bluuebunny/crossref_metadata_2025 huggingface dataset:
On the Interplay between the Circulation in the Surface and the Intermediate Layers of the Arctic Ocean
Authors: Lique Camille , Johnson Helen L. , Davis Peter E. D.
Published: March 2015

The circulation of the Arctic Ocean has traditionally been studied as a two-layer system, with a wind-driven anticyclonic gyre in the surface layer and a cyclonic boundary current in the Atlantic Water (AW) layer, primarily forced remotely through inflow and outflow to the basin. Here, an idealized numerical model is used to investigate the interplay between the dynamics of the two layers and to explore the response of the circulation in each of the layers to a change in the forcing in either layer. In the model, the intensity of the circulation in the surface and AW layers is primarily set by the ocean surface stress curl intensity and the inflow to the basin, respectively. Additionally, the surface layer circulation can strongly modulate the intensity of the intermediate layer by constraining the lateral extent of the AW current on the slope. In contrast, a change in the AW current strength has little effect on the surface layer circulation. The intensity of the circulation in the surface layer adjusts over a decade, on a time scale consistent with a balance between Ekman pumping and an eddy-induced volume flux toward the boundary, while the circulation in the AW layer adjusts quickly to any change of forcing (~1 month) through the propagation of boundary-trapped waves. As the two layers have different adjustment processes and time scales, and are subject to forcing that varies on all time scales, the interplay between the dynamics of the two layers is complex, and more simultaneous observations of the circulation within the two layers are required to fully understand it.
Novel PTPRQ Mutations Identified in Three Congenital Hearing Loss Patients With Various Types of Hearing Loss
Authors: Sakuma Naoko , Moteki Hideaki , Azaiez Hela , Booth Kevin T. , Takahashi Masahiro , Arai Yasuhiro , Shearer A. Eliot , Sloan Christina M. , Nishio Shin-ya , Kolbe Diana L. , Iwasaki Satoshi , Oridate Nobuhiko , Smith Richard J. H. , Usami Shin-ichi
Published: March 2015

Objectives:

We present 3 patients with congenital sensorineural hearing loss (SNHL) caused by novel PTPRQ mutations, including clinical manifestations and phenotypic features.

Methods:

Two hundred twenty (220) Japanese subjects with SNHL from unrelated and nonconsanguineous families were enrolled in the study. Targeted genomic enrichment with massively parallel DNA sequencing of all known nonsyndromic hearing loss genes was performed to identify the genetic cause of hearing loss.

Results:

Four novel causative PTPRQ mutations were identified in 3 cases. Case 1 had progressive profound SNHL with a homozygous nonsense mutation. Case 2 had nonprogressive profound SNHL with a compound heterozygous mutation (nonsense and missense mutation). Case 3 had nonprogressive moderate SNHL with a compound heterozygous mutation (missense and splice site mutation). Caloric test and vestibular evoked myogenic potential (VEMP) test showed vestibular dysfunction in Case 1.

Conclusion:

Hearing loss levels and progression among the present cases were varied, and there seem to be no obvious correlations between genotypes and the phenotypic features of their hearing loss. The PTPRQ mutations appeared to be responsible for vestibular dysfunction.
Hearing Loss Caused by a P2RX2 Mutation Identified in a MELAS Family With a Coexisting Mitochondrial 3243AG Mutation
Authors: Moteki Hideaki , Azaiez Hela , Booth Kevin T. , Hattori Mitsuru , Sato Ai , Sato Yoshihiko , Motobayashi Mitsuo , Sloan Christina M. , Kolbe Diana L. , Shearer A. Eliot , Smith Richard J. H. , Usami Shin-ichi
Published: March 2015

Objectives:

We present a family with a mitochondrial DNA 3243A>G mutation resulting in mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS), of which some members have hearing loss in which a novel mutation in the P2RX2 gene was identified.

Methods:

One hundred ninety-four (194) Japanese subjects from unrelated families were enrolled in the study. Targeted genomic enrichment and massively parallel sequencing of all known nonsyndromic hearing loss genes were performed to identify the genetic causes of hearing loss.

Results:

A novel mutation in the P2RX2 gene that corresponded to c.601G>A (p.Asp201Tyr) was identified. Two patients carried the mutation and had severe sensorineural hearing loss, while other members with MELAS (who did not carry the P2RX2 mutation) had normal hearing.

Conclusion:

This is the first case report of a diagnosis of hearing loss caused by P2RX2 mutation in patients with MELAS. A potential explanation is that a decrease in adenosine triphosphate (ATP) production due to MELAS with a mitochondrial 3243A>G mutation might suppress activation of P2X2 receptors. We also suggest that hearing loss caused by the P2RX2 mutation might be influenced by the decrease in ATP production due to MELAS.
Urban Elementary Single-Sex Math Classrooms
Authors: Bowe Anica G. , Desjardins Christopher D. , Covington Clarkson Lesa M. , Lawrenz Frances
Published: March 2015

This study utilized a mixed-methods approach to holistically examine single-sex and coeducational urban elementary mathematics classes through situated cognitive theory. Participants came from two urban low-income Midwestern elementary schools with a high representation of minority students ( n = 77 sixth graders, n = 4 teachers, n = 2 principals). Findings demonstrate that African American girls made more math achievement gains in single-sex classrooms; single-sex classrooms might mitigate math academic stereotypes for students and teachers; and that important contextual factors play a role in these outcomes. Testing these factors is a step toward delineating a theory of change for single-sex education in urban public schools.
Adolescent Racial Identity: Self-Identification of Multiple and “Other” Race/Ethnicities
Authors: Harris Bryn , Ravert Russell D. , Sullivan Amanda L.
Published: March 2015

This mixed methods study focused on adolescents who rejected conventional singular racial/ethnic categorization by selecting multiple race/ethnicities or writing descriptions of “Other” racial/ethnic identities in response to a survey item asking them to identify their race/ethnicity. Written responses reflected eight distinct categories ranging from elaborative descriptions of conventional race categories to responses refusing the construct of race/ethnicity. Students’ endorsement of multiple or “Other” ethnicities, and the resultant categories, differed by gender, grade, school type, and school compositions. Findings support scholars’ concern that common conceptualizations of race may not capture the complexity of self-identified racial categories among youth.
An infant with aphallia and its associated complication: A rare case report and review of literature
Authors: Bahe Priya , Sharma Deepak , Bahe Anupam , Pandita Aakash
Published: March 2015

Complete penile agenesis (aphallia) is a very rare congenital anomaly. Around 80 cases have been reported to date. Diagnosis of this rare anomaly is made by clinical examination, but treatment options and parental counselling for gender assignment is difficult and challenging for the treating doctor. We report a case of an infant with complete penile agenesis with recto-urethral fistula, who was referred on day 6 of life. This baby developed obstructive uropathy which required vesicostomy. Surgical management consists of gender assignment after discussing in detail the pertinent situation with the parents and accepting their final decision.
Building with Balint
Authors: Lichtenstein Albert
Published: March 2015

The American Balint Society held its First National Meeting in Estes Park Colorado in July 2014. The meeting brought together multiple generations of physicians and behavioral scientists interested in promoting Balint work in the United States. This article will provide an overview of the Balint method and its importance in medicine, a brief history of the American Balint Society, and the various elements of the First National Meeting.
Navigating by Nose
Authors: Kiechle Melanie
Published: March 2015

Attitudes toward fresh air and fear of stenches guided choices that restructured and changed the urban environment and governance between 1840 and 1880. This study of olfactory-inspired reforms demonstrates the cultural significance of nuisance beyond the courtroom. City dwellers used their understanding of stench nuisance as detrimental to health to construct smellscapes or olfactory maps of New York City. Such maps identified health threats and guided movements through or out of the city. These maps proliferated before and after the creation of the Metropolitan Board of Health in 1866. Sanitarian concern about stenches echoed lay concerns, and encouraged the creation of standing health boards. These boards mapped air currents that crossed political boundaries rather than pursuing individuals’ stench complaints. Considering individuals’ smellscapes alongside the health board’s maps demonstrates that 1866 was a turning point for the creation of both institutionalized public health and the conflict between lay and expert.
Assessing Needs and Feasibility of Diabetes Self-management Coaching at Faith-Based Organizations for Indo-Guyanese Immigrants
Authors: Hosler Akiko S. , Solanki Malini N. , Savadatti Sanghamitra
Published: March 2015

Purpose

The purpose of this study is to explore barriers and needs related to diabetes care and the feasibility of diabetes self-management (DSM) “coaching” at faith-based organizations (FBOs) for the Indo-Guyanese community in Schenectady, New York.

Methods

Participants were recruited though flyers and mass mailings, and in-depth interviews were conducted at their homes by a team of culturally matched interviewers using a semi-structured questionnaire. Characteristics of participants were compared with existing population-based data to confirm their representativeness. Responses were transcribed, coded, and summarized, and findings are presented along with selective quotations. Key dimensions of feasibility were scored and charted for visualization.

Results

Findings revealed barriers regarding diet-related knowledge and skills, access to structured DSM education, hyperglycemia control, and environmental support for physical activity. Participants responded positively to receiving free DSM coaching at their FBOs. All participants preferred a qualified health care professional such as certified diabetes educator as their coach and wanted coaching in all aspects of DSM; however, food preparation/diet was the most frequently requested specific topic. Participants uniformly disliked contact with the coach through e-mails and text messages but liked receiving periodic telephone calls at home by the coach. Overall, DSM coaching at FBOs rated high on the key dimensions of feasibility, namely, affordability, accessibility, acceptability, cultural relevance, and safety.

Conclusions

This study sheds light on the feasibility of an FBO-based DSM intervention for the Indo-Guyanese. It offers insights into developing culturally appropriate DSM intervention format and strategy.
The Thin Line Between Empowering and Laissez-Faire Leadership: An Expectancy-Match Perspective
Authors: Wong Sut I , Giessner Steffen Robert
Published: March 2015

Empowering leadership and laissez-faire leadership are generally thought to represent quite different leadership styles—the former more active and directed in follower development and the latter more passive and dismissive of followers’ needs. The present study questions this sharp differentiation. Building on leader categorization theory, we suggest that empowering leadership can be perceived by followers as laissez-faire depending on followers’ empowerment expectations. Specifically, we propose that when leaders’ behaviors are not aligned with followers’ expectations (either higher or lower), followers may evaluate them as being laissez-faire. A two-stage field study of 150 leader-follower dyads employing a cross-level polynomial regression analysis supported our expectation-match hypotheses. Furthermore, followers’ perceptions of laissez-faire leadership as a mediator subsequently lead to lower leader effectiveness evaluation. Consequently, our results indicate that empowering and laissez-faire leadership in the perceptions of followers are closer to each other than researchers previously thought.
Treatment resistant or resistant to treatment? Antipsychotic plasma levels in patients with poorly controlled psychotic symptoms
Authors: McCutcheon Robert , Beck Katherine , Bloomfield Michael AP , Marques Tiago R , Rogdaki Maria , Howes Oliver D
Published: March 2015

A large proportion of individuals with schizophrenia show an inadequate response to treatment with antipsychotics. It can be unclear whether this is secondary to subtherapeutic antipsychotic plasma levels or to medication ineffectiveness. The purpose of the present study was to determine the extent of subtherapeutic antipsychotic plasma levels in a group of patients clinically identified as treatment-resistant. In addition we investigated the frequency of antipsychotic plasma level monitoring in standard clinical practice. Antipsychotic plasma levels were measured in 36 patients identified as having treatment-resistant schizophrenia by their treating clinicians. Sixteen (44%) patients showed either undetectable (19%) or subtherapeutic levels (25%), and 20 (56%) patients had levels in the therapeutic range. Subtherapeutic plasma levels were significantly associated with black ethnicity, shorter duration of current treatment and antipsychotics other than olanzapine and amisulpride. Antipsychotic plasma levels had been measured in only one patient in the year prior to our study. We found over one-third of patients identified as treatment-resistant have subtherapeutic antipsychotic levels. This indicates that they may be under-treated rather than treatment-resistant, and thus should receive different management. Currently the measurement of antipsychotic levels may be under-utilised.
Inflammatory Cytokines and Biomarkers of Cartilage Metabolism 8 Years After Anterior Cruciate Ligament Reconstruction
Authors: Åhlén Martina , Roshani Leyla , Lidén Mattias , Struglics André , Rostgård-Christensen Lars , Kartus Jüri
Published: March 2015

Background:

Patients who sustain an acute anterior cruciate ligament (ACL) rupture are at increased risk to develop posttraumatic arthritis (PTA) in the injured knee whether the ACL is reconstructed or treated nonoperatively. Inflammatory cytokines and cartilage degradation biomarkers are elevated at the time of acute injury and postoperatively. This suggests that one mechanism for PTA may be an inflammatory degradative process initiated on the acute injury and sustained for some length of time independent of whether adequate joint stability is restored.

Hypothesis:

Inflammatory cytokines and biomarkers of cartilage degradation are elevated in the synovial fluid several years after reconstruction of the ACL, indicating an ongoing imbalance between extracellular matrix destruction and repair.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

In 11 patients who had undergone ACL reconstruction 8 years earlier, knee synovial fluid was aspirated from the operated knee and the contralateral nonoperated knee. The synovial fluid was analyzed for interleukin (IL)–1β, IL-6, tumor necrosis factor (TNF)–α, sulfated glycosaminoglycans (sGAG), aggrecan neoepitope fragment (ARGS-aggrecan), and cartilage oligomeric matrix protein (COMP). At follow-up, the patients underwent bilateral weightbearing radiographs and bilateral MRIs of their knees.

Results:

No significant differences between the operated and the contralateral knee were found for the synovial fluid concentrations of IL-1β, IL-6, TNF-α, sGAG, ARGS-aggrecan, or COMP. There were significantly more radiographically visible osteoarthritic changes in the operated knees compared with the contralateral knees. MRIs revealed that all grafts and all contralateral ACLs were intact and, furthermore, that there was significantly more meniscal and cartilage damage in the index knees than the contralateral knees.

Conclusion:

Eight years after ACL reconstruction, there were no significant differences in inflammatory cytokines and biomarkers for cartilage degeneration between the nonoperated and the ACL-reconstructed knee, even though there were more osteoarthritic changes and meniscal and cartilage damage in the operated knee, as seen on weightbearing radiographs and MRI.
Strain rate effect on bond stress–slip relationship between basalt fiber-reinforced polymer sheet and concrete
Authors: Shen Dejian , Shi Xiang , Ji Yong , Yin Fenfang
Published: March 2015

Reinforced concrete structures that are strengthened with fiber-reinforced polymers frequently suffer dynamic loadings. The success of this strengthening method depends on the effectiveness of the bond between the fiber-reinforced polymer sheet and concrete. Determining the bond behavior between the fiber-reinforced polymer and concrete substrate is an important issue in technology because the typical failure mode of fiber-reinforced polymer-to-concrete joints is debonding of the composite from the concrete substrate. Although numerous experimental studies have investigated this static bond behavior, experimental data concerning dynamic tests on maximum bond stress, ultimate load, and the bond–slip relationship of the interface between basalt fiber-reinforced polymer sheets and concrete under different strain rates are lacking. This study presents an experimental investigation of the dynamic performance between the basalt fiber-reinforced polymer sheet and concrete under different strain rates. Double-lap shear specimens were used in the tests. The dynamic test results are reported and discussed in this paper to evaluate and compare the influence of the strain rate on the dynamic maximum bond stress, ultimate load, as well as the bond–slip relationship between the basalt fiber-reinforced polymer sheets and concrete. The data show that the maximum bond stress, ultimate load, and bond–slip relationship are sensitive to the strain rate. The test results indicate that (1) the dynamic maximum bond stress of the basalt fiber-reinforced polymer–concrete interface increases with the increase of the strain rate; (2) the dynamic ultimate load of the basalt fiber-reinforced polymer–concrete interface increases with the increasing strain rate as a logarithmic function; and (3) the strain rate has no effect on the slip at the maximum bond stress, and the dynamic bond–slip relationships of basalt fiber-reinforced polymer–concrete interface under different strain rates are similar. The calculation models of the dynamic maximum bond stress, ultimate load, and bond–slip relationship were established through a regression analysis of the dynamic test data while considering the influence of the strain rate.
Study of creep–fatigue behavior in a 1000 MW rotor using a unified viscoplastic constitutive model with damage
Authors: Wang WZ , Buhl P , Klenk A , Liu YZ
Published: March 2015

A unified viscoplastic constitutive model with damage is presented to describe creep–fatigue deformation behavior. Creep and fatigue tests under different temperature and loading conditions were conducted to validate the material model. Good agreement was achieved between the simulated and measured values. The material model was further applied to a specific part of a steam turbine rotor for numeric investigation of the creep–fatigue behavior. The multiaxial mechanical behavior of the rotor was studied in detail in terms of temperature, von Mises stress, equivalent strain, accumulated plastic strain, and damage. The results illustrate that the stress is concentrated on the notch of the groove. In addition, although the accumulation of damage at the rotor locations is dominated by creep behavior, the results actually disclose that the combination of creep and fatigue deformation behavior further accelerate the damage.
Numerical modelling of the compression-after-impact performance of a composite sandwich panel
Authors: James Chris T , Watson Andrew , Cunningham Paul R
Published: March 2015

A numerical model for the quasi-static indentation and compression-after-impact behaviour of a composite sandwich panel is presented, using cohesive surfaces for interlaminar damage prediction. Intra-laminar damage and core crushing is also included. The models show generally good agreement with experimental results for residual strength, performing best when two cohesive surfaces are used in the impacted skin, but tend to over-estimate the undamaged panel strength. Damage extent predictions from the indentation phase of the analysis are often quite poor, but do not necessarily correlate with the accuracy of the strength estimates. The model provides a promising basis for further development.
Deleterious Effect of Radiation Therapy on Epidermodysplasia Verruciformis Patients
Authors: de Oliveira Walmar Roncalli , da Cruz Silva Lana Luiza , Festa Neto Cyro , Tyring Stephen
Published: March 2015

Background:

Epidermodysplasia verruciformis (EV) is a rare genodermatosis caused by specific human papillomavirus (HPV) types associated with the development of multiple squamous cell carcinomas (SCC). The treatment for this skin tumour may be difficult. Among the therapy options, radiotherapy (RT) should be avoided due to its deleterious effects on HPV-induced carcinogenesis.

Objective:

To describe 4 patients with EV who underwent radiotherapy to treat cutaneous SCC.

Methods:

This is a retrospective study. The evolution of cutaneous SCC after adjuvant radiotherapy in 4 patients with EV was observed.

Results:

This study included 4 patients with diagnosis of EV. All 4 of the patients had cutaneous SCC. They underwent surgical resection and adjuvant radiotherapy. Over a period of up to 2 years, there was aggressive tumour recurrence.

Conclusion:

Radiotherapy might be associated with progression of SCC in patients with EV, and it is recommended that radiotherapy should be avoided in this patient population.
Coalition formation at the local level
Authors: Debus Marc , Gross Martin
Published: March 2015

This article examines the determinants of coalition formation on the local level. In addition to standard office- and policy-seeking variables, we incorporate the local institutional setting and the constraints on local coalition politics emerging from patterns of party competition at the superior level of the political system. We test our expectations on the basis of a dataset providing information on the characteristics of potential and formed coalitions in 29 German cities. The results show that – even on the local level, which is often described as less politicised – not only office-seeking variables but also the ideological positioning of parties are good predictors for local coalition formation in German cities. Additionally, our findings suggest that local political actors take the party affiliation of the directly elected mayor into account when forming coalitions in local councils. The findings imply that political actors on all levels of political systems try to maximise their payoffs and form coalitions accordingly.
Achieving high acceptability of HIV testing in a population-based survey among immigrants in Finland
Authors: Tiittala Paula J , Kivelä Pia S , Ristola Matti A , Surcel Heljä-Marja , Koponen Päivikki MS , Mölsä Mulki , Ollgren Jukka , Liitsola Kirsi
Published: March 2015

Aims: The aim of this study was to assess the acceptability of human immunodeficiency virus (HIV) testing among migrants in Finland and the factors contributing to non-acceptance. Methods: The Finnish Migrant Health and Wellbeing Study ‘Maamu’ was the first national population-based Health Interview and Examination Survey (HIS/HES) among migrants in Finland. A total of 386 Kurdish, Russian and Somali immigrants in Helsinki participated in the study. Results: Despite the participants’ different sociodemographic backgrounds, a high rate of test acceptability (92%, 95% CI 90–95) was achieved. HIV test acceptance was associated with pretest counselling, ability to understand spoken Finnish or Swedish and employment status. No participants tested positive for HIV. Conclusions: The results imply that a universal HIV testing strategy is well accepted in a low-HIV prevalence immigrant population and can be included in a general health examination in immigrant population-based surveys.
News via Voldemort: Parody accounts in topical discussions on Twitter
Authors: Highfield Tim
Published: March 2015

Parody accounts are prevalent on Twitter, offering irreverent interpretations of public figures, fictional characters and more. These accounts post comments framed within the context of their fictional universes or stereotypes of their subjects, responding in-character to topical events. This article positions parody accounts as a ritualised social media practice, an extension of fan practices and irreverent Internet culture. By providing a typology of parody accounts and analysing the topicality of selected parody accounts’ tweets, the research examines how these accounts contribute to topical discussions. In-character framing of topical comments allows parody accounts to offer original interpretations of breaking news that receive more attention than their other tweets. The presence and longevity of parody accounts underline the importance of humour on social media, including within news and topical coverage.
Multibody modelling of an internal gyroscopic micro-mechanism for development of lateral deviation of a projectile
Authors: Umstead CM , Tay YY , Lankarani HM
Published: March 2015

The lateral control of a projectile for targeting and impacting a nonstationary target is of interest in many applications. Through the use of internal moving parts, gyroscopic forces can be generated, thus changing the flight trajectory of the projectile. In this study, three small internal swing masses are introduced to the projectile and their motions are controlled. The masses are attached to the end of massless rods that are located on points of an equilateral triangle centered about the major axis of the projectile. A mathematical model for the internal gyroscopic rotating disks of this multibody mechanism and its trajectory path is presented. For this mechanism, the dynamics equations of motion are developed and solved numerically to simulate the trajectory of the projectile. The concept projectile model is shown to move cyclically about the axis of rotation and to deviate from its axis in a relatively even slope. A parametric study is then focused on actuating each mass in sequence or changing the weight of the masses and their initial positions to examine and evaluate the flight trajectory of the projectile. The results from this study show that the lateral deviation of a projectile can be controlled by altering the initial configuration of the rotating mass mechanism. This application may hold merit for controlling the re-entry flight trajectory of air vehicles.
Effect of annealing on the microstructures and deformation behaviour of Ti–50.7at.%Ni shape memory alloy
Authors: Hastuti Kurnia , Hamzah Esah , Hashim Jasmi
Published: March 2015

In this paper Ti–50.7at.%Ni as a commercial material was examined to analyse the effect of annealing temperature on the microstructure and deformation behaviour. It was found that the microstructure and deformation behaviour of as-received material was affected by the existence of dislocations that was introduced during manufacturing process. The presence of martensite variant and the B2 austenite broadening in XRD spectra of as-received material verified this conclusion. However, annealing treatment has gradually eliminated this effect. The plateau region on stress–strain curve which was absent in the as-received material started to appear and get longer with increasing annealing temperature. Maximum tensile strength was observed in the sample annealed at 400 ℃ for 1 h. Annealing treatment above 500 ℃ transformed the B19′ martensite to B2 austenite, which leads to a decrease in the tensile strength of the material. Nearly perfect superelasticity was found in the as-received material and sample annealed at 300 ℃.
Objects past, objects present: Materials, resistance and memory from the Le Morne Old Cemetery, Mauritius
Authors: Seetah Krish
Published: March 2015

This article centres on two distinct material assemblages, both representing resistance but in markedly different ways and at different times. It introduces a regional comparative of religious syncretism, longanis, to an archaeological audience. Longanis, a belief system that developed within slave communities, offers insightful similarities to Atlantic counterparts, as well as unique features in its own right. The article applies an archaeological viewpoint to burial and belief practice to better assess the role that materials have played in serving as proxies for African toolkits and memory.
Using purpose-made objects for visual research: an exploratory case study
Authors: Hinthorne Lauren Leigh , Simpson Reeves Laura
Published: March 2015

This article responds to Pauwels’ assertion that visual research is no longer the (nearly) exclusive domain of camera-based visual materials and methods. The authors argue that, in certain contexts, objects can provide appropriate and valid visual research materials in their own right. The article begins by examining the institutionalized parameters for visual research established by this journal ( Visual Communication), Visual Studies and the International Visual Sociology Association. Next, a careful review of the contemporary literature reveals that objects are already recognized as legitimate visual research materials, albeit discreetly. After describing an exploratory research process that integrated participatory mapping and 3D model-building activities, the authors discuss the potential of purpose-made objects as a distinctive type of visual material. The article concludes by encouraging the acceptance of visual research that looks beyond images.
Subjective quality of life of those 65 years and older experiencing dementia
Authors: Stewart-Archer Lois A , Afghani Afrooz , Toye Christine M , Gomez Frank A
Published: March 2015

Background/Objectives

To describe how people experiencing dementia define quality of life and how this may be supported.

Design

Qualitative descriptive component of mixed methods cross-sectional study.

Setting

Western Canadian community (4-h weekly care minimum), supportive housing (24-h support/supervision), personal care homes (24-h nursing).

Participants

One hundred and thirty-six persons aged 65+ experiencing dementia.

Measurements

Semi-structured interview questions. Rating of meeting life’s goals.

Results

Participants characterised quality of life as: freedom, independence, having basic needs met, physical health, engagement in meaningful activities and tranquility. A need for self-determination/choice was evidenced across all domains. Increased access to skilled nursing care, support for meaningful engagement with family and meeting life’s goals were endorsed as adding most to quality of life; 43% reported meeting all life’s major goals.

Conclusion

People experiencing dementia may have better quality of life when choice/self-determination is supported. Enhancements in care environment, independence, engagement and meeting of life’s goals merit urgent attention.
Swedish preschool teachers’ ideas of the ideal preschool group
Authors: Pramling Samuelsson Ingrid , Williams Pia , Sheridan Sonja , Hellman Annette
Published: March 2015

In Sweden, preschool has been noted as being of a high quality compared to many other countries. However, dramatic changes in the preschool sector are taking place. A recent law states that it is a child’s right to get a preschool place within a few months. As a consequence, the number of children in preschool has increased, which could influence group sizes since there is no state regulation of the number of children in a group. This article based on the project The impact of group size on children’s affordances in preschool aims to describe and analyse preschool teachers’ ideas of what an ideal preschool group is. It is a qualitative study based on a questionnaire with mainly open-ended questions, answered by preschool teachers. The results show that preschool teachers define a well-functioning group as having a balance between gender, age and ethnicity. The preschool teachers stress that they prefer a group with fewer children than they have today. A key aspect of having a well-functioning group is also the preschool teachers’ competence and the preschool environment. Preschool teachers’ ideas of what constitute an ideal group of children may contribute to why they perceive the group size too large.
Endograft Planning without Preoperative Arteriography: A Clinical Feasibility Study
Authors: Beebe Hugh G. , Kritpracha Boonprasit , Serres Sharon , Pigott John P. , Price Charles I. , Williams David M.
Published: March 2015

Purpose:

To investigate an alternative method of preprocedural planning for aortic endografting based solely on spiral computed tomography (CT) with 3-dimensional (3D) reconstruction without preoperative arteriography.

Methods:

From August 1997 to April 1998, 25 consecutive patients with abdominal aortic aneurysms (AAA) were evaluated for endovascular repair by spiral CT scans (2-mm slice thickness) and computerized 3D model construction. No additional imaging for planning was performed. The aortoiliac dimensions, thrombus load, calcification, and vessel tortuosity were measured and evaluated from the 3D model of the aortoiliac segment. These data were used for selecting the patients; the configuration, diameter, and length of the endograft; and the attachment sites for deployment.

Results:

Primary procedural success was 92% (23/25). All endografts were deployed as planned, and there were no conversions to open repair. Six patients required adjunctive procedures for delivery system access or for iliac aneurysm exclusion, as predicted by the 3D model. Mean procedural time was 91 minutes (range 24 to 273). Two (8%) type II (side branch) endoleaks both sealed spontaneously within 1 month. No graft-related complications or death occurred, for a 30-day technical success rate of 100%.

Conclusions:

This computerized 3D model provided accurate data for preoperative evaluation of the aortoiliac segment for endovascular AAA repair. Satisfactory technical outcomes for aortic endografts can be achieved without the use of preprocedural invasive imaging.
Immediate Endovascular Repair for Descending Thoracic Aortic Transection Secondary to Blunt Trauma
Authors: Lobato Armando C. , Quick Rhonda C. , Phillips Bradley , Vranic Mitar , Rodriguez-Lopez Julio , Douglas Myles , Diethrich Edward B.
Published: March 2015

Purpose:

To report the immediate endovascular treatment of a thoracic aortic tear secondary to blunt trauma.

Methods and Results:

A 39-year-old man was injured in a motor vehicle collision. In addition to significant trauma to the head, chest, and abdomen, there were signs of a deceleration injury to the thoracic aorta. After urgent celiotomy to repair a lacerated spleen, the thoracic aortic transection was treated intraluminally using an endograft made of Gianturco Z-stents covered with polytetrafluoroethylene. The patient recovered from his injuries, and the thoracic endograft shows no evidence of endoleak 7 months after treatment.

Conclusions:

Endoluminal techniques can be used successfully in the immediate repair of thoracic aortic injuries.
Sigmoid Ischemia and the Inflammatory Response following Endovascular Abdominal Aortic Aneurysm Repair
Authors: Elmarasy Nabil M. , Soong Chee V. , Walker Stuart R. , Macierewicz Jan A. , Yusuf Syed W. , Wenham Peter W. , Hopkinson Brian R.
Published: March 2015

Purpose:

To assess the relationship between sigmoid colonic perfusion, endotoxemia, and cytokine generation in patients undergoing elective open repair (OR) or endovascular repair (EVR) of infrarenal abdominal aortic aneurysms (AAA).

Methods:

Ten patients (9 males; average age 67.6 ± 2.5 years, mean aneurysm diameter 6.9 ± 0.6 cm) undergoing OR were compared to 10 patients (all males; average age 70.3 ± 2.6 years, mean aneurysm diameter 6.5 ± 0.5 cm) whose repair was performed using the EVR technique. The partial pressure of the carbon dioxide gap (Pco2gap = tissue Pco2 — arterial Pco2) of the sigmoid colonic mucosa was measured using a silicone tonometer to evaluate bowel perfusion. Blood samples were collected into pyrogen-free heparinized tubes for quantification of plasma concentrations of endotoxin, tumor necrosis factor alpha (TNF-α), and interleukin 6 (IL-6) before, during, and after aortic repair.

Results:

Patients in the OR group had a significantly greater increase in Pco2gap, suggesting a greater degree of bowel ischemia compared to the EVR group. This was associated with significantly greater postoperative concentrations of endotoxin, TNF-α, and IL-6 in the OR group. A significant correlation was found between Pco2gap, IL-6, and postoperative core temperature.

Conclusions:

The results suggest that the degree of bowel ischemia, endotoxemia, and cytokine generation following elective infrarenal AAA reconstruction may be reduced if the endovascular technique is used instead of conventional surgery.
Carotid Stenting for Severe Radiation-Induced Extracranial Carotid Artery Occlusive Disease
Authors: Al-Mubarak Nadim , Roubin Gary S. , Iyer Sriram S. , Gomez Camilo R. , Liu Ming W. , Vitek Jiri J.
Published: March 2015

Purpose:

To present our experience with carotid artery stenting as an alternative treatment to endarterectomy in patients with radiation-induced carotid artery occlusive disease.

Methods and Results:

Fourteen patients (10 males; mean age 61 years, range 52 to 79) underwent percutaneous stenting of 15 carotid arteries for severe radiation-induced extracranial stenoses. Technical success was achieved in all patients, with reduction of the mean stenosis from 77% ± 6% to 8% ± 2%. In 2 patients, ipsilateral vertebral artery lesions were stented concomitantly. One patient had a minor stroke after the procedure but recovered fully in 2 days. No other complications were encountered. Nine (64%) patients had 6-month follow-up imaging (angiography or duplex scanning) that showed no evidence of restenoses (obstruction ≥50%). At 18 ± 2 months, 3 (21%) patients had died from unrelated causes. No neurological events occurred, and no repeat carotid artery interventions were required in the remaining patients.

Conclusions:

Carotid stenting is an effective treatment option for severe radiation-induced carotid artery occlusive disease.
Endovascular Repair of Thoracic Aortic Aneurysm in Dogs: Evaluation of a Nitinol-Polyester Self-Expanding Stent-Graft
Authors: Formichi Maxime , Marois Yves , Roby Patrice , Marinov Georgui , Stroman Patrick , King Martin W. , Douville Yvan , Guidoin Robert
Published: March 2015

Purpose:

To validate the ease of deployment and in vivo healing performance of a nitinol-polyester self-expanding stent-graft using a canine thoracic aortic aneurysm model.

Methods:

Arterial aneurysms were surgically created in 8 dogs by sewing a polyester patch onto the anterior side of the thoracic aorta. The nitinol-polyester self-expandable stent-grafts (Cragg EndoPro System 1) were implanted transluminally via the femoral route and deployed at the site of the thoracic aneurysm. Aneurysm exclusion and endograft patency were assessed by angiography after implantation and before animal sacrifice at scheduled periods ranging from 1 week to 3 months. The explanted specimens were examined with magnetic resonance imaging (MRI) to study the position of the stent-graft with respect to the aneurysmal sac. Histological analysis using light microscopy and scanning electron microscopy was performed to examine the inflammatory response and healing characteristics of the device.

Results:

Seven of 8 stent-grafts were implanted successfully; a bend occurred within the aneurysmal sac in 1 dog, which led to continued perfusion of side branches. This endoleak sealed spontaneously within 1 week, and complete exclusion of the aneurysms in all 8 animals continued throughout implantation. At the time of explantation, all devices were structurally intact and well positioned in the aneurysmal sac. At 1 week, the luminal surface displayed a thin layer of thrombotic matrix, which was gradually replaced by a collagenous internal capsule with endothelial-like cell coverage along both ends of the stent-grafts at 2 and 3 months. No exacerbated inflammatory reaction due to either the nitinol wires or the polyester sleeve was observed after 3 months of implantation.

Conclusions:

This short-term in vivo study of a nitinol-polyester self-expanding endograft demonstrated the effective exclusion of thoracic aneurysms with a satisfactory healing response and no excessive tissue or inflammatory reactions.
Open Subintimal Angioplasty of the Superficial Femoral and Distal Arteries
Authors: Balas Panagiotis , Pangratis Nicolas , Ioannou Nikos , Milas Photis , Klonaris Christos , Masouridou Efi
Published: March 2015

Purpose:

To describe an open approach to subintimal angioplasty.

Technique:

Through a subinguinal incision and arteriotomy over the superficial femoral artery origin, the opening of a subintimal channel is created surgically. The subintimal plane is advanced distally with a guidewire, and this neolumen is expanded with sequential balloon dilations. The atherosclerotic core is dissected proximally in the common femoral artery and tacked down to ensure inflow. A patch graft closes the arteriotomy.

Conclusions:

Open subintimal angioplasty is a simple, minimally invasive alternative treatment for complete SFA occlusion. Long-term follow-up in a large group of patients will be necessary to determine the durability of the false arterial lumen.
First-Generation Aortic Endografts: Analysis of Explanted Stentor Devices from the EUROSTAR Registry
Authors: Guidoin Robert , Marois Yves , Douville Yvan , King Martin W. , Castonguay Martin , Traoré Amidou , Formichi Maxime , Staxrud Lars Erik , Norgren Lars , Bergeron Patrice , Becquemin Jean-Pierre , Egana Jose M. , Harris Peter L.
Published: March 2015

Purpose:

To examine the structure and healing characteristics of chronically implanted Stentor endografts that were explanted due to migration, endoleak, thrombosis, or aneurysm expansion.

Methods:

The devices were harvested following reoperation (n = 5) or autopsy (n = 1) with implantation times ranging from 13 to 53 months. Structural modifications to the metal components were examined using radiography, endoscopy, and magnetic resonance imaging (MRI). Specimens taken from components of the modular stent-grafts were examined histologically and with scanning electron microscopy (SEM) to assess healing behavior. Physical and chemical stability of the nitinol wires and woven polyester graft material was evaluated using SEM and electron spectroscopy for chemical analysis.

Results:

Although the endografts were retrieved for a variety of reasons, they exhibited similar healing and structural modifications. The woven polyester sleeve showed evidence of yarn shifting and distortion, yarn damage, and filament breakage leading to the formation of openings in the fabric. The luminal surface endografts showed incomplete healing characterized by a poorly organized, nonadherent thrombotic matrix of variable thickness. Radiographic and endoscopic observations indicated that structural failure of the grafts, particularly in the main aortic component, was related to severe compaction and dislocation of the metallic frame due to suture breaks. Corrosion marks were observed on some nitinol wires in all devices. Chemical analysis and ion bombardment of the nitinol wires revealed that the surface concentrations of titanium and nickel were not homogenous. The first layer was composed of carbon or organic elements, followed by a stratum of highly oxidized titanium with a low nickel concentration; the titanium-nickel alloy lay beneath these layers.

Conclusions:

Although the materials selected for construction of endovascular grafts appears judicious, the assembly of these biomaterials into various interrelated structures within the device requires further improvement.
Cerebrospinal Fluid Drainage to Reverse Paraplegia after Endovascular Thoracic Aortic Aneurysm Repair
Authors: Tiesenhausen Kurt , Amann Wilfried , Koch Günter , Hausegger Klaus A. , Oberwalder Peter , Rigler Bruno
Published: March 2015

Purpose:

To report a case of endovascular descending thoracic aortic aneurysm (TAA) repair in which delayed-onset paraplegia was reversed using cerebrospinal fluid (CSF) drainage.

Methods and Results:

A 74-year-old patient with a 6.0-cm TAA underwent endovascular stent-graft repair that involved overlapping placement of 3 Talent devices to cover the 31-cm-long defect. Twelve hours later, a neurological deficit occurred manifesting as left leg paralysis with paresis on the right. After urgent intrathecal catheter placement and drainage of cerebrospinal fluid for 48 hours, the neurological deficit resolved. The patient's clinical condition was normal and endoluminal exclusion of the TAA remained secure at 8-month follow-up.

Conclusions:

This case demonstrates the potential therapeutic role for CSF drainage to reduce the complications of spinal cord injury after endovascular thoracic aneurysm repair.
Aortic Aneurysm Size and Graft Behavior after Endovascular Stent-Grafting: Clinical Experiences and Observations over 3 Years
Authors: Schunn Christian D. , Krauss Martin , Heilberger Peter , Ritter Wolfgang , Raithel Dieter
Published: March 2015

Purpose:

To assess the long-term safety and efficacy of aortic endografts in terms of clinical outcome, continuing aneurysm exclusion, and changes of aneurysm size and graft configuration.

Methods:

Between August 1994 and July 1997, 190 patients (176 men; mean age 68.7 years, range 40–87) with aortic and aortoiliac aneurysms were treated with endovascular stent-grafts (Stentor, Vanguard, and EGS) in a tertiary care municipal hospital setting. Follow-up involved clinic visits every 3 to 6 months with contrast-enhanced computed tomography (CT), color duplex, and plain abdominal radiographs at regular intervals; angiography was used selectively. All data were collected prospectively and entered into a computerized database.

Results:

Implantation was possible in 188 (98.9%) patients. Early conversion to open surgical repair was required in 14 (7.4%) patients. Primary endoleaks were detected in 32 (16.8%) patients. Perioperative mortality was 0.53% (1/190). During follow-up, 17 (8.9%) additional patients were converted to open repair over a mean 20.9 months. Thirty-seven secondary procedures to treat endoleaks and pelvic outflow occlusions were performed in 30 (15.8%) patients. Changes in stent configuration suggestive of endograft disintegration were observed in 31 (29.8%) of 104 abdominal radiographs. Intraluminal layering of thrombus was seen on contrast-enhanced CT images in 20 patients. A significant trend (χ24 = 12.34, p < 0.025) toward aneurysm enlargement was seen in patients with persistent endoleaks at a mean 18-month follow-up.

Conclusions:

Although endoleaks after aortic stent-graft placement tend to cause ongoing aneurysm growth, we have also observed aneurysm shrinkage despite ongoing endoleak. The presence or absence of an endoleak in itself may be a poor predictor of successful stent-graft therapy. Lifelong surveillance is needed to assure successful aneurysm exclusion and stability or shrinkage of the aneurysm sac. Technical improvements in stent materials and design are necessary to guarantee long-term stability and safety of the device.