bluuebunny/crossref_metadata_2025 huggingface dataset:
Unconventional Therapy Use Among Children With Cancer in Saskatchewan
Authors: Bold June , Leis Anne
Published: February 2016

The study aimed to estimate the prevalence of unconventional therapy use among children with cancer in Saskatchewan, including identification of the most commonly used therapies, and to describe families' expectations and experiences in doing so. Researchers used a cross-sectional survey design with semi-structured telephone interviews to suit the descriptive and explor atory inquiry and the population focus. The personal telephone interviews occurred during the fall and winter of 1996 to 1997, with the parents coming from a wide range of geographic areas in the province of Saskatchewan. Parents of all children who were aged 14 years or younger when diagnosed with cancer during 1994 and 1995 in Saskatchewan and still living at the time of the study were identified through the provincial cancer registry with the assistance of the Saskatchewan Cancer Agency. Of the 44 families partici pating (92% of those eligible), 36% reported using unconventional therapy for their child's cancer; another 21% considered it. Reasons included comple menting medical treatment, coping with side effects; making the child stron ger ; and stopping the cancer. Experiences were generally positive. Reasons for not using unconventional therapies included the child doing well and parents placing confidence in the medical system. Parents identified a need for better quality information about unconventional therapies. Unconventional therapies play a substantial complementary role in cancer care for children. Families need support to identify safe and potentially helpful therapies when they choose that route. This requires: more research about therapies' effectiveness; more accessible, quality information; and more training for health professionals in understanding and discussing unconventional therapies. There is considerable research showing that use of unconventional therapies, also known as comple mentary or alternative therapies, is high among adult cancer patients. Although it is likely reasonable to assume this may also be true for children, there is almost no research on children's use of unconventional therapies for cancer. Knowing the extent of children's use of unconventional therapies and whether those experiences have been beneficial or harmful is essential for parents and health professionals making quality care decisions for children.
Describing the Value of Specialized Distance Education in Pediatric Oncology Nursing
Authors: Taylor Jennifer A. , Hobbie Wendy , Carlino Heather , Deatrick Janet , Fergusson Jean , Lipman Terri
Published: February 2016

Working as specialists in a changing environment, advanced practice nurses in pediatric oncology (APN-POs) benefit from specific pediatric oncology education. The graduates of a pediatric nurse practitioner pro gram in pediatric oncology completed a survey about their educational experience and its impact on their current practice. This practitioner program included a subspecialty education in pediatric oncology and an early form of distance learning. The respondents' answers parallel a num ber of emerging themes in APN-PO practice and education. Employing distance learning methods in providing subspecialty education holds im portant implications for future APN-PO education and practice and for the health care of communities throughout the country.
The Treatment of Retinoblastoma: A Case Study
Authors: Tomlinson Deborah
Published: February 2016

Research in the treatment of retinoblastoma and multidrug resistance has led to new treatment protocols for children. This case study introduces information regarding a clinical trial for the treatment of intraocular reti noblastoma. It also highlights important nursing issues in the care of these children and their families.
Childhood Leukemia: Understanding the Significance of Chromosomal Abnormalities
Authors: Robinson Deborah L.
Published: February 2016

The survival for children with acute lymphoblastic leukemia (ALL) has increased from 3% to greater than 70% in the last 30 years, with some patients achieving 95% survival. These advances have been made not only because therapy has improved, but also because there is a much greater understanding of the diversity of ALL. The identification of clinical and biological prognostic factors associated with ALL has resulted in the formation of subsets of patients classified into risk groups. Although age, initial white blood cell count, and central nervous system or testicular disease are all important prognostic factors, cytogenetic abnormal ities have now emerged as the single most important prognostic factor for children with ALL. There are specific cytogenetic findings in the leukemic blast cells of these children that influence their prognosis. Some of these findings are positive factors and some adverse. Treatment protocols for ALL today are now determined by these specific chromosomal abnormalities.
Parents' Perception of Their Child's Food Intake After the Start of Chemotherapy
Authors: Skolin Inger , Koivisto Hursti Ulla-Kaisa , Wahlin Ylva Britt
Published: February 2016

Adequate nutrition is an important part of supportive therapy for the pediatric cancer patient. The aim of this study was to assess parents' perceptions of their child's eating pattern after onset of chemotherapy and the strategies they used to cope when eating problems arose. A semistructured interview was performed with parents of 11 consecutively admitted children. The results showed that parents have a realistic perception of their child's food intake and that they are able to recognize reasons for poor food intake that may be unknown to the staff. The individual responses of the parents and the mechanisms of coping were unique for each individual. The responsibility of getting the child to eat was distressing for many parents. The study indicates that parents need continuous support to serve an optimal role in the nutritional care of their child.
International Hematology-Oncology Nursing Education in Latin America
Authors: Donahue Nora , Wilimas Judy , Urbina Concepcion , de Grimaldi Gilma , Ribeiro Raul
Published: February 2016

In countries with limited resources, the multidisciplinary hematology-oncology (H-O) treatment team model, which relies heavily on highly trained nurses, is generally not in use. Since 1996, St. Jude Children's Research Hospital has been working with medical centers in Mexico and Central and South America to improve the specialty training of nurses in pediatric H-O. In 1999, St. Jude developed a strategic plan to organize a cooperative nursing education project. The initial preparation consisted of three phases. In phase one, a curriculum was developed. A consultant was hired to create and institute an evaluation system for nurse graduates of the program and for the program itself. Phase two explored the possible collaborations among existing training centers and contracted with a nurse educator to provide on-site support. In phase three, a core team of skilled multicultural nursing educators was formed. To initiate the program, we used the "Teach the Teachers" method. Four classes to date have trained 76 nurses from different countries in Latin America. Development of the International Training Center for Hematology-Oncology Nurses in Latin America has been a challenging and rewarding experience. We hope that others will find it useful in planning international education programs that will not only serve the nursing profession, but also improve the quality of care of all children, regardless of their back ground, race, religion, or economic status.
The Role of the Primary Care Advanced Practice Nurse in Evaluating and Monitoring Childhood Cancer Survivors for a Second Malignant Neoplasm
Authors: Kolb Smith Pamela C.
Published: February 2016

The purpose of this literature synthesis was to (a) identify second malignant neoplasms found in childhood cancer survivors and (b) make recommendations for the advanced practice nurse's role in the primary care setting regarding health promotion activities and surveillance strategies for survivors across the life span. The database search produced 73 research articles published in English between 1990 and 2000 that were significant to the purpose of the study. The results identified genetic or familial factors, radiation therapy, and chemotherapy as risk factors for later developing a second malignant neoplasm. Each theme was analyzed, and guidelines were developed for primary care advanced practice nurses which integrated health promotion and surveillance activities for this patient population.
Uncertainty, Anxiety, and Symptoms of Posttraumatic Stress in Parents of Children Recently Diagnosed with Cancer
Authors: Santacroce Sheila
Published: February 2016

The purpose of the study was to describe relationships between uncertainty, anxiety, and symptoms of posttraumatic stress (PTS) in parents of children recently diagnosed with cancer. The study was guided by the Uncertainty in illness Theory. The setting was a children's hospital. Participants were 15 parents of 12 children recently diagnosed with cancer. Anxiety was measured by the State-Trait Anxiety Inventory. Uncertainty was measured by the Parent Perception of Uncertainty Scale. Symptoms of PTS were measured by the Reaction Index. Total scale scores were calculated and psychometrics estimated. Differences in uncertainty, anxiety, and symptoms of PTS by parent race were assessed using analysis of variance. The correlation matrix was estimated to assess relationships between variables. The level of uncertainty was lower than expected, but was significantly higher for black parents (p < .001). The level of anxiety was comparable to that for hospitalized persons with anxiety disorders. The level of symptoms of PTS was higher than reported for parents of childhood cancer survivors. The relationship between anxiety and symptoms of PTS was significant (r = .56, p < .02). Pediatric oncology nurses should offer parents interventions to relieve high levels of anxiety and symptoms of PTS; some parents could also benefit from interventions that target uncertainty.
End of Life in Pediatric Oncology: How Clinical Practice Leads to Research
Authors: Pritchard Michele , Davies Betty
Published: February 2016

In pediatric oncology nursing, and across practice disciplines in general, clinical research serves as the cornerstone for improving patient care. Historically, advances made in the care and cure of childhood cancer have stemmed directly from clinical research. The development of new research questions are varied in their origin—some questions are based on previous work that leads logically to the next question, some are based on a clinical problem that requires more immediate attention, and then there are those that arise from an individual clinical experience. This last category provides clinicians with a poignant reason to search for answers on how to provide the most optimal care for all future patients. As the number of advanced practice nurses in pediatric oncology increases, there is the likelihood of an increased pursuit of clinical research. This article describes how one clinician's experience with dying children resulted in the pursuit of answers to clinical research questions. By reflecting on clinical practice and incorporating our practice in the development of research questions, we can improve the quality of care provided to all children with cancer.
The Development of an Off-Therapy Needs Questionnaire and Protocol for Survivors of Childhood Cancer
Authors: Nagel Kim , Eves Marilyn , Waterhouse Linda , Alyman Cheryl , Posgate Susan , Jamieson Janet , Metzger Victoria , Wright Marilyn
Published: February 2016

The purpose of this project was to obtain input from the families of survivors of childhood cancer regarding their needs surrounding the "coming off treatment" (COT) period. A questionnaire was developed to record their needs, their wishes, and their satisfaction surrounding this period of time. Closer examination of the time surrounding COT was undertaken in an attempt to enhance this area of service for patients and families in our clinic setting. Establishing a structured protocol is likely to alleviate some of the anxiety that surrounds this time for families and help us to provide better continuity of care. After identifying a cohort of patients and families, the reason for the survey was explained and they were asked to complete the questionnaire before they left the clinic setting. At the completion of the study, 82% of the cohort had been approached, and 100% of this group had completed the survey (n = 41). Less than 50% of participants felt they had had a formal "coming off treatment" review but, of that same group, 89% were satisfied with the process. Participants identified areas of importance and health care professionals who they would like involved in the COT process. After reviewing the responses to the questionnaires, the decision was made to proceed in preparing a COT protocol.
Through Their Words
Authors: Linder Lauri A. , Seitz Marie
Published: February 2016

An increased intensity of inpatient treatment, hospital-based routines, and separation from the familiar home environment may collectively increase the burden of the pediatric cancer experience. This study explored children and adolescents’ perceived sources of bother related to hospitalization using two questions: (1) What bothered you the most about the hospital or hospital environment? and (2) What do you think could improve the hospital or hospital environment? Fifty children and adolescents (mean age 12.6 years) responded to these questions during each shift of a 3-day/3-night data collection period. Responses were analyzed using content analysis and chi-square analyses. Themes related to sources of bother included (1) “nothing/don’t know,” (2) “treatment and its consequences,” (3) “isolation and loneliness,” (4) “imposed bother,” (5) “negative environment,” and (6) “staff behaviors.” Themes related to improving the hospital environment included (1) “nothing/don’t know,” (2) “normalizing activities,” (3) “quality of the hospital environment,” (4) “decrease burden of cancer and its treatment,” and (5) “patient care issues.” Participants’ responses to these questions provide a foundation for actionable change to alleviate the burden associated with hospitalization.
Is E-Reader Technology Killing or Kindling the Reading Experience?
Authors: Hancock Gabriella M. , Schmidt-Daly Tarah N. , Fanfarelli Joseph , Wolfe Jurate L. , Szalma James L.
Published: February 2016

The advent of e-reader technology has spawned a fundamental change in the reading experience. Such devices are meant to address what are perceived as shortcomings or flaws in the design of traditional paper-based books. Yet, as with any new technology, e-readers possess their own unique set of advantages and disadvantages, which we explore here. Research concerning reading media indicates a mild yet pervasive preference for traditional books, yet e-readers continue to gain in popularity. We offer quantitative data relating to readers’ attitudes and preferences for information presentation so as to better guide efforts for the design of e-reader systems.
Bypass, Augment, or Integrate
Authors: Chandler-Olcott Kelly , Doerr Helen M. , Hinchman Kathleen A. , Masingila Joanna O.
Published: February 2016

This 3-year qualitative study examined how 26 teachers in four U.S. secondary schools addressed the literacy demands of curriculum materials based on standards from the National Council of Teachers of Mathematics. It was grounded in sociocultural perspectives that encourage study of language in local contexts, including classrooms, communities, and disciplines. The research question asked, “How do secondary mathematics teachers in a teacher–researcher collaboration understand and address the literacy demands of standards-based curriculum materials?” An interdisciplinary team of literacy and mathematics education researchers and graduate students worked with teachers to examine required curriculum materials, plan lessons, and share resources, while collecting qualitative data to capture teachers’ understandings and actions. Findings indicated that teachers responded in three ways to the materials’ literacy demands: (a) they used the materials selectively to bypass or reduce the literacy demands, (b) they augmented use of the materials with literacy support, or (c) they integrated use of the materials into long-term frameworks to develop mathematics and literacy learning simultaneously. The study suggests the value of using insights from mathematics and literacy to inform mathematics curriculum design and reminds us to take teachers’ perspectives toward such materials seriously, particularly when they collaborate to address issues about the materials’ use in their own school contexts.
DSM-5 and Other Symptom Thresholds for ADHD: Which Is the Best Predictor of Impairment in College Students?
Authors: Hartung Cynthia M. , Lefler Elizabeth K. , Canu Will H. , Stevens Anne E. , Jaconis Maryanne , LaCount Patrick A. , Shelton Christopher R. , Leopold Daniel R. , Willcutt Erik G.
Published: February 2016

Objective: Approximately 5% of adults have ADHD. Despite recommendations regarding the diagnosis of emerging adults, there is not a strong consensus regarding the ideal method for diagnosing ADHD in both emerging and mature adults. We were interested in determining whether a threshold of four, five, or six ADHD symptoms would be associated with significantly different levels of functional impairment and be more or less indicative of a potential ADHD diagnosis. Method: We examined the relation between functional impairment and these ADHD symptom thresholds in 2,577 college students. Results: Our findings suggest that none of these symptom thresholds are differentially better at predicting functional impairment. Conclusion: The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) threshold of five symptoms for ages 17 years and older is not necessarily predictive of ADHD-related impairment in college students and may not be preferable to other thresholds. Options for resolving this diagnostic dilemma are discussed.
A Probabilistic-Based Approach to Evaluate Winter Maintenance Vehicle Wash Water Management Options
Authors: Miller Christopher M. , Slaga Joshua , Kennedy Marla J. , Schneider William H.
Published: February 2016

When locating new facilities, departments of transportation must consider how the wash water generated during routine winter operations will be managed. Previous research has shown that two options are likely to be the most cost-effective: (a) collecting and hauling off-site for disposal (CDISPOSE) or (b) connecting to an existing sanitary sewer system (CSAN). In this article, the cost-effectiveness of these two strategies for Ohio Department of Transportation (ODOT) maintenance facilities was evaluated probabilistically using Monte Carlo simulation. The probability CDISPOSE was the most cost-effective option was greater than 90% for existing ODOT facilities without sanitary sewer access if the sanitary sewer capital cost exceeded US$172,000. Considering all ODOT facilities, there was 90% probability CDISPOSE was the most cost-effective option if the sanitary sewer capital cost exceeded US$280,000. These results can be used to guide facilities management decisions regarding wash water management options for both existing and future facilities.
Association between psychosomatic health symptoms and common mental illness in Ghanaian adolescents: Age and gender as potential moderators
Authors: Glozah Franklin N , Pevalin David J
Published: February 2016

Little is known about the role of age and gender in the association between psychosomatic symptoms and common mental illness in Ghanaian adolescents. This cross-sectional study examined age and gender as moderators between psychosomatic symptoms and common mental illness using data from a school-based survey ( N = 770). Males reported higher psychosomatic symptoms and common mental illness, while younger adolescents reported higher common mental illness only. Psychosomatic symptoms were positively associated with common mental illness, but age and gender did not moderate this association. Interventions aimed at reducing the prevalence rate in psychosomatic symptoms are crucial in decreasing common mental illness in Ghanaian adolescents.
English single content morphemes in Persian structure: Applying the Matrix Language Frame Model (MLF) and 4M Model
Authors: Hadei Marzieh , Ramakrishna Rita AR
Published: February 2016

Aim and objective:

The aim of this study is to show how different English single content morphemes, in particular nouns and adjectives, occur in the Persian structure by applying the Matrix Language Frame and 4M models.

Methodology:

The data collection in the present study includes tape-recordings of spontaneous conversations involving 12 Persian–English bilingual speakers at a public university in Malaysia. The IELTS participants’ scores were 6.0 or higher and they were between 20 and 40 years old.

Data and analysis:

Qualitatively, 8 hours of tape-recorded conversations were transcribed and coded carefully according to the Canonical Trilinear Representation. Quantitatively, the English content morphemes, especially nouns and adjectives, were analysed syntactically and morphosyntactically to show how they grammatically occur in the bilingual complementiser phrases.

Findings and conclusions:

The findings of this study reveal that code-switching was permissible even when it led to structural dissimilarity. Wherever it was required by a Persian principle, the inserted English elements, particularly nouns and adjectives, received different Persian markers. They may also appear without any Persian marker where required by the Persian grammar. Moreover, the data supported the Matrix Language Frame and 4M models’ principles, Morpheme order principle and System morpheme principle, and no counterexample appeared against the mentioned models.

Originality/significance/implication:

There are few studies on code-switching between Persian and English that focus on typological differences between the languages involved and the use of the Matrix Language Frame model and 4M model. Thus, the present study contributes knowledge in the field of code-switching between Persian and English and discusses how English single content morphemes, particularly nouns and adjectives, occur in the Persian structure by applying both the Matrix Language Frame model and 4M model as references.
US service member tourniquet use on the battlefield: Iraq and Afghanistan 2003–2011
Authors: Dunn John C , Fares Austin , Kusnezov Nicholas , Chandler Philip , Cordova Christopher , Orr Justin , Belmont Philip , Pallis Mark
Published: February 2016

Introduction

Tourniquet use has not been studied regarding specifically combat-intense military occupational specificities. This analysis examined the survivability, frequency of use, and nature of injuries in which tourniquets were employed among personnel in a single combat-specific military occupational specialty during combat operations.

Methods

Injuries sustained by the combat-specific soldier, the cavalry scout, from 2003 to 2011 were identified using the Joint Theater Trauma Registry. Basic demographic information, mechanism of injury, injury characteristics, and mortality were recorded.

Results

Of the 453 cavalry scouts wounded in action, 313 had adequate documentation upon arrival to a field hospital. Tourniquets were applied to 24 (7.7%) extremity wounds, 23 (96%) of these soldiers survived and one died of wounds (4.2%). Among those is in which tourniquets were used, there were seven (30%) senior enlisted and 16 (70%) junior enlisted soldiers with an average age of 24.8 years. Injuries were caused by gunshot wounds in 4 (17%), explosions in 18 (74%) and other mechanisms in two (8.3%). The primary reason for tourniquet application was open fracture ( n = 14, 61%), followed by vascular injury ( n = 5, 22%), and amputation ( n = 3, 13%). Other penetrating injuries were present in 19 (83%) of scouts.

Conclusion

The high survivability of patients transported with tourniquet in place underscores the importance of battlefield tourniquet application. Continued focus on education and equipping combat personnel with tourniquets is critical to survivability of the injured solider.
Media audience homophily: Partisan websites, audience identity and polarization processes
Authors: Dvir-Gvirsman Shira
Published: February 2016

The study suggests that media consumers favor certain websites not only due to their content but also due to their audience. A new concept is introduced: “audience homophily,” which describes one’s preference for partisan media websites catering to a homogeneous, likeminded consumership. This attraction is explained in terms of the need for self-consistency, and I suggest that over time such behavior will polarize political identity through a spiral of reinforcement. Based on both a survey-experiment ( N = 300) and a panel study combined with web-tracking technology that recorded online-exposure behavior ( N = 397), it was found that individuals with more extreme ideology present higher levels of audience homophily and that, longitudinally, audience homophily is somewhat associated with ideological polarization, intolerance, and accessibility of political self-definition.
Causes and effects of wine tourism development in organizational context: The case of Alentejo, Portugal
Authors: Lavandoski Joice , Vargas-Sánchez Alfonso , Pinto Patrícia , Silva João Albino
Published: February 2016

Companies with innovative behavior seek differentiation and are constantly reconciling needs and internal objectives with new market opportunities and restrictions imposed by the institutional framework. The involvement of the wineries with the service sector, by adapting to wine tourism, raises an innovative process which requires some organizational change. This study deals with this issue, arguing that the wineries’ change process toward wine tourism development may occur as a result of internal drivers and external pressures. In this sense, the wineries are analyzed through two different points of view: an intraorganizational perspective with the dynamic capability approach, and an interorganizational perspective with the institutional theory. Structural equation modeling methodology is used to estimate and validate the model, which aims to explain the causes and effects of wine tourism development. Results support the propositions that through wine tourism development, the wineries create, extend, and modify their processes, building and using dynamic capabilities, whereas institutional factors shape firms’ behavior and ensure social legitimacy, besides improving their organizational performance.
Validation of a Spanish version of the Leicester Cough Questionnaire in non-cystic fibrosis bronchiectasis
Authors: Muñoz Gerard , Buxó Maria , de Gracia Javier , Olveira Casilda , Martinez-Garcia Miguel Angel , Giron Rosa , Polverino Eva , Alvarez Antonio , Birring Surinder S , Vendrell Montserrat
Published: February 2016

The Leicester Cough Questionnaire (LCQ) has been validated in non-cystic fibrosis bronchiectasis (NCFBC). The present study aimed to create and validate a Spanish version of the LCQ (LCQ-Sp) in NCFBC. The LCQ-Sp was developed following a standardized protocol. For reliability, we assessed internal consistency and the change in score over a 15-day period in stable state. For responsiveness, we assessed the change in scores between visit 1 and the first exacerbation. For validity, we evaluated convergent validity through correlation with the Saint George’s Respiratory Questionnaire (SGRQ) and discriminant validity. Two hundred fifty-nine patients (118 mild bronchiectasis, 90 moderate bronchiectasis and 47 severe bronchiectasis) were included. Internal consistency was high for the total scoring and good for the different domains (Cronbach’s α: 0.86–0.91). The test–retest reliability shows an intraclass correlation coefficient of 0.87 for the total score. The mean LCQ-Sp score at visit 1 decreased at the beginning of an exacerbation (15.13 ± 4.06 vs. 12.24 ± 4.64; p < 0.001). The correlation between LCQ-Sp and SGRQ scores was −0.66 ( p < 0.01). The differences in the LCQ-Sp total score between the different groups of severity were significant ( p < 0.001). The LCQ-Sp discriminates disease severity, is responsive to change when faced with exacerbations and is reliable for use in bronchiectasis.
The Determinants of State Legislator Support for Restrictive Voter ID Laws
Authors: Hicks William D. , McKee Seth C. , Smith Daniel A.
Published: February 2016

We examine state legislator behavior on restrictive voter identification (ID) bills from 2005 to 2013. Partisan polarization of state lawmakers on voter ID laws is well known, but we know very little with respect to other determinants driving this political division. A major shortcoming of extant research evaluating the passage of voter ID bills stems from using the state legislature as the unit of analysis. We depart from existing scholarship by using the state legislator as our unit of analysis, and we cover the entirety of the period when restrictive voter ID laws became a frequent agenda item in state legislatures. Beyond the obviously significant effect of party affiliation, we find a notable relationship between the racial composition of a member's district, region, and electoral competition and the likelihood that a state lawmaker supports a voter ID bill. Democratic lawmakers representing substantial black district populations are more opposed to restrictive voter ID laws, whereas Republican legislators with substantial black district populations are more supportive. We also find Southern lawmakers (particularly Democrats) are more opposed to restrictive voter ID legislation. In particular, we find black legislators in the South are the least supportive of restrictive voter ID bills, which is likely tied to the historical context associated with state laws restricting electoral participation. Finally, in those state legislatures where electoral competition is not intense, polarization over voter ID laws is less stark, which likely reflects the expectation that the reform will have little bearing on the outcome of state legislative contests.
Handgun Carrying Among Youth in the United States
Authors: Vaughn Michael G. , Salas-Wright Christopher P. , Boutwell Brian B. , DeLisi Matt , Curtis Mary P.
Published: February 2016

Despite a wealth of research finding that adolescents who carry handguns are involved in risky behaviors, there has been little exploration into the heterogeneity of this behavior. Using a pooled sample of 12- to 17-year-olds from the National Study on Drug Use and Health who report past-year handgun carrying ( N = 7,872), this study identified four subgroups of handgun carriers: low risk ( n = 3,831; 47.93%), alcohol and marijuana users ( n = 1,591; 20.16%), fighters ( n = 1,430; 19.40%), and severe externalizers ( n = 1,020, 12.51%). These subgroups differed on demographic, behavioral, and psychosocial characteristics. Findings are discussed in light of prevention and focused deterrence.
Lifestyle Modification for Secondary Stroke Prevention
Authors: Bailey Ryan R.
Published: February 2016

Of nearly 800 000 strokes that occur annually, 23% are recurrent events. Risk for disability and mortality is higher following a recurrent stroke than following a first-time stroke, which makes secondary stroke prevention a priority. Many risk factors for stroke are modifiable and amenable to improvement through lifestyle modification. Lifestyle modification can be difficult for people with stroke, however, in part because of stroke-related physical and cognitive deficits. Despite these challenges, risk factor management through lifestyle modification is important. This article reviews the multiple cardiovascular and metabolic benefits associated with the modification of several lifestyle behaviors: diet, physical activity, smoking cessation, and alcohol consumption. Health behavior theories and existing lifestyle intervention programs are also reviewed to identify important behavioral and cognitive skills that can be used to facilitate modification of health behaviors, and practical skills and suggestions for health care providers are provided.
Transformative teachers or teachers to be transformed? The cases of Bolivia and Timor-Leste
Authors: Shah Ritesh , Cardozo Mieke TA Lopes
Published: February 2016

Applying the Strategic Relational Approach, this paper analyses the circumstances behind and educators’ strategies in response to education reforms in two nation-states undergoing socio-political transformation – Bolivia and Timor-Leste. Despite the starkly different histories and contemporary context of each nation, we suggest that transformation in both settings is driven by a desire to unshackle histories of colonisation and social conflict. Education reform, at least discursively, aims to dislocate past practices and replace them with a new material reality. In such spaces, we find that teachers are acting as strategic political actors, but in ways that are historically situated and driven by real and perceived personal and professional constraints. Their actions lead to particular types of ‘resistance’ and strategic action, leading to outcomes that are simultaneously continuous and disconnected from the past.
The perspectives of secondary school students with special needs in Spain during the crisis
Authors: Whitburn Ben
Published: February 2016

This paper presents an overview of a situational analysis of inclusive schooling in Spain from the perspective of students with special educational needs. The purpose of this work was to learn how young people collectively considered their experiences of school inclusion. The participants—aged 12–19 years who attended six different settings—highlighted the school community, resources, teacher pedagogy, support and social cohesion as germane aspects of their inclusion. Through a presentation of these characteristics, this analysis demonstrates how schools can effectively fulfil the core requirement of teaching and supporting diversity and, in so doing, how they can incite included subjectivities of differently abled students. This analysis is positioned within the climate of economic instability in Spain, which threatens to derail the headway made towards inclusive schooling via the introduction of severe austerity measures.
Protections for children before the law: An empirical analysis of the age of criminal responsibility, the abolition of doli incapax and the merits of a developmental immaturity defence in England and Wales
Authors: Fitz-Gibbon Kate
Published: February 2016

The law’s response to child offenders has long animated debate and sparked doctrinal law reform in England and Wales. The provision of legal protections for children in trouble with the law has been central to such debates, and questions surrounding the age at which a child should be held criminally responsible remain a contested area of law both domestically and internationally. In 1998 England and Wales abolished the presumption of doli incapax and retained the minimum age of criminal responsibility at 10 years old; two years below the United Nations’ recommended standard. This article examines the legal protections provided for child offenders under English criminal law with a focus on the adequacy of the age of criminal responsibility, the now abolished presumption of doli incapax and the merits of a developmental immaturity defence. Drawing on data obtained from interviews conducted with members of the English criminal justice system, this article analyses the extent to which legal practitioners perceive that the existing provisions are adequate and concludes by reinvigorating debate surrounding the need for future review and reform.
Leadership: Making it happen
Authors: Morgan-Jones DJ
Published: February 2016

As patient demand increases and national funding for the NHS in real terms decreases, there has never been a more important time for imaginative, innovative and effective leadership, particularly within primary care. This requirement has been fully recognised by both the General Medical Council and the RCGP. Effective leadership leads to outstanding care, whereas poor leadership is contributing directly to practice failures when inspected by the Care Quality Commission. Within the NHS, much is made about leadership to the point where it becomes almost too confusing to understand. This article outlines how the simple adherence to a set of basic principles takes leadership from the theoretical to reality.
New and emerging therapies for the treatment of irritable bowel syndrome: an update for gastroenterologists
Authors: Foxx-Orenstein Amy E.
Published: February 2016

Irritable bowel syndrome is a functional bowel disorder with gastrointestinal symptoms (e.g. abdominal pain, straining, urgency, incomplete evacuation, nausea, and bloating) that occur alongside bowel function alterations (i.e. constipation, diarrhea, or both). Patients with irritable bowel syndrome may also experience comorbid anxiety and depression. Irritable bowel syndrome is common, with a prevalence estimated between 3% and 28%, affecting patient health and quality of life. Patients with moderate or severe irritable bowel syndrome generally seek medical care, whereas those with milder symptoms may choose self-management. Most patients with irritable bowel syndrome receive outpatient care, but irritable bowel syndrome-related hospitalizations do occur. The pathophysiology of irritable bowel syndrome is multifactorial (i.e. genetics, immune components, changes in the gut microbiota, disturbances in physiologic stress response systems, and psychosocial factors). Management of irritable bowel syndrome can include lifestyle changes, dietary interventions, counseling, psychologic medication, and agents that affect gastrointestinal motility. A number of therapies have emerged in recent years with clinical trial data demonstrating efficacy and safety for patients with irritable bowel syndrome, including agents that target gastrointestinal motility (i.e. linaclotide), gastrointestinal opioid receptors (i.e. asimadoline, eluxadoline), and gut microbiota (i.e. rifaximin). Linaclotide has been shown to significantly improve stool frequency and abdominal pain compared with placebo in constipation-predominant irritable bowel syndrome (number needed to treat, 5.1). Asimadoline shows efficacy in patients with moderate-to-severe irritable bowel syndrome-related pain. Rifaximin provided adequate relief of global irritable bowel syndrome symptoms versus placebo for a significantly greater percentage of patients with diarrhea-predominant irritable bowel syndrome ( p < 0.001). Management that encompasses all aspects of irritable bowel syndrome (gastrointestinal symptoms) and comorbid psychologic symptoms (e.g. anxiety or depression) is important for improving overall patient health and well-being.
Current and future role of magnetically assisted gastric capsule endoscopy in the upper gastrointestinal tract
Authors: Ching Hey-Long , Hale Melissa Fay , McAlindon Mark Edward
Published: February 2016

Capsule endoscopy first captivated the medical world when it provided a means to visualize the small bowel, which was previously out of endoscopic reach. In the subsequent decade and a half we continue to learn of the true potential that capsule endoscopy has to offer. Of particular current interest is whether capsule endoscopy has any reliable investigative role in the upper gastrointestinal tract. Much research has already been dedicated to enhancing the diagnostic and indeed therapeutic properties of capsule endoscopy. Specific modifications to tackle the challenges of the gut have already been described in the current literature. In the upper gastrointestinal tract, the capacious anatomy of the stomach represents one of many challenges that capsule endoscopy must overcome. One solution to improving diagnostic yield is to utilize external magnetic steering of a magnetically receptive capsule endoscope. Notionally this would provide a navigation system to direct the capsule to different areas of the stomach and allow complete gastric mucosal examination. To date, several studies have presented promising data to support the feasibility of this endeavour. However the jury is still out as to whether this system will surpass conventional gastroscopy, which remains the gold standard diagnostic tool in the foregut. Nevertheless, a minimally invasive and patient-friendly alternative to gastroscopy remains irresistibly appealing, warranting further studies to test the potential of magnetically assisted capsule endoscopy. In this article the authors would like to share the current state of magnetically assisted capsule endoscopy and anticipate what is yet to come.
Authoritative School Climate and Student Academic Engagement, Grades, and Aspirations in Middle and High Schools
Authors: Cornell Dewey , Shukla Kathan , Konold Timothy R.
Published: February 2016

This study tested the theory that an authoritative school climate characterized by disciplinary structure and student support is conducive to positive academic outcomes for middle and high school students. Multilevel multivariate modeling at student and school levels was conducted using school surveys completed by statewide samples of 39,364 students in Grades 7 and 8 in 423 middle schools and 48,027 students in Grades 9 through 12 in 323 high schools. Consistent with authoritative school climate theory, both higher disciplinary structure and student support were associated with higher student engagement in school, higher course grades, and higher educational aspirations at the student level in both samples. At the school level, higher disciplinary structure was associated with higher engagement, and higher student support was associated with higher engagement and grades in both samples. Overall, these findings add new evidence that an authoritative school climate is conducive to student academic success in middle and high schools.
Is it time to abandon suicide risk assessment?
Authors: Murray Declan
Published: February 2016

Suicide risk assessment includes estimating the likelihood of suicide in
words such as ‘low, medium or high’. A ‘high suicide risk’ rating can
trigger a powerful urge to eliminate risk immediately. But it is far from
clear what ‘high suicide risk’ actually means. In the current state of
knowledge, suicide reduction measures should apply to all psychiatric
patients, irrespective of an individual patient's perceived risk. For
patients presenting with suicidal thoughts, feelings and behaviour,
assessment and management should focus on reducing or tolerating emotional
pain.
Predicting hospital aggression in secure psychiatric
care
Authors: Ireland Jane L. , Priday Lee J. , Ireland Carol A. , Chu Simon , Kilcoyne Jennifer , Mulligan Caroline
Published: February 2016

Background

Risk assessment instruments have become a preferred means for predicting
future aggression, claiming to predict long-term aggression risk.

Aims

To investigate the predictive value over 12 months and 4 years of two
commonly applied instruments (Historical, Clinical and Risk Management -
20 (HCR-20) and Violence Risk Appraisal Guide (VRAG)).

Method

Participants were adult male psychiatric patients detained in a high
secure hospital. All had a diagnosis of personality disorder. The focus
was on aggression in hospital.

Results

The actuarial risk assessment (VRAG) was generally performing better than
the structured risk assessment (HCR-20), although neither approach
performed particularly well overall. Any value in their predictive
potential appeared focused on the longer time period under study (4
years) and was specific to certain types of aggression.

Conclusions

The value of these instruments for assessing aggression in hospital among
patients with personality disorder in a high secure psychiatric setting
is considered.
Pulmonary Function in Patients With Germ Cell Cancer Treated With Bleomycin, Etoposide, and Cisplatin
Authors: Lauritsen Jakob , Kier Maria Gry Gundgaard , Bandak Mikkel , Mortensen Mette Saksø , Thomsen Frederik Birkebæk , Mortensen Jann , Daugaard Gedske
Published: February 2016

Purpose

For patients with germ cell cancer, various pulmonary toxicity risk factors have been hypothesized for treatment with bleomycin, etoposide, and cisplatin (BEP). Because existing studies have shortcomings, we present a large, unselected cohort of patients who have undergone close monitoring of lung function before, during, and after treatment with BEP to disclose valid pulmonary toxicity risk factors.

Patients and Methods

All patients who were treated with BEP at Rigshospitalet, Copenhagen, Denmark, from 1984 to 2007, were included. Pulmonary function tests (PFTs) that measured the diffusing capacity of the lungs for carbon monoxide (DLCO), forced expiratory volume in 1 second, and forced vital capacity were performed systematically before, during, and after treatment with BEP for 5 years of follow-up. According to local protocol, bleomycin was discontinued if hemoglobin-corrected DLCO (DLCOc) decreased ≥ 25% compared with pretreatment value. Covariates of possible importance were evaluated with a multiple regression analysis for pretreatment PFTs and with a mixed model for follow-up PFTs. Bleomycin was adjusted on the basis of PFT results and was thus omitted as covariate.

Results

Overall, 565 patients were evaluated with a PFT before or after treatment with BEP. During BEP, 15 patients died of progressive disease or toxicity, including one patient from bleomycin-induced pneumonitis. Post-treatment DLCOc decreased significantly, with a rebound during follow-up. Forced expiratory volume in 1 second and forced vital capacity remained unchanged after BEP but increased significantly to levels above pretreatment during follow-up. International Germ Cell Cancer Collaborative Group (IGCCCG) prognostic group, mediastinal primary, pulmonary metastases, and smoking all significantly influenced baseline PFT results. Pulmonary surgery, pulmonary embolism, IGCCCG poor prognosis, and smoking influenced PFT during follow-up. Mediastinal primary, pulmonary metastases, age, or doses of cisplatin and etoposide had no influence on follow-up PFT, and renal function did not influence PFT.

Conclusion

After 5 years of follow-up, pulmonary impairment in patients with germ cell cancer who were treated with BEP was limited. Exceptions were patients treated with pulmonary surgery, those who suffered pulmonary embolism, and those in the IGCCCG poor prognostic group.
The Use (and Abuse) of Robinson Crusoe in Neoclassical Economics
Authors: Söllner Fritz
Published: February 2016

Robinson Crusoe stories were and are extensively used in neoclassical economics. The behavior of neoclassical Robinson Crusoe, however, is at odds both with that of Defoe's hero, the original Robinson Crusoe, and that of real-world castaways. Only the early neoclassicals can be criticized for these contradictions because they intended to explain the behavior of their isolated individuals, whereas modern neoclassicals only seek to describe the decisions of Robinson Crusoe in terms of modern choice theory. This contrast mirrors the change in the way utility theory is conceived—no longer as a means to explain behavior but only as a means to describe it. It is argued that Robinson Crusoe and homo economicus are closely related and that, therefore, the Robinson Crusoe stories afford insights into the development of neoclassical economics and the problems resulting from its reliance upon the isolated-individual paradigm.