bluuebunny/crossref_metadata_2025_split huggingface dataset:
“Come un pesce entro due acque”. Alcune annotazioni sull’intima duplicità del fanciullo penniano
Authors: Moslemani Fadil 
Published: February 2018

La poesia di Sandro Penna costituisce un caso letterario sui generis nel Novecento poetico italiano. Fedele a un monotematismo incentrato sulla figura del personaggio-mito del fanciullino, il poeta perugino, a partire dalla sua prima raccolta ( Poesie, 1939), perviene efficacemente a “riesumare”, rielaborandola attraverso la propria soggettività di uomo-poeta, l’immagine multiforme del fanciullo di pascoliana memoria. Prendendo in esame la vasta produzione lirica di Penna, il saggio che qui proponiamo intende porre in evidenza alcuni dei punti salienti della poetica penniana del fanciullo in rapporto all’“archetipo” elaborato da Giovanni Pascoli e, più in generale, rispetto alla tradizione critica e poetica del Novecento. Dai contorni talvolta arcani, la figura del fanciullo, in Penna, si contraddistingue sovente per la sua duplicità, in quanto opera sia da vero e proprio oggetto dei desideri del poeta, sia da intima “presenza interiore” (di pascoliana memoria) volta a conferire allo scrittore un’aura di apparente ingenuità e bambinesca innocenza. Nella convinzione che la duplice natura del fanciullino costituisce uno dei maggiori elementi di interesse riscontrabili nella lirica considerata, il presente contributo, attraverso un tentativo di analisi di tale doppiezza, si prefigge pertanto di scrutare la “poetica del fanciullo” allo scopo di meglio contestualizzarla all’interno dell’intero corpus poetico penniano.
Psychiatric Misjudgments in German Restitution Proceedings: Blindness or Spite?
Authors: Wangh Martin 
Published: February 2018

When restitution is claimed for psychic damage sustained as a result of Nazi persecution, a German psychiatrist, usually a prominent member of his profession, is called upon by the German court as chief evaluator. In cases where the claimant was an infant at the time of the persecution, the chief evaluator has often come to some variant of the following conclusion: Since the patient was an infant during the height of the persecution, he could not have been consciously aware of the events taking place around him and therefore could not have sustained any psychic damage from them. Three such cases are described and the evaluations of the chief evaluators quoted. Documentation, including a letter from Dr. Anna Freud, is brought to show that such judgment is wholly erroneous.
A Forensic Psychiatry Clinic in Evolution
Authors: Hoffman Browning , Showalter Robert , Whitebread Charles 
Published: February 2018

In 1969, a teaching program in forensic psychiatry was launched at the University of Virginia School of Medicine. Initially oriented toward the training of psychiatric residents, the Forensic Psychiatry Clinic now offers academic credit to selected law students and draws upon an interdisciplinary faculty. In light of special problems which may arise in forensic evaluations, the paper focuses upon client privacy, confidentiality and privileged communications. Also described are the difficulties of formulating a teaching program responsive simultaneously to the needs of medical students, psychiatric residents and law students.
The Borderland of Autonomy: Medical-Legal Criteria for Capacity to Consent
Authors: Janicak Philip G. , Bonavich Peter R. 
Published: February 2018

This article focuses on one aspect of informed consent: the capacity to give consent. This legal concept has developed from theological, philosophical, and legal perspectives, and is now employed commonly in medical-legal decisions, as exemplified by the recently enacted Mental Health Code of Illinois. Unfortunately, there is little scientific direction for applying this concept either by the courts or the clinician attempting to obtain informed consent. This article attempts to establish guidelines to assess capacity to consent by developing criteria from a standard psychiatric evaluation and correlating these guidelines with certain existing categories for tests of competency.1
Public Acceptance/Rejection of Insanity–-mental Illness Legal Defenses for Defendants in Criminal Homicide Cases
Authors: Tygart Clarence E. 
Published: February 2018

A representative sample of public opinion was investigated concerning the processes by which the public accepts/rejects homicide defendants’ mental illness legal defenses. Lesser acceptance of a mental illness defense was associated with: (1) political conservatism; (2) traditional or orthodox religious beliefs; and (3) a “free will” rather than a “determinism” philosophical stance. Mental health professionals were accorded little influence in the public's determination of their positions on the mental illness defense. However, for those who did not have strong opinions on the mental illness defense, mental health professionals were defined generally as having significant influence on their decisions.
Clinical Consensus Statement: Balloon Dilation of the Sinuses
Authors: Piccirillo Jay F. , Payne Spencer C. , Rosenfeld Richard M. , Baroody Fuad M. , Batra Pete S. , DelGaudio John M. , Edelstein David R. , Lane Andrew P. , Luong Amber U. , Manes R. Peter , McCoul Edward D. , Platt Michael P. , Reh Douglas D. , Corrigan Maureen D. 
Published: February 2018

ObjectiveTo develop a clinical consensus statement on the use of sinus ostial dilation (SOD) of the paranasal sinuses.MethodsAn expert panel of otolaryngologists was assembled to represent general otolaryngology and relevant subspecialty societies. The target population is adults 18 years or older with chronic or recurrent rhinosinusitis (with or without nasal polyps, with or without prior sinus surgery) for whom SOD is being recommended, defined as endoscopic use of a balloon device to enlarge or open the outflow tracts of the maxillary, frontal, or sphenoid sinuses, as a standalone procedure or with endoscopic surgery. A modified Delphi method was used to distill expert opinion into clinical statements that met a standardized definition of consensus.ResultsAfter 3 iterative Delphi method surveys, 13 statements met the standardized definition of consensus while 45 statements did not. The clinical statements were grouped into 3 categories for presentation and discussion: (1) patient criteria, (2) perioperative considerations, and (3) outcomes. Strong consensus was obtained for not performing SOD in patients without sinonasal symptoms or positive findings on computed tomography (CT) in patients with symptoms only of headache or sleep apnea without criteria for sinusitis. In addition, strong consensus was met that CT scan of the sinuses was necessary before performing SOD and that surgeons need to understand and abide by regulations set forth by the US Food and Drug Administration if they choose to reuse/reprocess devices.ConclusionExpert panel consensus may provide helpful information for the otolaryngologist considering the use of SOD for the management of patients with a diagnosis of rhinosinusitis. This panel reached consensus on a number of statements that defined the use of SOD as inappropriate in the management of a variety of symptoms or diseases in the absence of underlying sinusitis. When patients meet the definition of chronic sinusitis as confirmed by CT scan, SOD of the sinuses can be indicated and/or effective in certain scenarios. Additional consensus statements regarding proper setting and safeguards for performing the procedure are described.
Migraine and the risk of incident hypertension among women
Authors: Rist Pamela M , Winter Anke C , Buring Julie E , Sesso Howard D , Kurth Tobias 
Published: February 2018

Background Few studies have examined whether migraine is associated with an increased risk of incident hypertension. Methods We performed a prospective cohort study among 29,040 women without hypertension at baseline. Women were classified as having active migraine with aura, active migraine without aura, a past history of migraine, or no history of migraine. Incident hypertension was defined as new physician diagnosis or newly self-reported systolic or diastolic blood pressure ≥140 mmHg or ≥90 mmHg respectively. Cox proportional hazards models were used to evaluate the association between migraine and incident hypertension. Results During a mean follow-up of 12.2 years, 15,176 incident hypertension cases occurred. Compared to those with no history of migraine, women who experience migraine with aura had a 9% increase in their risk of developing hypertension (95% CI: 1.02, 1.18); women who experience migraine without aura had a 21% increase in their risk of developing hypertension (95% CI: 1.14, 1.28); and women with a past history of migraine had a 15% increase in their risk of developing hypertension (95% CI: 1.07, 1.23). Conclusions Women with migraine have a higher relative risk of developing hypertension compared to women without migraine.
Predicting Activity and Workload in General Practice from the Demographic Structure of the Practice Population
Authors: Whynes David , Baines Darrin 
Published: February 2018

Objectives: The managerial requirements of budget-setting and performance monitoring in general practice (primary care) in the UK require an understanding of the causal relationship between practice activities and the characteristics of both the practice and its patients. This study sought to model the determinants of three major components of general practice activities (consultations, prescribing costs and referrals to secondary care), paying particular attention to the influence of the demographic structure of the patient list. Methods: Stepwise regression analysis was carried out on data for 98 practices in the county of Lincolnshire using 12 independent variables pertaining to patient and practice characteristics plus 14 statistical measures derived from the demographic structure of the patients registered with the practice. Results: Robust statistical models were estimated for the three dependent variables, of which list size emerged as the most significant independent variable. In addition, six other independent variables, including the patients' unemployment rate, fundholding status and single-handed status, were statistically significant in one or more of the equations. Variables based on the demographic structure of the practice population also appeared in each model. The Jarman score and degree of urbanization did not achieve statistical significance. Conclusions: Activity and workload in general practice can be predicted from routine data. Such models are of particular value for planning and financial management when demographic change in practice populations is anticipated.
The Costs of Alternative Types of Routine Antenatal Care for Low-Risk Women: Shared Care Vs Care by General Practitioners and Community Midwives
Authors: Ratcliffe Julie , Ryan Mandy , Tucker Janet 
Published: February 2018

Objectives: To compare the costs to the health service, women and their families of routine antenatal care provided by either traditional obstetrician-led shared care or general practitioner (GP)/community midwife care. Method: A multicentre randomized controlled trial in 51 general practices linked to nine maternity hospitals in Scotland: 1667 low-risk pregnant women provided information on costs to the health service. 704 of these women provided information on non-health service costs. Results: GP/midwife antenatal care was found to cost statistically significantly less than shared care. This was the case for investigations carried out at routine antenatal visits (GP/midwife = £87.25, shared care = £91.15, P = 0.05), staffing costs at routine antenatal visits (GP/midwife = £127.76, shared care = £131.09, P = 0.001), and non-health service costs incurred by women and their companions (GP/midwife = £118.53, shared care = £133.49, P = 0.001). While non-routine care in the GP/midwife arm of the trial costs less than in the shared care arm, the difference was not statistically significant (GP/midwife = £83.74, shared care = £94.43, P = 0.46). The total societal cost of antenatal care was £417.28 per woman in the GP/midwife arm of the trial and £450.19 in the shared care arm of the trial. This difference was statistically significant ( P < 0.001). The application of sensitivity analysis did not change these results. Conclusions: GP/midwife antenatal care is a satisfactory option for low-risk pregnant women in Scotland provided that clinical outcomes and women's satisfaction are at least the same as those of women with shared care.
Did the Introduction of General Practice Fundholding Change Patterns of Emergency Admission to Hospital?
Authors: Toth Ben , Harvey Ian , Peters Tim 
Published: February 2018

Objectives: To test the hypothesis that the introduction of general practice fundholding was associated with a change in the proportion of emergency admissions to hospital. Methods: Before and after natural experiment with control group. The experimental group was first-wave fundholding general practices in the South Western Regional Health Authority, the control group was all practices that remained non-fundholding as of April 1993. Data were collected on episodes of care in hospitals in the South Western region involving cholecystectomy, hernia repair, intervertebral disc operation and prostatectomy. The additional impact of fundholding status on any underlying changes in proportions of emergency admissions was examined using multiple logistic regression. Results: There was no evidence of an interaction between fundholding status and before/after time period. Odds ratios and confidence intervals for the interaction of general practice fundholding status and time were: Prostatectomy 1.02 (0.77 to 1.34); hernia repair 0.94 (0.7 to 1.24); intervertebral disk operations 1.67 (0.8 to 3.47); prostatectomy 0.94 (0.69 to 1.27). Conclusions: The results provide no evidence that, in the first 2 years of the scheme, fundholding had an impact on the proportion of emergency admissions to hospital.
The Relationship between the Supply of Cardiac Catheterization Laboratories, Cardiologists and the use of Invasive Cardiac Procedures in Northern New England
Authors: Wennberg David , Dickens John , Soule David , Kellett Mirle , Malenka David , Robb John , Ryan Thomas , Bradley William , Vaitkus Paul , Hearne Michael , O'Connor Gerald , Hillman Robert 
Published: February 2018

Objectives: Utilization rates of coronary angiography and cardiac revascularization have been found to vary between areas. This study addresses the relationship between resource supply and procedure rates. Methods: We compared the association of per capita catheterization laboratories, per capita cardiologists and multi-provider markets (where more than one hospital offers coronary angiography services) with the utilization rates for angiography and cardiac revascularization in northern New England, USA. Administrative data were used to capture invasive cardiac procedures. Small area analyses were used to create coronary angiography service areas. Linear regression methods were used to measure associations between the resource supply and utilization rates. Results: Variation in the use of invasive cardiac procedures was strongly associated with the population-based availability of catheterization facilities and multi-provider markets and unrelated to cardiologist supply or need (as reflected in the hospitalization rates for myocardial infarction). In the multivariate model, an increase of 1 catheterization laboratory per 100 000 population was associated with an increase in the angiography rate of 1.62 per 1000 population; those service areas with multi-provider markets were associated with an additional increase in the angiography rate of 1.27 per 1000 population ( R2= 0.84, P = 0.0006). There was a moderately strong relationship between the catheterization laboratories per capita and the revascularization rates ( R2 = 0.43, P = 0.029). Angiography rates were highly associated with cardiac revascularization rates: An increase in the angiography rate of 1 per 1000 population was associated with a 0.46 per 1000 increase in the cardiac revascularization rate ( R2 = 0.85, P = 0.0001). Conclusions: Our work suggests that current efforts to address variation in cardiac procedures through activities such as appropriateness criteria, guidelines and utilization review are misdirected and should be redirected towards capacity, in this case the supply of catheterization facilities.
Spectral-Domain Optical Coherence Tomography Associations of Neovascular Conversion in Age-Related Macular Degeneration
Authors: Yu Siqing , Wolf Sebastian , Munk Marion R. , Zinkernagel Martin S. , Ebneter Andreas 
Published: February 2018

Purpose: To identify spectral-domain optical coherence tomography (SD-OCT) features associated with exudative conversion in fellow eyes of patients treated for neovascular age-related macular degeneration (nAMD) in their first eye. Methods: Retrospective observational study. Spectral-domain optical coherence tomography images of converting fellow eyes (study eyes) from 83 patients with nAMD were compared to fellow eyes of age- and sex-matched patients with nAMD who did not convert (control eyes). Parameters related to drusen, pigment epithelium detachment, hyperreflective foci (HRF), retinal pigment epithelium atrophy, small cystic cavities, and vitreoretinal interface were graded. Longitudinal analysis in study eyes and cross-sectional comparison with control eyes at the last 3 semiannual visits before nAMD conversion were performed. Results: For most biomarkers, the prevalence in study eyes increased and imaging findings worsened more than in control eyes. Drusen size and reticular pseudodrusen presence were significantly greater in converting eyes at all 3 time points. Outer retinal small cystic cavities were significantly more common in study eyes shortly before conversion. Binary logistic regression revealed that biggest drusen width was significantly associated with nAMD at all 3 time points (odds ratio [OR] > 1.010; P < .001). The presence of soft drusen was strongly associated with nAMD 18 months before conversion (OR: 7.034; P = .040). Clustering HRF in the inner retina were significantly associated with nAMD both 12 (OR: 1.324; P = .049) and 6 months (OR: 2.161; P = .035) before conversion. Conclusions: Emergence of HRF in fellow eyes, particularly in the inner retina, are sensitive SD-OCT features indicating conversion to exudative disease in patients treated unilaterally for nAMD.
Prevalence, risk factors and clinical correlates of COPD in a rural setting in Tanzania
Authors: Magitta Ng'weina Francis , Walker Richard William , Apte Komalkirti Keshavkiran , Shimwela Meshack Denson , Mwaiselage Julius David , Sanga Anna Alphonce , Namdeo Anil Kumar , Madas Sapna Jitendra , Salvi Sundeep Santosh 
Published: February 2018

Chronic obstructive pulmonary disease (COPD) causes substantial burden of disease in developed countries, but there are limited data from Africa. We aimed to estimate the prevalence of COPD in Tanzania and identify the risk factors associated with it.This was a cross-sectional descriptive survey involving adults aged ≥35 years. We collected data on symptoms and risk factors using the Burden of Obstructive Lung Diseases questionnaire. Spirometry was performed and COPD diagnosed based on post-bronchodilator forced expiratory volume in 1 s/forced vital capacity <70%. We also measured indoor and outdoor carbon monoxide (CO) levels.A total of 869 participants (49.1% females) completed the questionnaires. Of these, 57.1% completed post-bronchodilator spirometry. Of the 25.2% ever-smokers, only 5.4% were current smokers. COPD prevalence was estimated at 17.5% (21.7% in males and 12.9% in females). COPD was associated with a history of cough, phlegm production and wheezing. 51.7% of COPD patients reported cough and 85% had mild to moderate airway limitation. Females had a higher rate of exacerbation. Pulmonary tuberculosis (TB) was reported in 10% of patients. Only 1.7% of patients who were diagnosed as COPD had ever received any medication, with only one female COPD patient having received an inhaler. 99.5% of the population used biomass fuels for cooking. The majority of households had CO levels up to 20 ppm.The prevalence of COPD in Tanzania is high, with a peak at a relatively young age and a preponderance in males. A history of TB, cigarette smoking and male sex are important risk factors. Indoor air pollution coupled with use of biomass fuel for cooking and heating may be an important risk factor for developing COPD in rural Tanzania. However, these factors need to be studied further.
Does physical fitness enhance lung function in children and young adults?
Authors: Hancox Robert J. , Rasmussen Finn 
Published: February 2018

Although physical activity is important for lung health, it is unclear whether physical fitness influences lung function. We investigated associations between lung function and fitness in two population-based cohort studies of children and young adults.Aerobic fitness was measured using a maximal cycle ergometer test at ages 9, 15, 21 and 29 years in Odense, Denmark and using a submaximal cycle test at ages 15, 26, 32 and 38 years in Dunedin, New Zealand.Aerobic fitness was positively associated with forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) in cross-sectional analyses at all ages in both cohorts, independently of height, weight, sex, asthma and smoking. Each standard deviation difference in fitness was associated with 2–3% predicted higher values of FEV1and FVC. Improvements in fitness during childhood and adolescence were associated with growth in lung volumes in longitudinal analyses. These associations tended to be stronger in males than females. No longitudinal associations were found after peak adult lung function had been attained. Fitness was not significantly associated with FEV1/FVC ratios.Aerobic fitness is positively associated with lung volumes. Improving fitness during childhood and adolescence is associated with greater adult lung volumes, but not with airway calibre.
The independent contribution ofPseudomonas aeruginosainfection to long-term clinical outcomes in bronchiectasis
Authors: Araújo David , Shteinberg Michal , Aliberti Stefano , Goeminne Pieter C. , Hill Adam T. , Fardon Thomas C. , Obradovic Dusanka , Stone Glenda , Trautmann Marion , Davis Angela , Dimakou Katerina , Polverino Eva , De Soyza Anthony , McDonnell Melissa J. , Chalmers James D. 
Published: February 2018

Pseudomonas aeruginosais responsible for chronic infection in many bronchiectasis patients but it is not known whether it is associated with worse clinical outcomes independent of the underlying severity of disease.This study analysed data from 2596 bronchiectasis patients included from 10 different bronchiectasis clinical centres across Europe and Israel, with a 5-year follow-up period. Prevalence ofP. aeruginosachronic infection and its independent impact on exacerbations, hospitalisations, quality of life and mortality was assessed.The prevalence ofP. aeruginosachronic infection was 15.0% (n=389).P. aeruginosawas associated with a higher mortality in a univariate analysis (hazard ratio (HR) 2.02; 95% (confidence interval) CI 1.53–2.66; p<0.0001) but an independent impact on mortality was not found in a multivariate analysis (HR 0.98; 95% CI 0.70–1.36; p=0.89).P. aeruginosawas independently associated with increased mortality only in patients with frequent exacerbations (two or more per year) (HR 2.03; 95% CI 1.36–3.03; p=0.001). An independent association with worse quality of life of 7.46 points (95% CI 2.93–12.00; p=0.001) was found in a multivariable linear regression.P. aeruginosawas therefore found to be independently associated with exacerbation frequency, hospital admissions and worse quality of life. Mortality was increased in patients withP. aeruginosaparticularly in the presence of frequent exacerbations.