bluuebunny/crossref_metadata_2025 huggingface dataset:
25. International humanitarian law
Authors: Sivakumaran Sandesh
Published: August 2018

This chapter examines international humanitarian law, the principal body of international law which applies in times of armed conflict, and which seeks to balance the violence inherent in an armed conflict with the dictates of humanity. International humanitarian law protects the civilian population from the ravages of conflict, and establishes limitations on the means and methods of combat. The chapter is organized as follows. Section 2 considers the nature of international humanitarian law and identifies some of its cardinal principles and key rules. Section 3 explores the similarities and differences between international humanitarian law and international human rights law, comparing and contrasting their historical origins and conceptual approaches. Given that international humanitarian law applies during armed conflict, Section 4 considers whether there is a need for international human rights law also to apply. Section 5 ascertains the relationship between the two bodies of law and Section 6 considers some of the difficulties with the application of international human rights law in time of armed conflict.
29. Terrorism
Authors: Scheinin Martin
Published: August 2018

This chapter first addresses the question of whether terrorism constitutes a violation of human rights, or whether the notion of human rights violations can only be applied to action by states, and then considers challenges to the applicability of human rights law in the fight against terrorism, particularly since 9/11. It focuses on the notion of terrorism, and in particular the risks posed to human rights protection by vague or over-inclusive definitions of terrorism. The main section of the chapter deals with some of the major challenges posed by counter-terrorism measures to substantive human rights protections. It is argued that the unprecedented post-9/11 wave of counter-terrorism laws and measures that infringed upon human rights was a unique situation, and that governments and intergovernmental organizations are realizing that full compliance with human rights in the fight against terrorism is not only morally and legally correct but is also the most effective way of combating terrorism in the long term.
4. The Theory and Reality of the Sources of International Law
Authors: Roberts Anthea , Sivakumaran Sandesh
Published: August 2018

The classic starting point for identifying the sources of international law is Article 38 of the ICJ Statute, which refers to three sources: treaties, customary international law, and general principles of law; as well as two subsidiary means for determining rules of law, namely judicial decisions and the teachings of publicists. However, Article 38 does not adequately reflect how the doctrine of sources operates in practice because it omits important sources of international law while misrepresenting the nature and weight of others. To appreciate how sources operate in practice, international lawyers need to understand how international law is created through a dialogue among States, State-empowered entities, and non-State actors. States are important actors in this process, but they are not the only actors. It is only by understanding this process of dialogue that one can develop a full understanding of the theory —and reality—of the sources of international law.
21. The Law of the Sea
Authors: Evans Malcolm D
Published: August 2018

This chapter explores how international law has responded to the increasing complexity of the uses of maritime space, focusing particularly on recent trends and developments. It considers the nature of the sovereign rights which States exercise over both space and living and non-living resources, and the extent to which control may be exercised over other users of the seas. It provides an introduction to the basic rules concerning the principal zones of maritime jurisdiction and looks at the rules for the construction of baselines and the problem of determining boundaries where claims to zones overlap. It also considers trends in governance over fisheries and over the deep seabed. While the law of the sea has undergone a remarkable transformation in the last 50 years, much more needs to be done to balance the competing demands of access to ocean space whilst recognizing the need to preserve order and good governance.
Constitutional Law, Administrative Law, and Human Rights
Authors: Loveland Ian
Published: August 2018

Constitutional Law, Administrative Law, and Human Rights provides an in-depth cross disciplinary introduction to the subject of public law, covering the core elements of a constitutional and administrative law syllabus. In addition, it explores the latest ongoing debates around potential constitutional reforms. The book draws heavily on historical sources and on ideas from political science and political theory aswell as legal and social history. It also includes detailed coverage of the UK’s proposed departure from the European Union after the 2016 referendum and the subsequent Miller litigation aswell as the on-going negotiations on terms of departure. It looks at the polarised positions of ‘soft brexit’ and ‘hard brexit’ and examines what brexit might actually mean for the United Kingdom.
20. Human Rights IV: The Human Rights Act 1998
Authors: Loveland Ian
Published: August 2018

This chapter discusses the main provisions of the Human Rights Act 1998 (HRA) and considers its implications for the understandings attached to the core constitutional principles of parliamentary sovereignty, the rule of law, and the separation of power. It argues that the Blair government’s rapid and determined efforts to convince Parliament to pass the HRA demonstrates that members of the first New Labour administration did not share the simplistic view of democracy embraced by the Conservative Party during the judicial supremacism episode. The 1998 Act may be criticised on the basis that it transfers a dangerous amount of political power from the government to the judges, but the sentiments evinced by many Conservative MPs on this issue had little to commend them from a constitutional perspective.
International Human Rights Law
Authors: Smith Rhona K. M.
Published: August 2018

International Human Rights Law provides a concise introduction for students new to the subject. Clearly written and broad in scope, this popular text gives a concise introduction to international human rights, including regional systems of protection and the key substantive rights. The author skillfully guides you through the complexities of the subject, making it accessible to those with little or no prior legal and/or international knowledge. Key cases and areas of debate are highlighted throughout, and a wealth of references to cases and further readings are provided at the end of each chapter. The book continues to be relied upon by students worldwide as the first book to turn to for clear and accurate coverage. It discusses the United Nations; the International Bill of Human Rights; the United Nations’ organizational structure; regional protection of human rights; Europe; the Americas; Africa; monitoring, implementing, and enforcing human rights; substantive rights; equality and non-discrimination; the right to life; freedom from torture; cruel, inhuman, and degrading treatment or punishment; the rights to liberty of person; equality before the law; the right to a fair trial; the right to self-determination; freedom of expression; the right to work; the right to education and human rights education; minority rights; and group rights.
11. Statutory shareholder remedies
Authors: Dignam Alan , Lowry John
Published: August 2018

Titles in the Core Text series take the reader straight to the heart of the subject, providing focused, concise, and reliable guides for students at all levels. This chapter deals with statutory remedies available to aggrieved minority shareholders, particularly their right to seek relief through a winding-up order on the just and equitable ground. It first considers the classic case of Ebrahimi v Westbourne Galleries Ltd (1973), which addressed the scope of the court’s jurisdiction under the just and equitable ground, and presents illustrations of the grounds which will support a petition under s 122(1)(g) of the Insolvency Act 1986. It also examines the issue of whether the principles promulgated in Ebrahimi extend beyond the statutory context of just and equitable winding-up by focusing on the case of Clemens v Clemens Bros Ltd (1976). In addition, the chapter gives examples of unfair prejudice; explains locus standi and procedural aspects of s 994 of the Companies Act 2006; and looks at other specific statutory rights available to aggrieved minority shareholders. Finally, it explains the Law Commission’s proposed reforms for the unfair prejudice provision.
Article 101(1)
Authors: Whish Richard , Bailey David
Published: August 2018

This chapter discusses Article 101(1) of the Treaty on the Functioning of the European Union (TFEU), which prohibits agreements, decisions by associations of undertakings and concerted practices that restrict competition. It begins by explaining the terms ‘undertakings’ and ‘associations of undertakings’. It then considers what is meant by the terms ‘agreements’, ‘decisions’ and ‘concerted practices’, as well as what is meant by the phrase ‘prevention, restriction and distortion of competition’ that serves as the purpose of the provision. The chapter then deals with the de minimis doctrine, before explaining the requirement of an effect on trade between Member States. The chapter concludes with a checklist of agreements that, for a variety of reasons, normally fall outside Article 101(1).
Competition Act 1998 and the cartel offence: public enforcement and procedure
Authors: Whish Richard , Bailey David
Published: August 2018

This chapter describes the system of public enforcement under the Competition Act 1998. Reinforced by the Enterprise Act 2002 and Enterprise Regulatory Reform Act 2013, the Competition Act provides a set of procedural rules of investigation for the enforcement of the Chapter I and II prohibitions. After a section on complaints, it considers the extent to which it may be possible to receive guidance from the Competition and Markets Authority (‘the CMA’) on the application of the Act. It then deals in turn with enforcement of the Competition Act 1998, the criminal cartel offence and company director disqualification. This is followed by an overview of the concurrency provisions, stating that the CMA works hand-in-hand with the sectoral regulators. The final two sections discuss the appeal mechanism under the Competition Act and the possibility of Article 267 references to the Court of Justice.
Searching for the lost Unicorn: a prominent feature in the radial velocity distribution of stars in Vela from Gaia DR2 data
Authors: de la Fuente Marcos R , de la Fuente Marcos C
Published: August 2018

Stellar streams are ubiquitous in the Galactic halo and they can be used to improve our understanding of the formation and evolution of the Milky Way as a whole. The so-called Monoceros Ring might have been the result of satellite accretion. Guglielmo et al. have used N-body simulations to search for the progenitor of this structure. Their analysis shows that, if the Ring has a dwarf galaxy progenitor, it might be found in the background of one out of eight specific areas in the sky. Here, we use Gaia DR2 data to perform a systematic exploration aimed at confirming or rejecting this remarkable prediction. Focusing on the values of the radial velocity to uncover possible multimodal spreads, we identify a bimodal Gaussian distribution towards Galactic coordinates (l, b) = (271°, +2°) in Vela, which is one of the locations of the progenitor proposed by Guglielmo et al. This prominent feature with central values 60 ± 7  and 97 ± 10 km s−1, may signal the presence of the long sought progenitor of the Monoceros Ring, but the data might also be compatible with the existence of an unrelated, previously unknown, kinematically coherent structure.
Sternocleidomastoid Encephalomyosynangiosis for Treatment-Resistant Moyamoya Disease
Authors: Chiarelli Peter A , Patel Anoop P , Lee Amy , Chandra Srinivasa R , Sekhar Laligam N
Published: August 2018

BACKGROUND AND IMPORTANCE

Refractory ischemic symptoms in moyamoya disease are a challenging problem, particularly in situations in which multiple direct and indirect revascularization techniques have already been employed. In addition, revascularization of the parietal lobes is difficult, as this area is a watershed between the middle cerebral artery and posterior cerebral artery distributions.

CLINICAL PRESENTATION

This is the case of a 50-yr-old woman with hemibody sensorimotor deficits, who had previously undergone bilateral arterial bypass and temporalis myosynangiosis. A method for indirect surgical cerebral revascularization is described, utilizing a rotated and tunneled sternocleidomastoid flap. The perfused muscle is approximated to the cortical surface, with adjacent sulci dissected to expose the underlying vasculature. After sternocleidomastoid encephalomyosynangiosis, the patient experienced symptomatic improvement, along with the appearance of new pial collateral vasculature on diagnostic cerebral angiography. Pre- and postoperative dynamic perfusion computed tomography with acetazolamide challenge demonstrate an increase in cerebral blood flow and decrease in mean transit time, as well as improved cerebrovascular reserve.

CONCLUSION

Sternocleidomastoid encephalomyosynangiosis using a tunneled muscle flap is a useful method for revascularization of the parietal and occipital lobes, particularly for refractory moyamoya in cases where a variety of other options have been exhausted.
Resection of a Lumbar Intradural Extramedullary Schwannoma: 3-Dimensional Operative Video
Authors: Dekker Simone E , Glenn Chad A , Ostergard Thomas A , Smith Mickey L , Rothstein Brian D , Ray Abhishek , Bambakidis Nicholas C
Published: August 2018

This 3-dimensional operative video illustrates resection of a lumbar schwannoma in a 57-yr-old female who presented with right lower extremity numbness, paresthesias, as well as a long history of lower back pain with rest. On magnetic resonance imaging (MRI), there was evidence of an intradural extramedullary enhancing lesion at L5, nearly completely encompassing the spinal canal. This video demonstrates the natural history, treatment options, surgical procedure, risks, and complications of treatment of these types of tumors. The patient underwent a posterior lumbar laminectomy with a midline dural opening for tumor resection. The tumor was encountered intradurally and electromyography recording confirmed that the tumor arose from a lumbar sensory nerve root. The sensory root was then divided and the tumor was then removed. The mass was removed en bloc and histopathologic analysis was consistent with a schwannoma. Postoperative MRI demonstrated gross total resection of the patient's neoplasm with excellent decompression of the spinal cord. The patient had an uneventful postoperative course with full recovery and complete resolution of her back pain and leg paresthesias.
Right Pretemporal-Transsylvian Approach for Resection of a Midbrain Cavernous Malformation: 3-Dimensional Operative Video
Authors: Mascitelli Justin R , Gandhi Sirin , Cavallo Claudio , Nanaszko Michael J , Wright Ernest J , Lawton Michael T
Published: August 2018

Brainstem cavernous malformations (CMs) account for 15% to 18% of all intracranial CMs
1
and 13% of all cerebrovascular pathology in the posterior fossa.
1,2
This video demonstrates the resection of a pontomesencephalic CM through a pretemporal approach through the oculomotor-tentorial triangle (OTT).
3
A 49-yr-old woman presented with an acute onset of left hemiparesis, diplopia, vertigo, partial oculomotor, and facial palsy. Neuroimaging revealed a 25-mm diameter right pontomesencephalic CM with evidence of prior hemorrhage. Institutional Review Board approval and patient consent were obtained for surgery. A right orbitozygomatic craniotomy was performed, and the lesion was exposed through a pretemporal-transsylvian approach. After a wide Sylvian fissure split, the oculomotor nerve (CN III) was dissected away from the temporal lobe, and the temporal lobe was mobilized posteriorly to access the OTT. The posterior cerebral and superior cerebellar arteries were visualized in this triangle, and the cerebral peduncle and the CM were accessed deep to these arteries. After hematoma evacuation, the CM was resected in a piece-meal fashion using an intracapsular technique. Postoperative imaging confirmed the gross total resection of the lesion. The patient had persistent right CN III palsy and a slight worsening of left hemiparesis, which had resolved completely at the 6-mo follow-up. The OTT provides access to the upper ventrolateral pontomesencephalic area.
3
This triangular surgical workspace is entered through a pretemporal-transsylvian corridor and widened with posterior temporal lobe retraction. The OTT is an important working space for accessing midbrain and upper pontine CMs posterolateral to CN III.
Associations Between Physical Therapy Continuity of Care and Health Care Utilization and Costs in Patients With Low Back Pain: A Retrospective Cohort Study
Authors: Magel John , Kim Jaewhan , Thackeray Anne , Hawley Charles , Petersen Sterling , Fritz Julie M
Published: August 2018

Background

Patients who consult a physical therapist for low back pain (LBP) may receive initial and subsequent management from different therapists. The impact that physical therapy provider continuity has on health care use in patients with LBP is insufficiently studied.

Objective

The objective of this study was to examine the impact of continuity of the physical therapy provider on health care use and costs in patients with LBP referred from primary care.

Design

The study design included a retrospective analysis of claims data.

Methods

Data from an all-payer claims database were examined. Logistic regression was used to evaluate the association between physical therapy provider continuity and health care use during the 1-year period following a visit with a primary care provider for LBP.

Results

Patients who experienced greater physical therapy provider continuity had a decreased likelihood of receiving lumbar surgery. They also paid less (mean = ${\$}$1737 [95% confidence interval, ${\$}$1602–${\$}$1871]) than those who experienced less physical therapy provider continuity (mean = ${\$}$2577 [95% confidence interval, ${\$}$2008–${\$}$3145]).

Limitations

The degree of causality between any predictor and outcome variables cannot be determined due to the observational nature of the study.

Conclusions

Greater continuity of the physical therapy provider appears to be associated with a decreased likelihood of surgical treatment for LBP and lower health care costs related to LBP.
Extended McKay correspondence for quotient surface singularities
Authors: Ishii Akira , Nakamura Iku
Published: August 2018

Let G be a finite subgroup of GL(2) acting on A2/{0} freely. The G-orbit Hilbert scheme G-Hilb(A2) is a minimal resolution of the quotient A2/G as given by A. Ishii, On the McKay correspondence for a finite small subgroup of GL(2,C), J. Reine Angew. Math. 549 (2002), 221–233. We determine the generator sheaf of the ideal defining the universal G-cluster over G-Hilb(A2), which somewhat strengthens a version [10] of the well-known McKay correspondence for a finite subgroup of SL(2).
Polyhedrality and Decomposition
Authors: Abrahamsen Trond A , Fonf Vladimir P , Smith Richard J , Troyanski Stanimir
Published: August 2018

The aim of this note is to present two results that make the task of finding equivalent polyhedral norms on certain Banach spaces, having either a Schauder basis or an uncountable unconditional basis, easier and more transparent. The hypotheses of both results are based on decomposing the unit sphere of a Banach space into countably many pieces, such that each one satisfies certain properties. Some examples of spaces having equivalent polyhedral norms are given.
Secretome Analysis and In Planta Expression of Salivary Proteins Identify Candidate Effectors from the Brown Planthopper Nilaparvata lugens
Authors: Rao Weiwei , Zheng Xiaohong , Liu Bingfang , Guo Qin , Guo Jianping , Wu Yan , Shangguan Xinxin , Wang Huiying , Wu Di , Wang Zhizheng , Hu Liang , Xu Chunxue , Jiang Weihua , Huang Jin , Shi Shaojie , He Guangcun
Published: August 2018

The brown planthopper (BPH), Nilaparvata lugens (Stål), is a phloem sap-feeding insect. During feeding on rice plants, BPH secretes salivary proteins with potential effector functions, which may play a critical role in the plant–insect interactions. However, a limited number of BPH effector proteins have been identified to date. Here, we sequenced the salivary gland transcriptomes of five BPH populations and subsequently established a N. lugens secretome consisting of 1,140 protein-encoding genes. Secretome analysis revealed the presence of both conserved and rapidly evolving salivary proteins. A screen for potential effectors that elicit responses in the plant was performed via the transient expression analysis of 64 BPH salivary proteins in Nicotiana benthamiana leaves and rice protoplasts. The salivary proteins Nl12, Nl16, Nl28, and Nl43 induced cell death, whereas Nl40 induced chlorosis and Nl32 induced a dwarf phenotype in N. benthamiana, indicating effector properties of these proteins. Ectopic expression of the six salivary proteins in N. benthamiana upregulated expression of defense-related genes and callose deposition. Tissue expression analysis showed a higher expression level of the six candidate effectors in salivary glands than in other tissues. Subcellular localization and analysis of the domain required for cell death showed a diverse structure of the six effectors. Nl28, Nl40, and Nl43 are N. lugens specific; in contrast, Nl12, Nl16, and Nl32 are conserved among insects. The Nl40 family has numerous isoforms produced by alternative splicing, exemplifying rapid evolution and expansion of effector proteins in the BPH. Our results suggest a potential large effector repertoire in BPH and a higher level of effector conservation exist in BPH compared with that in plant pathogens.
Congress2017 poster winners
Authors: Hampton Michelle M. , Harfield Charolette , Maurer-Swan Ellen L.
Published: August 2018

The following articles represent the first-place and runner-up winners from the NMCongress2017 poster contest. Both posters were presented and recognized at last year's conference. Congratulations to our winners!
Assessment of internet sources on subungual melanoma
Authors: Kang Rachel , Lipner Shari
Published: August 2018

In this study, we sought to objectively determine the accuracy and comprehensibility of online material with regard to subungual melanoma, a nail disease that is rare within the general population, yet has high incidence in certain patient groups, and carries a poorer prognosis than other forms of cutaneous melanoma. Because improved prognosis relies on early diagnosis, the dissemination of accurate, understandable information is an important factor in patient education and health. Using a pro forma designed to score website reliability, the accountability, quality, readability, display, support features, and transparency of the most commonly listed search engine hits related to subungual melanoma were analyzed. A total of 27 websites were assessed, with a mean overall score of 16.1 out of a maximum of 40 (range: 7–25). Accountability (mean: 3.4/10, range: 0–9) and quality (mean: 4/10, range: 0–9) varied among websites, while readability was poor overall, with only 22% of websites meeting the accepted seventh grade reading level for online health material. In addition, commonly visited websites for health information, including Wikipedia.org and Medscape.com, scored low in readability. Notably, the American Academy of Dermatology website was not listed under any search engine results for subungual melanoma. Our study demonstrates the variability in online materials with regard to subungual melanoma, stressing the importance of scrutinizing internet resources for accuracy and readability when presenting health material.
A concurrent pictorial drug choice task marks multiple risk factors in treatment-engaged smokers and drinkers
Authors: Hardy Lorna , Parker Steph , Hartley Lucie , Hogarth Lee
Published: August 2018

Concurrent choice tasks, where participants choose between a drug versus natural reward, predict dependence vulnerability in animals and humans. However, the sensitivity of concurrent choice tasks to multiple risk factors in treatment-engaged drug users has not been comprehensively tested. In experiment 1, 33 recently hospitalized smokers who were engaged with the smoking cessation service made forced choices between enlarging pictures of people smoking versus not smoking. In experiment 2, 48 drinkers who were engaged in an outpatient alcohol treatment service made forced choices between enlarging pictures of alcohol versus food. In these experiments, percent drug picture choice was significantly associated with dependence severity, craving, self-reported reasons for drug use (negative coping and cued craving), depression, anxiety, withdrawal intolerance, drug use frequency prior to treatment, and current abstinence status (coefficients ranged fromr=0.39 to 0.66). The concurrent pictorial drug choice task is sensitive to multiple risk factors in clinical, treatment-engaged drug users, and may be used to identify individuals requiring more support, to test experimental treatment manipulations, and to translate to animal concurrent self-administration procedures.
Self-reported Balance Disturbance and Performance-Based Balance Impairment After Concussion in the General Population
Authors: Inness Elizabeth L. , Sweeny Michelle , Habib Perez Olinda , Danells Cynthia , Chandra Tharshini , Foster Evan , Saverino Cristina , Comper Paul , Bayley Mark , Mochizuki George
Published: August 2018

Objective:

To characterize the prevalence of, and relationship between, self-reported balance disturbance and performance-based balance impairment in the general population with concussion.

Setting:

Rehabilitation hospital outpatient concussion clinic.

Participants:

One hundred six individuals with concussion (49 males, mean age = 32.4; SD = 11.5 years), mean (SD) = 5 (1.8) days postinjury.

Design:

Cross-sectional observational study.

Main Measures:

SCAT3 Symptoms Subscale, Balance Error Scoring System, modified Balance Error Scoring System, and center-of-pressure root-mean-square amplitude and velocity in eyes open and closed conditions.

Results:

The majority of participants reported balance or dizziness symptoms (54% and 63%, respectively) and demonstrated balance impairment on the Balance Error Scoring System and modified Balance Error Scoring System (66% and 58%, respectively). The prevalence of balance impairment across center-of-pressure measures varied from 32% to 48%. There was no effect of balance or dizziness symptom severity on any of the balance measures (F
2,103 = 1.02; P = .44) and (F
2,103 = 1.45; P = .10), respectively. There was poor agreement between self-report of balance/dizziness symptoms and identified balance impairment across all balance measures (all κ ≤ 0.26 and κ ≤ 0.20, respectively).

Conclusions:

There was no clear relationship between the subjective experience of balance disturbance and objective measures of balance impairment in the general population. These results have implications for clinical evaluation of postconcussive deficits and determination of recovery.
Late-Onset Microsporidial Keratitis in Femtosecond Astigmatic Keratotomy After Laser-Assisted Phacoemulsification
Authors: Grillo Lola M. , Epstein Ilan J. , Donnenfeld Eric D. , Perry Henry D.
Published: August 2018

Purpose:

To present a case of microsporidial keratitis in a femtosecond laser–created astigmatic keratotomy (AK) incision.

Methods:

Case report.

Results:

A 65-year-old Middle Eastern man presented 2 months after uncomplicated femtosecond laser–assisted cataract surgery (FLACS) and AK with mildly decreased vision and corneal edema in the operative eye. Shortly after treatment with topical corticosteroids, a fulminant corneal infiltrate manifested along the temporal arcuate incision. Multiple corneal scrapings sent for laboratory analysis were inconclusive. Two weeks after the initial presentation, a deep tissue sample was obtained using a 27-gauge cannula passed within the arcuate incision. The gram stain was directly observed, revealing intracellular microsporidial spores. The patient was treated with oral albendazole 400 mg once daily over 2 weeks and topical voriconazole 1% and fumagillin 3 mg/mL eye drops over 10 weeks. During this course, visual function steadily recovered as the infiltrate coalesced and ocular inflammation subsided.

Conclusions:

This is the first reported case of microsporidial keratitis presenting as a late-onset infection after femtosecond laser–assisted AK.
Visualization of the Lamina Cribrosa Microvasculature in Normal and Glaucomatous Eyes: A Swept-source Optical Coherence Tomography Angiography Study
Authors: Numa Shogo , Akagi Tadamichi , Uji Akihito , Suda Kenji , Nakanishi Hideo , Kameda Takanori , Ikeda Hanako Ohashi , Tsujikawa Akitaka
Published: August 2018

Purpose:

The purpose of this study was to investigate the lamina cribrosa (LC) microvasculature using swept-source optical coherence tomography angiography (OCTA) images that have been processed using multiple image averaging and a projection-resolved algorithm. OCTA has recently gained popularity for assessing retinal and choroidal microvasculature. However, it is not known if the LC microvasculature, which likely holds important information for further understanding of glaucoma, can be visualized with OCTA.

Methods:

One normal subject and 1 glaucomatous subject were enrolled and optic disc 3×3 mm swept-source OCTA cubic images were obtained for each subject. Anterior LC slab frames were developed, and the averaged images were created using 3 frames. Images were examined both with and without removal of projection artifacts.

Results:

The OCTA images of anterior LC slabs before projection artifact removal contained information on superficial and deep layer vessel blood flow. However, after projection artifact removal, fewer blood flow signals remained. These en face OCTA images showed flow signals on or immediately adjacent to lamina beams, but not inside lamina pores. The glaucomatous eye had a sectoral reduction in LC microvasculature blood flow that was not detected in normal eye.

Conclusions:

This is the first demonstration of imaging of the inner LC microvasculature, which, in agreement with previous histologic reports, was arranged in a polygonal pattern. Furthermore, glaucomatous eye had decreased flow signals in comparison with normal eye. Therefore, future imaging studies with OCTA may be helpful for identifying and better understanding LC pathologic changes associated with glaucoma.
A Case of Glaucoma in Hereditary Spherocytosis
Authors: Chen Haiying , Symons Robert C.A. , Mayson Eleni , Skalicky Simon E.
Published: August 2018

Purpose:

To report a case of glaucoma and the inherited red cell membranopathy hereditary spherocytosis diagnosed simultaneously in 2 individuals in a family.

Patient:

A 66-year-old man with normal pressure glaucoma and hereditary spherocytosis.

Results:

This patient presented with a branch retinal vein occlusion, and normal tension glaucoma that was incidentally detected. Further history revealed that the patient’s maternal grandmother also had hereditary spherocytosis and glaucoma.

Conclusions:

We hypothesize that glaucoma and hereditary spherocytosis may be associated. Hereditary spherocytosis may be a potential risk factor for glaucoma by causing impaired blood supply to the optic nerve.
The Risk of Serious Bacterial Infection in Febrile Infants 0–90 Days of Life With a Respiratory Viral Infection
Authors: Nicholson Erin G. , Avadhanula Vasanthi , Ferlic-Stark Laura , Patel Kirtida , Gincoo Karen E. , Piedra Pedro A.
Published: August 2018

Background:

Molecular diagnostic methods enhance the sensitivity and broaden the spectrum of detectable respiratory viruses in febrile infants ≤90 days of life. We describe the occurrence of respiratory viruses in this population, as well as the rates of serious bacterial infection (SBI) and respiratory viral coinfection with regard to viral characteristics.

Methods:

This was a prospective observational cohort study performed in the emergency department that included previously healthy febrile infants ≤90 days of life. Clinical and historical characteristics were documented, and a respiratory nasal wash specimen was obtained from each patient. This sample was tested for 17 common respiratory pathogens, and a chart review was conducted to ascertain whether the infant was diagnosed with an SBI.

Results:

In a 12-month period, 67% of the 104 recruited febrile infants were positive for a respiratory virus. The most commonly detected viruses were rhinovirus, respiratory syncytial virus, enterovirus and influenza. The rate of respiratory viral and SBI coinfection was 9% overall, and infants with either a systemic respiratory virus or negative viral testing were 3 times more likely to have an SBI than those with viruses typically restricted to the respiratory mucosa (95% confidence interval: 1.1, 9.7).

Conclusions:

Respiratory viruses are readily detectable via nasopharyngeal wash in febrile infants ≤90 days of life. With the enhanced sensitivity of molecular respiratory diagnostics, rates of coinfection of respiratory viruses and SBI may be higher than previously thought. Further investigation utilizing molecular diagnostics is needed to guide usage in febrile infants ≤90 days.
A Multi-Centered Case-Case-Control Study of Factors Associated With Klebsiella pneumoniae Carbapenemase-Producing Enterobacteriaceae Infections in Children and Young Adults
Authors: Logan Latania K. , Nguyen David C. , Scaggs Huang Felicia A. , Qureshi Nadia K. , Charnot-Katsikas Angella , Bartlett Allison H. , Zheng Xiaotian , Hujer Andrea M. , Domitrovic T. Nicholas , Marshall Steven H. , Bonomo Robert A. , Weinstein Robert A.
Published: August 2018

Background:

Klebsiella pneumoniae carbapenemase (KPC)–producing Enterobacteriaceae (KPC-CRE) are multidrug-resistant organisms causing morbidity and mortality worldwide. KPC-CRE prevalence is increasing in pediatric populations, though multi-centered data are lacking. Identifying risk factors for KPC-CRE infection in children and classifying genotypes is a priority in this vulnerable population.

Methods:

A case-case-control study of patients (0–22 years) at 3 tertiary-care Chicago-area medical centers, 2008–2015, was conducted. Case group 1 children possessed KPC-CRE infections; case group 2 harbored carbapenem-susceptible Enterobacteriaceae (CSE) infections; controls had negative cultures. Case-control matching was 1:1:3 by age, infection site and hospital. Statistical and molecular analyses were performed.

Results:

Eighteen KPC-CRE infections were identified; median patient age was 16.5 years. Of 4 available KPC-CRE, 2 were unrelated, non-ST258 KP strains harboring bla
KPC-2, one was a ST258 KP harboring bla
KPC-3, and the last was an E. coli containing bla
KPC-2. KPC-CRE and CSE-infected patients had more multidrug-resistant organisms infections, long-term care facility admissions and lengths of stay (LOS) > 7 days before culture. KPC-CRE and CSE patients had more gastrointestinal comorbidities (odds ratios [Ors], 28.0 and 6.4) and ≥ 3 comorbidities (Or 15.4 and 3.5) compared with controls; KPC-CRE patients had significantly more pulmonary and neurologic comorbidities (both ORs 4.4) or GI and pulmonary devices (ORs, 11.4 and 6.1). Compared with controls, CSE patients had more prior fluoroquinolone use (OR, 7.4); KPC-CRE patients had more carbapenem or aminoglycoside use (ORs, 10.0 and 8.0). Race, gender, LOS and mortality differences were insignificant.

Conclusions:

Pediatric patients with KPC-CRE infection suffer from high multi-system disease/device burdens and exposures to carbapenems and aminoglycosides. Different from adult reports, non-ST258 KP strains were more common, and LOS and mortality rates were similar in all groups. Pediatric CRE control in should focus on modifiable risk factors including antibiotic and device utilization.
Nationwide Study on the Course of Influenza A (H1N1) Infections in Hospitalized Children in the Netherlands During the Pandemic 2009–2010
Authors: Ahout Inge M. L. , Philipsen Ria L. A. , Las Mariëtte , Baysan Meryem , Brus Frank , Rahamat-Langendoen Jeanette C. , Roeleveld Nel , Fraaij Pieter L. , Osterhaus Albert D. M. E. , Ferwerda Gerben , de Groot Ronald
Published: August 2018

Background:

The influenza H1N1 pandemic of 2009–2010, provided a unique opportunity to assess the course of disease, as well as the analysis of risk factors for severe disease in hospitalized children (< 18 years).

Methods:

Retrospective national chart study on hospitalized children with H1N1 infection during the 2009–2010 pH1N1 outbreak.

Results:

Nine hundred forty patients (56% boys), median age 3.0 years, were enrolled; the majority were previously healthy. Treatment consisted of supplemental oxygen (24%), mechanical ventilation (5%) and antiviral therapy (63%). Fifteen patients died (1.6%), 5 of whom were previously healthy. Multivariable analyses confirmed pre-existent heart and lung disease as risk factors for intensive care unit admission. Risk factors for mortality included children with a neurologic or oncologic disease and psychomotor retardation.

Conclusions:

This nationwide overview of hospitalized children confirms known risk groups for severe influenza infections. However, most of the acute and severe presentations of influenza occurred in previously healthy children.
Understanding Congenital Syphilis
Authors: Porter Sallie , Qureshi Rubab , Benenson Irina
Published: August 2018

The incidence of infants with congenital syphilis (CS) has been accelerating in the United States and remains an issue of global concern. Infants with CS often experience poor birth, health, and developmental outcomes. These poor outcomes (e.g., prematurity, bone changes, neurodevelopmental impairment) may be exacerbated by social vulnerabilities (e.g., housing instability, incarceration) experienced by their mothers and families. As such, infants with CS may benefit from neurodevelopmental assessments offered early in life, comprehensive in scope, and repeated over time; developmental intervention, as well as family support services that acknowledge the co-occurring health, developmental, and social challenges they may face.
Physical Therapists' Perspectives on Importance of the Early Intervention Competencies to Physical Therapy Practice
Authors: Weaver Priscilla , Cothran Donetta , Dickinson Stephanie , Frey Georgia
Published: August 2018

The purpose of this study was to examine perspectives of physical therapists on the level of importance of the early intervention competencies to practice in early intervention and differences in perspectives based on demographic factors. A web-based survey was disseminated to physical therapists who worked in early intervention or with children birth to 3 years of age by nonprobability sampling techniques. Of 288 surveys, 80.4% of responses on the importance level of the early intervention competencies were within “extremely important (5.0)” or “very important (4.0)” categories, with a mean score of 4.18. Thirteen competencies received greater than 60% of responses within the “extremely important” category, with no significant differences among therapists based on demographic factors. Physical therapists rated all early intervention competencies on the positive side of the importance scale, with certain competencies rated as more important than others. Competencies with highest ratings should be emphasized at all levels of physical therapy professional development.
Changes in Symptoms of Problematic Eating Over 6 Months in Infants and Young Children
Authors: Park Jinhee , McComish Cara , Pados Britt Frisk , Estrem Hayley H. , Thoyre Suzanne M.
Published: August 2018

The purpose of this article is to describe changes in problematic eating symptoms across 6 months in children seen in an outpatient feeding clinic and explore child characteristics associated with symptom changes. Participants were 58 parents of children aged 6 months to 7 years of age who were seen in an outpatient feeding clinic. Parents completed an online survey at 3 time points: enrollment and 3 and 6 months later. The survey consisted of the Pediatric Eating Assessment Tool (PediEAT) and a set of questions assessing demographic information, child's medical and feeding history, medical diagnoses, gastrointestinal function, and medications. Linear mixed modeling was used to examine changes in PediEAT total and subscale scores over time and explore associated child characteristics. The PediEAT total score significantly decreased over time with the greatest change in the Physiologic Symptoms subscale. Several child characteristics were associated with more severe symptoms of problematic feeding: older child age, more symptoms of constipation, and diagnoses of speech–language delay, developmental delay, food allergy, and/or genetic disorder. Parent report of child symptoms of problematic eating decreased across 6 months. Associations with child characteristics highlight the complexity of pediatric eating problems and the need for more research on potential factors influencing symptoms of eating problems.
Pharmacological rescue of nociceptive hypersensitivity and oxytocin analgesia impairment in a rat model of neonatal maternal separation
Authors: Melchior Meggane , Juif Pierre-Eric , Gazzo Géraldine , Petit-Demoulière Nathalie , Chavant Virginie , Lacaud Adrien , Goumon Yannick , Charlet Alexandre , Lelièvre Vincent , Poisbeau Pierrick
Published: August 2018

Oxytocin (OT), known for its neurohormonal effects around birth, has recently been suggested for being a critical determinant in neurodevelopmental disorders. This hypothalamic neuropeptide exerts a potent analgesic effect through an action on the nociceptive system. This endogenous control of pain has an important adaptive value but might be altered by early life stress, possibly contributing to its long-term consequences on pain responses and associated comorbidities. We tested this hypothesis using a rat model of neonatal maternal separation (NMS) known to induce long-term consequences on several brain functions including chronic stress, anxiety, altered social behavior, and visceral hypersensitivity. We found that adult rats with a history of NMS were hypersensitive to noxious mechanical/thermal hot stimuli and to inflammatory pain. We failed to observe OT receptor–mediated stress-induced analgesia and OT antihyperalgesia after carrageenan inflammation. These alterations were partially rescued if NMS pups were treated by intraperitoneal daily injection during NMS with OT or its downstream second messenger allopregnanolone. The involvement of epigenetic changes in these alterations was confirmed since neonatal treatment with the histone deacetylase inhibitor SAHA, not only normalized nociceptive sensitivities but also restored OT receptor–mediated stress-induced analgesia and the endogenous antihyperalgesia in inflamed NMS rats. There is growing evidence in the literature that early life stress might impair the nociceptive system ontogeny and function. This study suggests that these alterations might be restored while stimulating OT receptor signaling or histone deacetylase inhibitors, using molecules that are currently available or part of clinical trials for other pathologies.
A Novel Method for Assessing Prosthesis Use and Accommodation Practices of People with Transtibial Amputation
Authors: Sanders Joan E. , Redd Christian B. , Larsen Brian G. , Vamos Andrew C. , Brzostowski Jacob T. , Hafner Brian J. , Allyn Katheryn J. , Henrikson Katrina M. , McLean Jake B. , Hinrichs Paul
Published: August 2018

Introduction

Practitioners typically rely on patient self-report for information about prosthesis use and limb volume accommodation. Electronic monitoring may provide a more accurate and easier means of collecting these data.

Methods

A novel low-profile sensor was used for 2 weeks to track when the limb was within the socket. Each participant also recorded daily prosthesis don times, doff times, and sock changes in a written log.

Results

Participants (n = 21) wore their prosthesis frequently, for approximately 14.1 hrs/day (interquartile range [IQR], 12.5–14.9), and doffed their prosthesis for 0.5 hr/day (IQR, 0.1–1.2). Of those participants who performed sock changes, participants most often performed sock changes 0.4 times per day (IQR, 0.3–1.0) and socket releases (temporary doffs) 1.3 times per day (IQR, 0.5–3.8). Measured and self-reported beginning-of-prosthesis day were not significantly different (P= 0.002), whereas end-of-prosthesis day were significantly different (P= 0.573).

Conclusions

The developed electronic monitor may improve recording of prosthesis use and monitoring of socket releases. Data collected in this study may serve as a starting point for characterizing socket wear and accommodation in people with limb loss.
Vaginal Intraepithelial Neoplasia: Clinical Presentation, Management, and Outcomes in Relation to HIV Infection Status
Authors: Bradbury Melissa , Xercavins Natalia , García-Jiménez Ángel , Pérez-Benavente Asunción , Franco-Camps Silvia , Cabrera Silvia , Sánchez-Iglesias José Luis , De La Torre Javier , Díaz-Feijoo Berta , Gil-Moreno Antonio , Centeno-Mediavilla Cristina
Published: August 2018

Objectives

The data available on vaginal intraepithelial neoplasia (VAIN) and infection by HIV are scarce. We therefore aimed to review the clinical presentation, management, and survival outcomes of VAIN in this group of women.

Materials and Methods

This is an observational cohort study of women diagnosed with VAIN for a 23-year period. Clinical characteristics and outcomes were analyzed according to women's HIV infection status. Disease-free and progression-free survival were compared between groups.

Results

Twenty-two of 87 women were HIV positive (25.3%) compared with the HIV-negative group, HIV-positive women were younger (median age = 39 vs 57 years, p < .001) and more frequently smokers (p < .001). They also presented with multifocal and multicentric disease more often (p = .004 and p = .033, respectively) in relation to infection by human papillomavirus. All HIV-positive women were receiving antiretroviral treatment. The median time from the diagnosis of HIV to the development of VAIN was 14 years (range = 1–22 years). There were no significant differences in survival outcomes between groups.

Conclusions

HIV-positive women are at an increased risk of developing VAIN and frequently present at a younger age with multifocal and multicentric disease. Vaginal intraepithelial neoplasia lesions can develop many years after the initial diagnosis of HIV infection reason why prolonged surveillance is essential to enable prompt diagnosis and treatment.