mixed. It is centred around several paradoxes and impossibility results identifying conflicts between different intuitively plausible desiderata. In recent years, there has been a growing dialogue between the two literatures. This paper discusses the connections between them. Important insights are that (i) deliberation can complement aggregation and open up an escape route from some of its negative results; and (ii) the formal models of social choice theory can shed light on some aspects of deliberation, such as the nature of deliberation-induced opinion change.
Deliberative Democracy and Science
Authors: Moore Alfred
Published: October 2018

What might a deliberative politics of science look like? This chapter addresses this question by bringing together science studies and the theories and practices of deliberative democracy. This chapter begins by discussing the importance of considering the role of deliberation within scientific communities and institutions, particularly as it bears on the production of scientific judgments and decisions at the boundary between science and politics. The chapter then discusses the emergence of institutions for communicating scientific knowledge to policy-makers, public officials and citizens, which include not only expert tribunals but also the development of citizen panels, consensus conferences, and other forms of mini-publics. Finally, the chapter considers the role of “uninvited” ’ participation in science, emphasizing the role of social movements and critical civil society in both challenging and informing scientific knowledge production.
Deliberative Ideals Across Diverse Cultures
Authors: Sass Jensen
Published: October 2018

In the scheme of history, most political deliberation has taken place outside the modern West. But the study of deliberation, however extensive it has become, has largely ignored this wider world. Examining how deliberation manifests across different societies has considerable promise for both explanatory and normative political theory. To explain why people deliberate—which should be among the first questions deliberative democrats ponder—it is first necessary to examine how people deliberate, and why this varies. Doing so with a comparative and historical perspective, even in the preliminary fashion presented here, reveals how social and political ideals can motivate and shape deliberative practice. And there are normative stakes in this agenda. If collective deliberation is to prevail in global governance, we must fashion political ideals which motivate diverse peoples to come together in discourse, rather than confront their problems, or compound them, by less desirable means.
Deliberative Democracy and Comparative Democratization Studies
Authors: Curato Nicole , Steiner Jürg
Published: October 2018

This chapter provides an overview of the relationship between the normative theory and empirical research on deliberative democracy and comparative studies of democratization. We begin the chapter by making a case for the role of deliberation in democratic transitions. We provide case studies on each of the roles we identify to illustrate how precisely deliberation unfolds amidst sensitive political contexts. We then chart directions for deliberative democratic scholarship to deepen its engagement with democratization studies. We first focus on how deliberative democracy can speak to current indices that measure the quality of democracy, and then propose ways in which the literature on deliberative systems and sequences can further contribute to challenging our assumptions about what counts as “good” democratic transition.
Deliberation in Deeply Divided Societies
Authors: O´Flynn Ian , Caluwaerts Didier
Published: October 2018

Many comparative scholars argue that deliberation has little or no role to play in managing deep national, ethnic, or linguistic divisions. In their view, seeking compromise across deep divides should be the exclusive preserve of political elites, since ordinary people will tend to be highly insecure and hence lack the capacity to deliberate meaningfully across deep divides. In this chapter, we want to consider, and indeed defend, the claim that deliberation has a vital role to play in deeply divided societies—not just in terms of shaping relationships between competing political elites, but also between elites and the ordinary citizens they claim to represent. To substantiate this argument, we draw on and contribute to a growing body of literature on deliberative consociation and deliberative democracy in divided societies that seeks to examine whether deliberation can help ethnic groups in conflict to deal democratically with their divisions.
Team Reflection
Authors: Otte Kai-Philip , Knipfer Kristin , Schippers Michaéla
Published: October 2018

This chapter posits that team reflection, which the authors conceive as the collective evaluation of prior team activities, is a major driver for the development and attainment of expertise in teams. To develop its argument, the chapter first reviews previous team reflection research (self-regulatory team reflection, as for example team reflexivity, and guided team reflection approaches, as for example team debriefings) and elaborates the mechanisms that link team reflection to expertise in teams. Secondly, the chapter discusses multiple catalysts of team reflection. Finally, the chapter elaborates two important shortcomings of previous team reflection research (level of analysis, and short- and long-term consequences) that should be further addressed by future studies in order to deepen our understanding of the effects of team reflection on the development of expertise in teams.
Skill Decay
Authors: Arthur Winfred , Day Eric Anthony
Published: October 2018

With a focus on its intersection with the expertise literature, a number of conclusions arise from the present review of the skill/knowledge decay and retention literature. First, decay is more a matter of interference rather than simply the forgetting of information and processes through the passage of time. Second, decay is highly dependent on task and situational factors. Third, decay on complex tasks appears to be smaller than that observed for simple tasks. Fourth, retention is generally stronger with more practice, elaborative rehearsal, and greater mastery—expertise—of the task. Fifth, although related, retention, reacquisition, and transfer are meaningfully distinct. Sixth, there is very limited empirical research that integrates the study of expertise in the context of skill acquisition with the study of decay, adaptable performance, and enhancing retention (or mitigating loss) in complex real-world performance domains. Intersecting these rich yet separate literatures would be of great theoretical and practical value and warrants future research attention.
Music through the Lens of Cultural Neuroscience
Authors: Hodges Donald A.
Published: October 2018

A central thesis of this chapter is that biological and cultural aspects of musical experiences are inextricably intertwined. Cultural neuroscience is a field of study concerned with investigating relationships between culture and brain, as expressed in a culture–behavior–brain loop model.Accordingly, musical practices of any given culture must adapt to neural constraints and contrarily, the brain adapts to cultural practices. Genetic instructions and environmental experiences interact in the development of musical expertise. The neural plasticity of the brain is likewise a factor of gene–environment interactions, as evidenced in such processes as neural pruning and myelination. Infant musical behaviors are an amalgam of genetic predispositions and learning experiences. The search for music universals and cross-cultural music research also provide evidence for cultural and biological influences. Virtually nothing about musical experiences is purely biological or purely cultural.
Neurologic Music Therapy for Speech and Language Rehabilitation
Authors: Lee Yune S. , Thaut Corene , Santoni Charlene
Published: October 2018

This chapter examines the connection between music and speech, and points out areas of intersection relative to the mechanisms guiding their practice, application, and execution. This work also investigates the role of neurologic music therapy as a developmental, remedial, and rehabilitative protocol in the area of speech and language. In order to operationalize findings, the chapter is divided into sections by speech and language disorder: dysarthria, apraxia of speech, aphasia, fluency, sensory deficits, voice disorders, and dyslexia. Literature is provided hereafter outlining the premise for music prescription relative to the aforementioned areas, as well as areas of speech and language therapy wherein music discernibly exists as a fundamental construct in various therapeutic protocols; the practice of singing being a main area of concentration. The review provides an overview of related research and outlines areas in preliminary stages of investigation.
Neurologic Music Therapy Targeting Cognitive and Affective Functions
Authors: Hegde Shantala
Published: October 2018

Cognitive deficits play a central role in recovery and determining functional outcome in neurological and psychiatric conditions. New techniques of cognitive rehabilitation address the issue of sustenance and generalizability of improved cognitive functions to activities of daily living. Research in the field of music and neuroscience has contributed immensely towards better understanding of neural correlates of music perception and cognition and music production. Neurologic music therapy (NMT) has emerged as a neuroscientific based systematic method to improve sensorimotor, language, cognition, and affective domains of functioning. The two interrelated dynamic models, the “Rational Scientific Mediating Model” and the “Transformational Design Model” of NMT are discussed in comparison with principles of cognitive remediation. An increase in research examining the role of music-based intervention to target cognition and emotion has been initiated. NMT has facilitated the field of music therapy from a predominantly social science model to a neuroscientific model based technique.
The Neuroscience of Children on the Autism Spectrum with Exceptional Musical Abilities
Authors: Ockelford Adam
Published: October 2018

This chapter sets out a neuroscientific model to explain the exceptional musicianship that characterizes some children on the autism spectrum who have learning difficulties. The model builds on Gaver’s “ecological” interpretation of auditory processing using Ockelford’s “zygonic” theory. This attributes the perception of musical structure to the recognition of intentional repetition, and establishes a hierarchy of music-structural forms of differing complexity that are reflected ontogenetically in children’s musical understanding. The cognition of music is far less neurologically demanding than the processing of language, and is a developmental precursor. In some children on the autism spectrum, auditory development focuses on the perceptual qualities of sounds that in some cases leads to acquisition of “absolute pitch,” and a fascination for the repetitive patterns in sound. The children can process both language and everyday sounds as though they were music. This drives exceptional musical development, but at the cost of language and an appreciation of everyday sounds.
Network Neuroscience: An Introduction to Graph Theory Network-Based Techniques for Music and Brain Imaging Research
Authors: Wilkins Robin W.
Published: October 2018

This chapter provides an introduction to network neuroscience techniques for music and brain imaging research. Key to this chapter is a background to the field of network science more broadly, as an approach to the study of complex systems, in addition to the more currently accepted graph theory techniques and applied analysis methods within network neuroscience. The focus of the chapter is on two main components. First, an introduction to network-based techniques that may be successfully applied to neuroimaging data for understanding structural and functional brain connectivity. Second, some of the more recent results and implications from the application of these techniques to fMRI data for advancing our understanding of the effects of music and musical training on structural and functional brain networks. Ultimately, the promising evidence resulting from the application of network-based techniques may help resolve fundamental questions surrounding the effects of music on the brain.
Whose Refuge, This House?
Authors: Garcia-Mispireta Luis Manuel
Published: October 2018

Electronic dance music (EDM) scenes have passed through several cycles of broad popularity and exposure, often weakening their ties to the queer, Black, Latinx, and transgender urban nocturnal worlds from which they emerged. Given the importance of these originating music scenes to their minoritized participants as spaces of survival, comfort, recognition, and community-building, it is equally important to examine this pattern of estrangement and assess its stakes for the queers of color who have played a pivotal role in this music’s development. This chapter first seeks to redress the lacunae of conventional EDM historiography by providing a revisionist history that focuses on issues of sexuality, race, and ethnicity. It then traces queer counterhistories into the present, redressing the apparent disappearance of queers of color from present-day scenes and industries.
Suzaku X-ray observations of the mixed-morphology supernova remnant CTB 1
Authors: Katsuragawa Miho , Nakashima Shinya , Matsumura Hideaki , Tanaka Takaaki , Uchida Hiroyuki , Lee Shiu-Hang , Uchiyama Yasunobu , Arakawa Masanori , Takahashi Tadayuki
Published: October 2018

We present an X-ray study of the mixed-morphology supernova remnant CTB 1 (G116.9+0.2) observed with Suzaku. The 0.6–2.0 keV spectra in the northeastern breakout region of CTB 1 are well represented by a collisional ionization-equilibrium plasma model with an electron temperature of ∼0.3 keV, whereas those in the southwestern inner-shell region can be reproduced by a recombining plasma model with an electron temperature of ∼0.2 keV, an initial ionization temperature of ∼3 keV, and an ionization parameter of ∼9 × 1011 cm−3 s. This is the first detection of the recombining plasma in CTB 1. The electron temperature in the inner-shell region decreases outwards, which implies that the recombining plasma is likely formed by the thermal conduction via interaction with the surrounding cold interstellar medium. The Ne abundance is almost uniform in the observed regions whereas Fe is more abundant toward the southwest of the remnant, suggesting an asymmetric ejecta distribution. We also detect a hard tail above the 2-keV band that is fitted with a power-law function with a photon index of 2–3. The flux of the hard tail in the 2–10 keV band is ∼5 × 10−13 erg cm−2 s−1 and peaks at the center of CTB 1. Its origin is unclear but one possibility is a putative pulsar wind nebula associated with CTB 1.
Comparative Effectiveness of mHealth-Supported Exercise Compared With Exercise Alone for People With Parkinson Disease: Randomized Controlled Pilot Study
Authors: Ellis Terry D , Cavanaugh James T , DeAngelis Tamara , Hendron Kathryn , Thomas Cathi A , Saint-Hilaire Marie , Pencina Karol , Latham Nancy K
Published: October 2018

Background

Declining physical activity commonly occurs in people with Parkinson disease (PD) and contributes to reduced functional capacity and quality of life.

Objective

The purpose of this study was to explore the preliminary effectiveness, safety, and acceptability of a mobile health (mHealth)–mediated exercise program designed to promote sustained physical activity in people with PD.

Design

This was a 12-month single-blind (assessor), pilot, comparative-effectiveness, randomized controlled study.

Methods

An mHealth-mediated exercise program (walking with a pedometer plus engagement in planned exercise supported by a mobile health application) was compared over 1 year with an active control condition (walking with a pedometer and exercise only). There were 51 participants in a community setting with mild-to-moderately severe (Hoehn and Yahr stages 1–3) idiopathic PD. Daily steps and moderate-intensity minutes were measured using a step activity monitor for 1 week at baseline and again at 12 months. Secondary outcomes included the 6-Minute Walk Test, Parkinson Disease Questionnaire 39 mobility domain, safety, acceptability, and adherence.

Results

Both groups increased daily steps, moderate-intensity minutes, and 6-Minute Walk Test, with no statistically significant between-group differences observed. In the less active subgroup, changes in daily steps and moderate-intensity minutes were clinically meaningful. An improvement in the Parkinson Disease Questionnaire 39 mobility score favored mHealth in the overall comparison and was statistically and clinically meaningful in the less active subgroup.

Limitations

The limitation of the current study was the small sample size.

Conclusions

Both groups improved physical activity compared with expected activity decline over 1 year. The addition of the mHealth app to the exercise intervention appeared to differentially benefit the more sedentary participants. Further study in a larger group of people with low activity at baseline is needed.
A FULLY AUTOMATED SECONDARY STANDARD X-RAY CALIBRATION FACILITY FOR PERSONAL DOSEMETERS
Authors: Bandalo V , Brönner J , Greiter M B , Hoedlmoser H
Published: October 2018

The individual monitoring service at the Helmholtz Zentrum München has extended the calibration facilities provided at the Munich IAEA/WHO secondary standard dosimetry laboratory with a new fully automated X-ray calibration facility for the calibration of personal dosemeters according to the ISO 4037 standard series. This work describes the X-ray irradiation system and the automated dosemeter transport system as well as the measurements performed to characterize the photon fields and to ascertain conformity to the ISO standard. Standard uncertainties of the radiation quantities provided by the system are given together with a discussion of some of the problems that are encountered in fulfilling the requirements of a matched field according to the latest drafts of the ISO 4037-1 standard.
Noncoronary Cardiac Calcifications: Direct and Indirect Clinical Implications
Authors: Fairbanks Samuel , Lisanti Christopher J. , Grant David , Gore Rosco , Ahmadian Homayoun
Published: October 2018

Noncoronary cardiac calcifications often are seen on imaging, particularly on CT. These calcifications are characterized by their location in the heart. Intracavitary calcifications are found in chronic thrombus, myxoma, or papillary muscles, and these calcifications are distinguished by their typical location. Myocardial calcifications are commonly a sequela from prior myocardial infarction, but diffuse involvement may be due to metastatic calcification. Pericardial calcifications are commonly incidental; however, inspection of the heart for signs of constrictive pericarditis is essential. Valvular calcifications usually involve the aortic valve or the mitral annulus. Significant aortic valvular calcifications are associated commonly with aortic stenosis, whereas mitral annular calcifications are strongly associated with atrial fibrillation, and both of these types of calcifications are associated with higher risk of adverse cardiovascular events.
Evaluating the Validity of the DSM-5 Alcohol Use Disorder Diagnostic Criteria in a Sample of Treatment-seeking Native Americans
Authors: Serier Kelsey N. , Venner Kamilla L. , Sarafin Ruth E.
Published: October 2018

Objective:

Despite high rates of alcohol use disorder (AUD) and alcohol-induced deaths among Native Americans, there has been limited study of the construct validity of the AUD diagnostic criteria. The purpose of the current study was to examine the validity of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) AUD criteria in a treatment-seeking group of Native Americans.

Methods:

As part of a larger study, 79 Native Americans concerned about their alcohol or drug use were recruited from a substance use treatment agency located on a reservation in the southwestern United States. Participants were administered the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (SCID for DSM-IV-TR) reworded to assess 11 DSM-5 criteria for AUD. Confirmatory factor analysis (CFA) was used to test the validity of the AUD diagnostic criteria, and item response theory (IRT) was used to examine the item characteristics of the AUD diagnostic criteria in this Native American sample.

Results:

CFA indicated that a 1-factor model of the 11 items provided a good fit of the data. IRT parameter estimates suggested that “withdrawal,” “social/interpersonal problems,” and “activities given up to use” had the highest magnitude of discrimination. “Much time spent using” and “activities given up to use” were associated with the greatest severity.

Conclusions:

The current study provided support for the validity of the AUD DSM-5 criteria and a unidimensional latent construct of AUD in this sample of treatment-seeking Native Americans. IRT analyses replicate findings from previous studies. To our knowledge, this is the first study to examine the validity of the DSM-5 AUD criteria in a treatment-seeking sample of Native Americans. Continued research in other Native American samples is needed.
Nitrous Oxide Compared With Intravenous Sedation for Second-Trimester Abortion
Authors: Thaxton Lauren , Pitotti Jennifer , Espey Eve , Teal Stephanie , Sheeder Jeanelle , Singh Rameet H.
Published: October 2018

OBJECTIVE:

To assess whether inhaled nitrous oxide is noninferior to intravenous (IV) sedation for pain control during outpatient surgical abortion between 12 and 16 weeks of gestation.

METHODS:

We enrolled women undergoing surgical abortion at 12–16 weeks of gestation into a multisite, double-blind clinical trial. Participants were randomized to sedation with nitrous oxide (70% nitrous/30% oxygen) or IV fentanyl (100 micrograms) and midazolam (2 mg). Paracervical block was administered to both groups. The primary outcome measure was immediate postabortion recall of maximum pain on a 100-mm visual analog scale.

RESULTS:

Between August 2016 and March 2017, we assessed 170 women for eligibility and enrolled 39, 19 in the nitrous group and 20 in the IV sedation group. Seven participants in the nitrous group (36.8%) required conversion to IV sedation for inadequate pain control. No participants in the IV sedation group required additional medication. The proportion of women requiring additional pain control in the nitrous group exceeded our predefined stopping rule. Intention-to-treat analysis demonstrated that immediate postabortion visual analog scale pain scores were lower by 20.1 mm (95% CI 1.6–38.6) in women randomized to IV sedation than in women randomized to nitrous.

CONCLUSION:

Intravenous sedation is a better choice than inhaled nitrous oxide for pain control in second-trimester abortion.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02755090.
Torsemide for Prevention of Persistent Postpartum Hypertension in Women With Preeclampsia
Authors: Viteri Oscar A. , Alrais Mesk A. , Pedroza Claudia , Hutchinson Maria , Chauhan Suneet P. , Blackwell Sean C. , Sibai Baha M.
Published: October 2018

OBJECTIVE:

To evaluate whether torsemide reduces the rate of persistent postpartum hypertension in women with preeclampsia.

METHODS:

We conducted a randomized, double-blind, placebo-controlled trial of women with preeclampsia at a tertiary center from August 2016 to September 2017. Those with gestational hypertension or renal or cardiopulmonary failure were excluded. Within 24 hours of delivery, women were randomized one to one to oral torsemide, 20 mg/d, or placebo, for 5 days. Our primary outcome was blood pressure greater than or equal to 150 mm Hg systolic or 100 mm Hg diastolic (or both) on two occasions at least 4 hours apart by postpartum day 5 or by the time of hospital discharge. Assuming a 50% rate of persistent hypertension in women with preeclampsia, 118 participants were required to detect a 50% rate reduction. Analyses were by intention to treat.

RESULTS:

From August 2016 to September 2017, 118 women were randomized: 59 were allocated to torsemide and 59 to placebo. Overall, 43 (73%) women in the torsemide and 45 (76%) in the placebo group had either preeclampsia with severe features or preeclampsia superimposed on chronic hypertension. The rate of persistent postpartum hypertension was 44% in the torsemide and 58% in the placebo group (relative risk 0.76, 95% CI 0.5–1.1). No differences were seen in rate of hypertension 7–10 days or 6 weeks postpartum, severe hypertension, length of postpartum hospital stay, readmission for hypertension, or adverse events. There were no cases of severe composite morbidity or deaths.

CONCLUSION:

In this trial of women with preeclampsia, a 5-day course of postpartum torsemide did not have a significant effect on the rate of postpartum hypertension.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02813551.
Evaluating Delivery of Low Tidal Volume Ventilation in Six ICUs Using Electronic Health Record Data*
Authors: Sjoding Michael W. , Gong Michelle N. , Haas Carl F. , Iwashyna Theodore J.
Published: October 2018

Objectives:

Mechanical ventilation with low tidal volumes is recommended for all patients with acute respiratory distress syndrome and may be beneficial to other intubated patients, yet consistent implementation remains difficult to obtain. Using detailed electronic health record data, we examined patterns of tidal volume administration, the effect on clinical outcomes, and alternate metrics for evaluating low tidal volume compliance in clinical practice.

Design:

Observational cohort study.

Setting:

Six ICUs in a single hospital system.

Patients:

Adult patients who received invasive mechanical ventilation more than 12 hours.

Interventions:

None.

Measurements and Main Results:

Tidal volumes were analyzed across 1,905 hospitalizations. Although mean tidal volume was 6.8 mL/kg predicted body weight, 40% of patients were exposed to tidal volumes greater than 8 mL/kg predicted body weight, with 11% for more than 24 hours. At a patient level, exposure to 24 total hours of tidal volumes greater than 8 mL/kg predicted body weight was associated with increased mortality (odds ratio, 1.82; 95% CI, 1.20–2.78), whereas mean tidal volume exposure was not (odds ratio, 0.87/1 mL/kg increase; 95% CI, 0.74–1.02). Initial tidal volume settings strongly predicted exposure to volumes greater than 8 mL/kg for 24 hours; the adjusted rate was 21.5% when initial volumes were greater than 8 mL/kg predicted body weight and 7.1% when initial volumes were less than 8 mL/kg predicted body weight. Across ICUs, correlation of mean tidal volume with alternative measures of low tidal volume delivery ranged from 0.38 to 0.66.

Conclusions:

Despite low mean tidal volume in the cohort, a significant percentage of patients were exposed to a prolonged duration of high tidal volumes which was correlated with higher mortality. Detailed ventilator records in the electronic health record provide a unique window for evaluating low tidal volume delivery and targets for improvement.
Association Between Elevated Mean Arterial Blood Pressure and Neurologic Outcome After Resuscitation From Cardiac Arrest: Results From a Multicenter Prospective Cohort Study*
Authors: Roberts Brian W. , Kilgannon J. Hope , Hunter Benton R. , Puskarich Michael A. , Shea Lisa , Donnino Michael , Jones Christopher , Fuller Brian M. , Kline Jeffrey A. , Jones Alan E. , Shapiro Nathan I. , Abella Benjamin S. , Trzeciak Stephen
Published: October 2018

Objectives:

Laboratory studies suggest elevated blood pressure after resuscitation from cardiac arrest may be protective; however, clinical data are limited. We sought to test the hypothesis that elevated postresuscitation mean arterial blood pressure is associated with neurologic outcome.

Design:

Preplanned analysis of a prospective cohort study.

Setting:

Six academic hospitals in the United States.

Patients:

Adult, nontraumatic cardiac arrest patients treated with targeted temperature management after return of spontaneous circulation.

Interventions:

Mean arterial blood pressure was measured noninvasively after return of spontaneous circulation and every hour during the initial 6 hours after return of spontaneous circulation.

Measures and Main Results:

We calculated the mean arterial blood pressure and a priori dichotomized subjects into two groups: mean arterial blood pressure 70–90 and greater than 90 mm Hg. The primary outcome was good neurologic function, defined as a modified Rankin Scale less than or equal to 3. The modified Rankin Scale was prospectively determined at hospital discharge. Of the 269 patients included, 159 (59%) had a mean arterial blood pressure greater than 90 mm Hg. Good neurologic function at hospital discharge occurred in 30% of patients in the entire cohort and was significantly higher in patients with a mean arterial blood pressure greater than 90 mm Hg (42%) as compared with mean arterial blood pressure 70–90 mm Hg (15%) (absolute risk difference, 27%; 95% CI, 17–37%). In a multivariable Poisson regression model adjusting for potential confounders, mean arterial blood pressure greater than 90 mm Hg was associated with good neurologic function (adjusted relative risk, 2.46; 95% CI; 2.09–2.88). Over ascending ranges of mean arterial blood pressure, there was a dose-response increase in probability of good neurologic outcome, with mean arterial blood pressure greater than 110 mm Hg having the strongest association (adjusted relative risk, 2.97; 95% CI, 1.86–4.76).

Conclusions:

Elevated blood pressure during the initial 6 hours after resuscitation from cardiac arrest was independently associated with good neurologic function at hospital discharge. Further investigation is warranted to determine if targeting an elevated mean arterial blood pressure would improve neurologic outcome after cardiac arrest.
OCULAR HYPERTENSION AFTER INTRAVITREAL INJECTION OF 2-MG TRIAMCINOLONE
Authors: Storey Philip P. , Obeid Anthony , Pancholy Maitri , Goodman Jake , Borkar Durga , Su Daniel , Regillo Carl
Published: October 2018

Purpose:

To report the incidence and course of ocular hypertension after intravitreal injection of 2-mg triamcinolone acetonide (IVT).

Methods:

In a retrospective, consecutive series, all patients receiving 2-mg IVT at a single institution between March 1, 2012, and March 1, 2017, with a minimum of 3-month follow-up were reviewed. Ocular hypertension was defined as an intraocular pressure (IOP) measurement over 24 mmHg at any follow-up visit after IVT. Patients receiving topical, periocular, or intravitreal corticosteroid other than 2-mg IVT were excluded.

Results:

A total of 106 eyes in 100 patients receiving at least one injection of 2-mg IVT were included. Eyes received an average of 2.9 injections (range 1–17), and average patient follow-up was 15.1 months (range 3.0–52.5 months). A total of 14 eyes (13.2%) in 14 patients developed ocular hypertension after a median of 1.5 injections (range 1–9) with an average peak IOP of 29 mmHg (range 25–38 mmHg). Overall, a total of 11 eyes (10.4%) had an IOP elevation ≥10 mmHg above baseline at any point after first IVT. In all cases of ocular hypertension, IOP was successfully managed with observation or topical IOP-lowering medication alone; no patients required surgical intervention.

Conclusion:

Ocular hypertension developed in 13.2% of eyes receiving intravitreal injection of 2-mg triamcinolone acetonide. Incidence of ocular hypertension after 2-mg IVT compares favorably with other intravitreally administered corticosteroids.
IDIOPATHIC FULL-THICKNESS MACULAR HOLE IN AN 8-YEAR-OLD BOY
Authors: Manayath George J. , Jain Arvind , Ranjan Ratnesh , Naik Adarsh S. , Narendran Vekatapathy
Published: October 2018

Purpose:

To report a case of idiopathic full-thickness macular hole in a young boy, which was managed surgically with good visual and anatomical outcomes.

Method:

Single case report.

Results:

An 8-year-old boy presented for defective vision in the left eye noticed for the past 2 weeks with best-corrected visual acuity of 6/24. A large full-thickness macular hole was diagnosed clinically and was confirmed on optical coherence tomography. There was no clinical or tomographic findings suggestive of trauma or retinal degeneration. After observation for 8 weeks, the patient underwent macular hole surgery in the left eye including internal limiting membrane peeling and C3F8 gas tamponade. Intraoperatively abnormally tight vitreoretinal adherence was noted during the induction of posterior vitreous detachment. Optical coherence tomography at 1 month after surgery showed decrease in the size of macular hole suggestive of incomplete closure. Repeat optical coherence tomography at 3 months showed closed macular hole with mild foveal thinning and ellipsoid zone discontinuity with best-corrected visual acuity improving to 6/18. The tomographic features and best-corrected visual acuity remained stable at 6-month follow-up.

Conclusion:

We hereby report the first case, to the best of our knowledge, of a truly idiopathic full-thickness macular hole in an 8-year-old boy. Surgical treatment offers the best outcomes in these cases and should be considered at the earliest without waiting for spontaneous closure unlike in the case of traumatic full-thickness macular hole.
Detection of Lipid Mediators of Inflammation in the Human Tear Film
Authors: Panthi Shyam , Chen Jianzhong , Wilson Landon , Nichols Jason J.
Published: October 2018

Purpose:

Lipid mediators of inflammation are a group of signaling molecules produced by various cells under physiological conditions and modulate the inflammatory process during various pathologic conditions. Although eicosanoids and F2-isoprostanes are recognized lipid mediators of inflammation, there is no consensus yet on the extraction and mass spectrometry (MS) method for their analysis in individual human tear samples. Thus, the aim of this study was to develop an optimal method for extraction of lipid mediators of inflammation in the tear film and evaluate MS techniques for their analysis.

Methods:

Basal tears were collected from each eye of 19 subjects using glass microcapillaries. Lipid extraction was performed using either varying concentrations of acidified methanol, a modified Folch method, or solid-phase extraction. Initially, an untargeted analysis of the extracts was performed using SCIEX TripleTOF 5600 mass spectrometer to identify any lipid mediators of inflammation (eicosanoids) and later a targeted analysis was performed using the SCIEX 6500 Qtrap to identify and quantify prostaglandins and isoprostanes. Mass spectra and chromatograms were analyzed using Peakview, XCMS, and Multiquant software.

Results:

Prostaglandins and isoprostanes were observed and quantified using the Qtrap mass spectrometer under multiple reaction monitoring (MRM) mode after solid-phase extraction. Extraction with acidified methanol along with the Folch method produced cleaner spectra during MS with the Triple time of flight (TOF) mass spectrometer. Lipid mediators of inflammation were not observed in any of the tear samples using the Triple TOF mass spectrometer.

Conclusions:

Solid-phase extraction may be the method of choice for extraction of prostaglandins and isoprostanes in low volumes of tears. The SCIEX Qtrap 6500 in MRM mode may be suitable to identify and quantify similar lipid mediators of inflammation.
Methylenedioxymethamphetamine (MDMA) in Psychiatry
Authors: Schenk Susan , Newcombe David
Published: October 2018

Background

For a number of mental health disorders, including posttraumatic stress disorders (PTSD), there are not many available treatment options. Recently, there has been renewed interest in the potential of methylenedioxymethamphetamine (MDMA) to restore function for patients with these disorders. The primary hypothesis is that MDMA, via prosocial effects, increases the ability of patients to address the underlying psychopathology of the disorder. However, the use of MDMA poses potential problems of neurotoxicity, in addition to its own potential for misuse.

Methods

In this article, the proposed potential of MDMA as an adjunct to psychotherapy for PTSD is evaluated. The rationale for the use of MDMA and the positive results of studies that have administered MDMA in the treatment of PTSD are provided (pros). A description of potential adverse effects of treatment is also presented (cons). An overview of MDMA pharmacology and pharmacokinetics and a description of potential adverse effects of treatments are also presented. Methylenedioxymethamphetamine-produced oxytocin release and decreased expression of fear conditioning as well as one of the MDMA enantiomers (the n R− entaniomer) are suggested as potential mechanisms for the beneficial effects of MDMA in PTSD (suggestions).

Results

There is some evidence that MDMA facilitates recovery of PTSD. However, the significant adverse effects of MDMA raise concern for its adoption as a pharmacotherapy. Alternative potential treatments with less adverse effects and that are based on the ubiquitous pharmacology of MDMA are presented.

Conclusions

We suggest that additional research investigating the basis for the putative beneficial effects of MDMA might reveal an effective treatment with fewer adverse effects. Suggestions of alternative treatments based on the behavioral pharmacology and toxicology of MDMA and its enantiomers are presented.