bluuebunny/crossref_metadata_2025 huggingface dataset:
ESD professional development of university educators in Serbia, Croatia and Macedonia
Authors: Nikolic Vesna , Milutinovic Slobodan , Nedanovski Pece , Mrnjaus Kornelija
Published: July 2017

Purpose

The paper aims to deal with the education for sustainable development (ESD) competences of university educators. The purpose of this paper is to provide a comparative analysis of opportunities for the development of ESD competences in higher education (HE) institutions in Serbia, Croatia and Macedonia. In addition, the paper explores the drivers and barriers experienced in this area using a process-oriented approach.

Design/methodology/approach

For the purpose of collecting data, internet and desktop research was carried out, which was then followed by interviews with key respondents and experts in HE. The interviews were carried out face-to-face or via telephone. In addition, information collected from the interviews was compared with both data found in the literature and official documents.

Findings

The comparative analysis indicated how specific institutional and cultural contexts affect the development of ESD competences in HE in the region. There were differences but also common opportunities for developing the ESD competences of university educators in the countries analysed. For each country, the drivers and barriers, as well as their relevance, were manifested differently and specific key constructs were identified to explain the implementation process for developing ESD competences of university educators.

Practical implications

This paper tried to respond to this diversity of perspectives, contexts and initiatives and attempted to extract the benefits of different approaches to the ESD professional development of university educators in Serbia, Croatia and Macedonia. It is hoped that this paper will provide valuable insights into the development of ESD in HE and support the development of ESD competences in the region.

Originality/value

This is one of the first papers that provide a comparative analysis of the ESD professional development of university educators in Balkan countries. The value of the paper lies in its potential to help us to understand the role that different drivers and barriers play in different patterns of implementation for developing the ESD competences of university educators.
A collaborative action research project towards embedding ESD within the higher education curriculum
Authors: Cebrián Gisela
Published: July 2017

Purpose

This paper aims to present a collaborative action research project conducted at the University of Southampton with the aim to promote curriculum and professional development in education for sustainable development (ESD) and learn from everyday practices of academics.

Design/methodology/approach

An action research approach guided by participatory and emancipatory approaches was used. An interdisciplinary group of five academic staff members from different subject areas (education; archaeology; electronics and computer sciences; biology; and health sciences) was created with the aim to support the group’s critical reflection and action towards embedding ESD in their teaching practice.

Findings

The main outcomes of delivery of sustainability teaching achieved through the project and evidences of the impact of the facilitator role are outlined. The facilitator role has enabled reflection and action, together with the identification of specific needs of academics and the factors influencing their engagement and action.

Originality/value

This research demonstrates the potential of using action research to rethink current practice in embedding ESD and to lead to new practices and actions of communities of practice. The facilitator role and second-order action research can contribute to better decision-making of sustainability as it questions practice, current assumptions and worldviews.
Learning for and about sustainability in higher education – a regional perspective based on experiences from the Baltic and the Mediterranean
Authors: Scoullos Michael , Malotidi Vicky , Lindroos Paula , Suomalainen Sinikka
Published: July 2017

Purpose

The purpose of the paper is to present and compare collective efforts of higher education institutions working through regional networks in introducing and promoting education for sustainable development (ESD) and environmental education (EE) in two most significant EU boarder regions. Efforts to support EE/ESD in higher education are usually undertaken at individual universities and, in some cases, at national level, still remaining very fragmented; therefore, the examples of University networks in the Baltic and the Mediterranean regions are of particular interest and importance. Both regions have regional conventions, protocols and strategies for the relevant seas, bringing EU and neighbouring countries of the regions together for the protection of the environment and the promotion of sustainable development (SD) within which EE and ESD are embedded.

Design/methodology/approach

This paper presents the driving forces for the establishment, evolution and design of relevant activities of these two networks, making also a few inter-comparisons and recommendations for further improvements.

Findings

Both regions, the Baltic and the Mediterranean, have multiple needs and high potential for more efficient linking of SD with higher education. Early enough it was realised that regional networking could stimulate countries and universities towards this task. Two networks were set up: the Baltic University Programme (starting already in 1991) and the Mediterranean Universities Network for SD focusing on ESD (starting in 2007). The paper reviews main activities of the networks together with lessons learned and gives directions for their future operations.

Originality/value

This paper is one of the rare case studies related to higher education networking on ESD and demonstrates how networking on ESD, apart from enhancing professional development, supports also SD and promotes cooperation and peace in regions that have a history of frequently turbulent relationships.
Multisensory mathematical gaming with the Energizer Bunny®
Authors: Kalish Mia
Published: July 2017

Purpose

Educational mathematics game models tend to be simplistic because they are target-oriented. This paper aims to show how game models that facilitate discovery and analysis can be derived from successful implementations already existing in the popular culture.

Design/methodology/approach

Based loosely on Rivera’s Toward a visually-oriented school mathematics curriculum, the analysis combines perspectives from psychology, the graphic arts and object-oriented technology to illustrate the depth and breadth of mathematics in a popular commercial.

Findings

This paper offers an cross-disciplinary justification for expanding curricular resources beyond traditional alphanumeric metonymies. Illustrations show the mathematical concepts underlying the commercial structure as well as the multimodal, sensuous, semiotic aspects.

Research limitations/implications

This analytical approach is intended to precede development of game mechanics. It is focused on expanding the psychology of mathematics beyond the metonymic, canned problem approach and toward more dynamic examples.

Practical implications

Games based on real examples from popular culture can provide learners with an answer to the following question: When will I ever use this in real life?

Social implications

The philosophy here is that learners will be excited and challenged by engaging real-life mathematics. The issue has always been that people cannot imagine what they have never seen, and this approach gives them a way to see the math in action, answering Rivera’s question, “Can we make a game based on visualizing the mathematics” with a resounding “Yes!”

Originality/value

This paper offers a fresh approach to designing games for learning mathematics.
Innovation in times of uncertainty
Authors: Squire Kurt
Published: July 2017

Purpose

This paper (published in two consecutive issues of On the Horizon) aims to contextualize research on games for learning by describing the current drivers of innovation in learning technologies situated within broader trends in open educational publishing.

Design/methodology/approach

The paper begins with an overview of changes, driven largely by technology in educational technology and publishing. Using massively open online courseware as an example, it describes how these factors are aligning to challenge the status quo. Next, it provides a brief discussion of changes in higher education more generally, including changes in education as a marketplace, reductions to state funding for education and changes in the research enterprise, particularly the rapid growth of the scientific enterprise and leveling off of federal support.

Findings

The paper pivots to describe the most recent chapter of over 15 years of work within the Games + Learning + Society (GLS) Center, which has sought to create innovative models of learning, innovative models for funding and conducting research in light of these challenges, and innovative ways of engaging the public.

Practical implications

The assumption driving GLS (and this paper) is that rather than wait for these changes to happen to us, educational technologists can help drive the future by creating it. A good way to get the kinds of learning systems we want is to go about creating them and seeing what works. During this time, GLS developed and released over a dozen game-based learning titles, raised US$10,000,000s in grants and contracts, graduated over 30 doctoral students and post docs, spun out multiple companies, created materials in use by 10,000s (or more) students across the world, and helped build a nascent field of games and learning.

Originality/value

The paper pivots to describe the most recent chapter of over 15 years of work within the GLS Center, which has sought to create innovative models of learning, innovative models for funding and conducting research in light of these challenges and innovative ways of engaging the public.
Novel games can come from novice game makers
Authors: Chen Mark
Published: July 2017

Purpose

This paper aims to describe how a novice to game design pushed theory about what makes a good game.

Design/methodology/approach

The game in question was developed in Twine for an introductory undergraduate course in interactive media.

Findings

It featured very little player agency, which ironically served to give players a richer experience.

Originality/value

That a novice could create something deeply personal that butted against conventional game design guidelines highlights the importance of opening game design up to as broad an audience as possible.
Links between community ecology theory and ecological restoration are on the rise
Authors: Wainwright Claire E. , Staples Timothy L. , Charles Lachlan S. , Flanagan Thomas C. , Lai Hao Ran , Loy Xingwen , Reynolds Victoria A. , Mayfield Margaret M.
Published: July 2017

Community ecology is frequently invoked as complementary to and useful for guiding ecological restoration. While the conceptual literature is devoted to this unification, first‐hand accounts from practitioners and ecologists suggest that integration may be weak in practice. To date, there have been no analyses of how extensively community ecology theory appears in the empirical restoration literature.

We address this knowledge gap with the first quantitative assessment of the extent to which community ecology concepts appear in empirical restoration literature by analysing the use of community ecology theories, concepts and conceptually derived tools in the design and interpretation of 1,000+ experimental ecological restoration studies over time (20 years) across all global regions. We also gauge general trends in author demographics, focal ecosystems and taxa targeted by these studies.

We found that the incorporation of community ecology into restoration research has increased significantly in recent years.

Community assembly and succession theories were the community ecology concepts integrated most often, while the functional traits framework and evolutionary theory have increased in usage recently.

Synthesis and applications. Restoration endeavours are increasingly infused with elements of community ecology. Our results highlight the widespread application of deterministic models of community structure in restoration design and the rise of ecosystem service and function‐focused restoration. With this diagnostic summary of these applications, ecologists and restoration practitioners can move forward while directly exploring underdeveloped synergies between theory and practice.
Practice Based Evidence Based Practice. Navigating based on coordinated improvisation, collaborative learning and multi‐methods research in Feedback Informed Systemic Therapy
Authors: van Hennik Robert , Hillewaere Bruno
Published: July 2017

In times when therapy is legitimized by transparency through control, standardization and benchmarking, the authors present a fluid manual of Feedback Informed Integrative Therapy within Systems (FITS) as a Practice Based Evidence Based Practice (PBEBP). The fluid manual FITS corresponds to the locality and complexity of social and cultural life and is substantiated by practice‐based research. The FITS therapist navigates her reflected responses on the basis of coordinated improvisation, organized feedback, collaborative learning and multi‐methods research. Accountability and transparency are offered through i) quantitative measurement of effects, developments and points of collaboration in therapy and ii) qualitative inquiry into navigational activities using improvisation and collaborative learning. FITS is a Practice Based Evidence Based Practice (PBEBP). The therapist is both practitioner and researcher and involves clients as co‐researchers. Therapist and clients examine the effects of their collaboration. The output of research is input for therapy in the ‘collaborative learning community’ constituted together.

Practitioner points

This article may inspire practitioners to manualize and research their own family therapy practice as a Practice Based Evidence Based Practice

In FITS, a PBEBP therapist and family members constitute a ‘collaborative learning community’, learning together how they learn and evaluating their collaboration in therapy

Practice Based Evidence Based Practice could be an alternative to standardized therapy models and manuals
Multi family member interview studies: a focus on data analysis
Authors: Van Parys Hanna , Provoost Veerle , De Sutter Petra , Pennings Guido , Buysse Ann
Published: July 2017

Although qualitative research about couples and families is becoming increasingly widespread, the aspect of data analysis remains largely underrepresented in the literature. In this methodological paper, we outline one specific approach to data analysis in the context of multi family member interview studies. Inspired by Interpretative Phenomenological Analysis and Dyadic Interview Analysis, this approach allows for the detailed and systematic analysis of family practices and the co‐construction of shared family realities. Based on an example study in the field of medically assisted reproduction, we give a detailed explanation of the aim of this approach, the different steps in the analysis process and the output of a multi family member interview study. The findings of this example study are discussed in light of the methodological challenges and opportunities.

Practitioner points

Multi family member interview analysis allows for the systematic analysis of family practices and the co‐construction of shared family realities

The findings might approximate to the therapeutic complexities that systemic therapists often encounter better than classical quantitative or qualitative research

One specific data analysis approach in the context of multi family member interview studies is outlined as data analysis remains underrepresented in the literature
New paradigms of parenthood: researching practice in a fertility clinic incarnating new forms of family
Authors: Bohme Helen
Published: July 2017

Traditional notions of parenthood are being challenged by the requests for treatment in a licensed fertility clinic. The unprecedented fast‐moving changes in assisted reproductive technology, especially gamete (sperm, eggs, embryo) donation, are enabling the creation of new forms of family. For this to be the subject of new systemic research, a reflexive intertwining of both research activities and professional practice activities is required with each informing and forming the other. Indeed, practitioners are researchers by virtue of rigorously using reflexive analytical processes in daily practice moment by moment. If we author ourselves in conversation with others, the ‘thing’ we are studying are ways of talking and relating to each other. Thus a paradigm shift has to be made, from examining entities to attending to language or language processes – especially in the counselling conversation that precedes treatment. This article presents a model where the ‘small’ stories of everyday lives are turned from a passing event into a research enterprise as witness to social change. For the social skills we use to do both practice and research attach us to real human beings in deeply human ways.

Practitioner points

One counselling conversation can help people to reflect on creating the new forms of family they envision and place this in an ethical context.

Conversational practice challenges institutional traditions and moves towards a more philosophical model of collaborative inquiry

Clients telling their story become observers of their own thinking and see themselves as experts in their own lives

The practitioner uses reflexive analytical processes, foregrounding the ethical in order to minimize social and power inequalities
Putting public health infrastructures to the test: introducing HPV vaccination in Austria and the Netherlands
Authors: Paul Katharina T. , Wallenburg Iris , Bal Roland
Published: July 2017

This article presents two cases of policymaking concerning the vaccine against Human Papilloma Virus (HPV), which is sexually transmitted and carcinogenic. Our analysis focuses on its introduction in Austria and the Netherlands. In both contexts, we find prevention and screening to be at once complementary and competing public health logics and we draw on the concept of ‘infrastructure’ to understand their roles in shaping the reception of the vaccine. We reveal how the HPV vaccine had to be made ‘good enough’, much like the Pap smear (Casper and Clarke ), by means of diverse tinkering practices that transformed both the technology and the infrastructures in which they emerged. At the same time, it was important that the vaccine would not come to problematise Pap smear‐based screening. The article points to the contextually contingent nature of policymaking around new medical technologies, and the skillful care with which public health infrastructures such as immunisation and screening programmes are handled and tinkered with.
Mobile text alerts are an effective way of communicating emergency information to adolescents: Results from focus groups with 12‐ to 18‐year‐olds
Authors: Wong Daniel Jinghe , Jones Emma , Rubin Gideon James
Published: July 2017

Mobile phone text messages can be used to disseminate information and advice to the public in disasters. We sought to identify factors influencing how adolescents would respond to receiving emergency text messages. Qualitative interviews were conducted with participants aged 12–18 years. Participants discussed scenarios relating to flooding and the discovery of an unexploded World War Two bomb and were shown example alerts that might be sent out in these circumstances. Intended compliance with the alerts was high. Participants noted that compliance would be more likely if: they were familiar with the system; the messages were sent by a trusted source; messages were reserved for serious incidents; multiple messages were sent; messages were kept short and formal.
Survival of Atherosclerotic Calcifications in Skeletonized Material: Forensic and Pathological Implications
Authors: Biehler‐Gomez Lucie , Cappella Annalisa , Castoldi Elisa , Martrille Laurent , Cattaneo Cristina
Published: July 2017

Atherosclerosis is a chronic inflammatory disease creating calcifying plaques in the arterial walls. Because its paleopathological diagnosis remains little studied on skeletal remains, its impact on forensic and archeological data is completely underestimated. Here, 24 skeletal remains from the Milano Cemetery Skeletal Collection have been studied to evaluate the chance of atherosclerotic calcification survival, retrieval, and identification. Through direct comparison with a known autopsy collection and literature, the identification and categorization of several types of calcifications were performed. Clothing elements such as tights or socks played a definitive role in the preservation of the calcifications; hence they are more likely to be found in forensic cases than in archeological ones. Therefore, vascular calcifications are possible to collect and identify in skeletal remains if sufficient care is given to their recovery. Consequently and as markers of the disease, such identification can provide valuable pathological information for forensic and archeological cases.
USB Storage Device Forensics for Windows 10
Authors: Arshad Ayesha , Iqbal Waseem , Abbas Haider
Published: July 2017

Significantly increased use of USB devices due to their user‐friendliness and large storage capacities poses various threats for many users/companies in terms of data theft that becomes easier due to their efficient mobility. Investigations for such data theft activities would require gathering critical digital information capable of recovering digital forensics artifacts like date, time, and device information. This research gathers three sets of registry and logs data: first, before insertion; second, during insertion; and the third, after removal of a USB device. These sets are analyzed to gather evidentiary information from Registry and Windows Event log that helps in tracking a USB device. This research furthers the prior research on earlier versions of Microsoft Windows and compares it with latest Windows 10 system. Comparison of Windows 8 and Windows 10 does not show much difference except for new subkey under USB Key in registry. However, comparison of Windows 7 with latest version indicates significant variances.
Takotsubo syndrome in hemodynamically unstable patients admitted to the intensive care unit – a retrospective study
Authors: Oras J. , Lundgren J. , Redfors B. , Brandin D. , Omerovic E. , Seeman‐Lodding H. , Ricksten S.‐E.
Published: July 2017

Introduction

Takotsubo syndrome (TS) is an acute cardiac condition that is often triggered by critical illness but that has rarely been studied in the intensive care unit (ICU) setting. The aim of this study was to (i) estimate the incidence of TS in a hemodynamically unstable ICU‐population; (ii) identify predictors of TS in this population; (iii) study the impact of TS on prognosis and course of hospitalization.

Methods

Medical records from all patients admitted to our general ICU from 2012 to 2015 were analyzed. TS was defined as having transient regional wall motion abnormalities (RWMA) with a typical pattern not attributable to a history of coronary artery disease or acute coronary syndromes.

Results

Out of 6470 patients admitted to the ICU, echocardiography due to hemodynamic instability was performed in 1051 patients; 467 had LV dysfunction and 59 fulfilled TS criteria. Patients with TS had higher SAPS 3 scores on admission than patients with normal LV function. Septic shock, cardiac arrest, cerebral mass lesion, female sex and low pH were independently associated with TS on admission. Patients with TS needed more ICU resources measured by higher NEMS scores and longer ICU‐stay. Crude mortality was higher in TS patients (32%) vs the ICU‐population (20%, P = 0.020), but there were no differences in a SAPS 3 adjusted analysis.

Conclusion

TS was not an uncommon cause of LV dysfunction in hemodynamically unstable ICU‐patients. Furthermore, TS was associated with a more complex disease. TS is a complication to take in consideration in the critically ill.
Health economic analysis of allergen immunotherapy for the management of allergic rhinitis, asthma, food allergy and venom allergy: A systematic overview
Authors: Asaria M. , Dhami S. , van Ree R. , Gerth van Wijk R. , Muraro A. , Roberts G. , Sheikh A.
Published: July 2017

Background

The European Academy of Allergy and Clinical Immunology (EAACI) is developing guidelines for allergen immunotherapy (AIT) for the management of allergic rhinitis, allergic asthma, IgE‐mediated food allergy and venom allergy. To inform the development of clinical recommendations, we undertook systematic reviews to critically assess evidence on the effectiveness, safety and cost‐effectiveness of AIT for these conditions. This study focusses on synthesizing data and gaps in the evidence on the cost‐effectiveness of AIT for these conditions.

Methods

We produced summaries of evidence in each domain, and then, synthesized findings on health economic data identified from four recent systematic reviews on allergic rhinitis, asthma, food allergy and venom allergy, respectively. The quality of these studies was independently assessed using the Critical Appraisal Skills Programme tool for health economic evaluations.

Results

Twenty‐three studies satisfied our inclusion criteria. Of these, 19 studies investigated the cost‐effectiveness of AIT in allergic rhinitis, of which seven were based on data from randomized controlled trials with economic evaluations conducted from a health system perspective. This body of evidence suggested that sublingual immunotherapy (SLIT) and subcutaneous immunotherapy (SCIT) would be considered cost‐effective using the (English) National Institute for Health and Clinical Excellence (NICE) cost‐effectiveness threshold of £20 000/quality‐adjusted life year (QALY). However, the quality of the studies and the general lack of attention to characterizing uncertainty and handling missing data should be taken into account when interpreting these results. For asthma, there were three eligible studies, all of which had significant methodological limitations; these suggested that SLIT, when used in patients with both asthma and allergic rhinitis, may be cost‐effective with an incremental cost‐effectiveness ratio (ICER) of £10 726 per QALY. We found one economic modelling study for venom allergy which, despite being based largely on expert opinion and plausible assumptions, suggested that AIT for bee and wasp venom allergy is only likely to be cost‐effective for very high‐risk groups who may be exposed to multiple exposures to venom/year (eg bee keepers). We found no eligible studies investigating the cost‐effectiveness of AIT for food allergy.

Conclusions

Overall, the evidence to support the cost‐effectiveness of AIT is limited and of low methodological quality, but suggests that AIT may be cost‐effective for people with allergic rhinitis with or without asthma and in high‐risk subgroups for venom allergy. We were unable to draw any conclusions on the cost‐effectiveness of AIT for food allergy.
Targeted antenatal anti‐D prophylaxis program for RhD‐negative pregnant women – outcome of the first two years of a national program in Finland
Authors: Haimila Katri , Sulin Kati , Kuosmanen Malla , Sareneva Inna , Korhonen Anu , Natunen Suvi , Tuimala Jarno , Sainio Susanna
Published: July 2017

Introduction

The aim of this study was to assess the accuracy of the non‐invasive fetal RHD test at 24–26 weeks of gestation as part of the national antenatal screening program to target routine antenatal anti‐D prophylaxis (RAADP) at 28–30 weeks at women carrying an RhD‐positive fetus.

Material and methods

A prospective cohort study involving all maternity care centers and delivery hospitals in Finland between February 2014 and January 2016. Fetal RHD genotyping using cell‐free fetal DNA in maternal plasma was performed with real‐time polymerase chain reaction in a centralized setting. The results were systematically compared with the serological newborn RhD typing. The main outcome measure was the accuracy of the fetal RHD assay; the secondary variable was compliance with the newly introduced RAADP program.

Results

Fetal RHD was screened from 10 814 women. For the detection of fetal RHD, sensitivity was 99.99% [95% confidence interval (CI) 99.92–99.99] and specificity 99.81% (95% CI 99.60–99.92). One false‐negative and seven false‐positive results were reported by the delivery hospitals in two years. The negative predictive value of the test was 99.97% (95% CI 99.81–99.99). At the end of the study period, over 98% of the RhD‐negative women participated in the new screening program.

Conclusions

The targeted RAAPD program was implemented effectively in the national maternity care program in Finland. An accurate fetal RHD screening test allows discontinuation of newborn testing without risking the postnatal prophylaxis program. In the future, the main area to investigate will be the clinical effect of RAADP on subsequent pregnancies.
Self‐management of stress urinary incontinence via a mobile app: two‐year follow‐up of a randomized controlled trial
Authors: Hoffman Victoria , Söderström Lars , Samuelsson Eva
Published: July 2017

Introduction

We investigated the long‐term effects of using a mobile app to treat stress urinary incontinence with a focus on pelvic floor muscle training.

Material and methods

A previous randomized controlled trial of 123 women aged 27–72 years found that three months of self‐managing stress urinary incontinence with support from the Tät® app was effective. We followed up the women in the app group (n = 62) two years after the initial trial with the same primary outcomes for symptom severity (International Consultation on Incontinence Questionnaire Short Form) and condition‐specific quality of life (ICIQ‐Lower Urinary Tract Symptom Quality of Life) and compared the scores with those at baseline.

Results

Of the 62 women, 61 and 46 (75.4%), respectively, participated in three‐month and two‐year follow‐ups. Baseline data did not differ between responders and non‐responders at follow‐up. The mean decreases in International Consultation on Incontinence Questionnaire Short Form and ICIQ‐Lower Urinary Tract Symptom Quality of Life scores after two years were 3.1 (95% confidence interval 2.0–4.2) and 4.0 (95% confidence interval 2.1–5.9), respectively. Of the 46 women, four (8.7%) rated themselves as very much better, nine (19.6%) as much better, and 16 (34.8%) as a little better. The use of incontinence protection products decreased significantly (p = 0.04), and the proportion of women who felt they could contract their pelvic muscles correctly increased from 14/46 (30.4%) at baseline to 31/46 (67.4%) at follow‐up (p < 0.001).

Conclusions

Self‐management of stress urinary incontinence with support from the Tät® app had significant and clinically relevant long‐term effects and may serve as first‐line treatment.
Is there a revision needed of the current FIGO staging system?
Authors: Menczer Joseph
Published: July 2017

The FIGO staging system has undergone many modifications since it first appeared in about the middle of the previous century. Due to the use of modern diagnostic tools, namely computed tomography, magnetic resonance imaging, positron emission tomography, sentinel lymph node biopsy and neoadjuvant chemotherapy, certain gynecological cancer cases cannot be allocated to a specific stage if one wishes to adhere strictly to FIGO requirements. In these circumstances such cases actually remain unstaged. This should prompt appropriate modifications of the current FIGO staging system so that it fulfills its aims.
Veno‐Arterial Extracorporeal Membrane Oxygenation Support in Patients Undergoing Aortic Surgery
Authors: Zhong Zhaopeng , Jiang Chunjing , Yang Feng , Hao Xing , Xing Jialin , Wang Hong , Hou Xiaotong
Published: July 2017

Veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) is an option for mechanical support for patients with postcardiotomy cardiogenic shock (PCS). However, the use of VA‐ECMO in patients suffering from aortic disease with PCS has not been greatly reported. This is a retrospective review of adult patients undergoing aortic surgery who received VA‐ECMO support to treat refractory PCS from August 2009 to May 2016. A total of 36 patients who underwent aortic surgery with VA‐ECMO support for refractory PCS were included. Preoperative, perioperative, and postoperative variables were assessed and analyzed for possible correlation with in‐hospital mortality. After a mean duration of 3.6 ± 2.9 days, 24 patients (67%) were weaned off VA‐ECMO, and 18 patients (50%) were discharged from the hospital. The overall in‐hospital mortality was 50%. The main cause of death was multiple organ dysfunction. The survivors had a lower level of preoperative creatine kinase‐MB (CK‐MB), a higher rate of antegrade cannulation, and a lower lactate level at 12 h, respectively. Relevant factors for in‐hospital mortality were retrograde‐flow cannulation (odds ratio [OR], 2.49), peak lactate levels greater than 20 mmol/L (OR, 5.0), and preoperative CK‐MB greater than 100 IU/L (OR, 6.40). Antegrade cannulation may provide better perfusion and should be emphasized to improve outcomes. Additionally, levels of peak serum lactate and preoperative CK‐MB may be relevant factors for in‐hospital mortality in aortic patients with PCS.
Learning curve for the thoracoscopic repair of esophageal atresia with tracheoesophageal fistula
Authors: Okuyama Hiroomi , Tazuke Yuko , Ueno Takehisa , Yamanaka Hiroaki , Takama Yuichi , Saka Ryuta , Usui Noriaki , Soh Hideki , Yonekura Takeo
Published: July 2017

Aim

Thoracoscopic repair (TR) of esophageal atresia with tracheoesophageal fistula (EA/TEF) remains a considerable challenge, even for the most experienced pediatric surgeons. The aim of this study is to report the outcomes of our experience with TR of EA/TEF and to determine the learning curve for this procedure.

Methods

Eleven consecutive cases that had undergone TR of EA/TEF at our institutes were included in this study. The medical charts were reviewed retrospectively. To determine the learning curve for TR of EA/TEF, a logarithmic curve‐fitting analysis was performed. The data were expressed as medians with ranges.

Results

The median age and birth weight were 1 day (range, 1–3 days) and 2.8 kg (range, 2.5–3.7 kg), respectively. TR was completed in all cases without any complications. The median operative time was 230 min (range, 164–383 min). There were no cases of anastomotic leakage. One patient with a long gap required repeated balloon dilatation for refractory anastomotic stricture. No mortality or recurrence of tracheoesophageal fistula occurred. The operative time was significantly longer in patients with a long gap (>20 mm) than in those with a shorter gap. Once the three cases with a long gap had been excluded, the operative time decreased as the number of treated cases increased. The relationship between the operative time and case number fit a logarithmic function curve well (operative time in minutes = 300 – 62 × log (case number), R2 = 0.8359, P = 0.0015).

Conclusions

Our results suggest that TR of EA/TEF is a safe procedure. It has a considerable learning curve, but requires advanced endoscopic surgical skills.
Conceptualizing and Treating Psychosis: A Lacanian Perspective
Authors: Vanheule Stijn
Published: July 2017

Starting from the hypothesis that psychosis makes up a structure with a precise status for the unconscious, the author explores how, from a Lacanian point of view, the treatment of psychosis is organized. Special attention is paid to the specificity of the psychotic symptom and the way transference characteristically takes shape. It is indicated that the occurrence of psychotic symptoms bears witness to a subjective crisis, in which no signifiers provide support when, at the level of the unconscious, the subject is dealing with fundamental self‐directed epistemic questions (‘who am I?’) and questions concerning the intentionality of the other (‘what do you want?’). Characteristically, such questions are organized around intimate topics like dealing with parenthood and authority; life in the light of death; sexuality in relation to love and procreation; and sexual identity. Psychotic crises are triggered upon confrontations with such issues in daily life, while no support by means of a master signifier or Name‐of‐the‐Father can be found. Crucial to the Lacanian approach to treatment is that the psychoanalyst aims at restoring a place for the subject in relation to the Other, which is threatened in episodes of acute psychosis. Clinical material from Lacanian work with a female patient suffering from manic‐depressive psychosis is discussed.
Session Block: Of Mirrors, Lamps, and other Methods for the Writing up of Notes
Authors: Robinson Benjamin L.
Published: July 2017

Writing up session notes is essential to therapists’ practice, yet the literature on psychotherapeutic writing focuses almost exclusively on more complex tasks, such as preparing case studies or pieces for publication. Nonetheless, problems with writing up seem widespread: this article finds that 85% of trainees report difficulty. Such ‘session block’ has not before been defined. Given the absence of well‐accepted psychotherapeutic tools to overcome such block, and given that writing sessions is a challenge of representation – a phenomenon well described in the world of art – this article appropriates methods from aesthetic theory to address the problem. Applying first the Classical aesthetic metaphor of art‐as‐mirror, the pressure on therapists to produce a clear likeness of the session is explored, and the mirror metaphor is found to be as oppressive as it is widely accepted. By contrast, a revolutionary metaphor from the Romantic era, namely art‐as‐lamp, wherein the poet casts an inner creative light over the world, holds promise in overcoming countertransferential blocks and permitting an imaginative write‐up. This too, though, has drawbacks, and the article concludes by proposing a method which, by integrating metaphors, permits a free‐flowing write‐up of the session, both creatively rich and clinically accurate.
Mental capacity to consent to research? Experiences of consenting adults with intellectual disabilities and/or autism to research
Authors: Hamilton Jahnese , Ingham Barry , McKinnon Iain , Parr Jeremy R. , Tam Louise Yuen‐Chong , Le Couteur Ann
Published: July 2017

Accessible Summary

The NHS Constitution states that all patients should have opportunity to take part in approved research

This study asked clinical researchers how they include people with intellectual disabilities and/or autism in research

Many barriers were identified that relate to making mental capacity judgements

Many researchers agreed new resources that support consent and capacity judgements for research would be helpful and gave some ideas about what could help

.

Background

Adults with intellectual disabilities and/or autism are often excluded from participating in health and healthcare research. Understanding study information, which is an important aspect of demonstrating capacity to give informed consent, can be a particular challenge. This study surveyed clinical researchers to discover: (i) their experiences of assessing mental capacity for research; (ii) what methods they used to facilitate the inclusion of adults with intellectual disabilities and/or autism; and (iii) their views about a proposal to develop new resources to facilitate mental capacity judgements with adults with intellectual disabilities and/or autism for informed consent for research.

Methods

Clinical researchers in North East England who conduct research with NHS patients with intellectual disabilities and/or autism were invited to participate in a 22‐item self‐completed semi‐structured questionnaire survey, either online or on paper.

Results

Twenty‐one clinicians completed the survey (response rate 30.4%). Participants reported on 18 research studies which included people with intellectual disabilities and/or autism. In many studies people who lacked capacity to give informed consent were excluded, and often shortcuts were taken in judging capacity. Limited adaptations to support capacity were used. Respondents welcomed the proposal of developing assistive resources that could support capacity judgements and informed consent to research.

Conclusions

To improve access to research for people with intellectual disabilities and/or autism, researchers need robust methods to facilitate informed consent and mental capacity judgements. Future research should determine which assistive resources show potential to support informed consent and capacity decisions, and whether such resources could improve inclusion in research.
Child understandings of the causation of childhood burn injuries: Child activity, parental domestic demands, and impoverished settings
Authors: Titi N. , van Niekerk A. , Ahmed R.
Published: July 2017

Background

Burns are a global public health problem. In South Africa, the rate of paediatric burn deaths is 5 times higher than other upper middle‐income countries, with concentrations in impoverished settings. Globally, the majority of research focuses on expert and caregiver descriptions of burn occurrence, causation, and prevention, with limited consideration of children's perspectives. This study investigated children's understanding of the causation and prevention of childhood burns.

Methods

Data were collected from eighteen 10‐ to 11‐year‐old children living in selected impoverished, fire‐affected neighbourhoods in Cape Town, through 3 isiXhosa focus groups. All focus groups were transcribed, coded, and analysed for emerging themes through thematic analysis.

Results

Themes regarding burn causation and risks centred around 4 themes: (a) developmental limits in context; (b) domestic chores, child capacity, and inability to say “no”; (c) inadequate supervision and compromised caregiving; and (d) unsafe structures. Child accounts of prevention pertained to (e) burn injury prevention activities in comprised environments and emphasized child agency, and upgrading the physical environment.

Conclusion

The children in this study ascribed burn injuries as the consequence of their developmental limits in the context of poverty, constraints on parental supervision, and unsafe environments. The children recommended safety education and upgrading their physical environments as part of burns injury prevention. The child accounts offer useful insights to inform safety interventions in impoverished settings.
Radiofrequency ablation for the management of thyroid nodules: A critical appraisal of the literature
Authors: Cesareo Roberto , Palermo Andrea , Pasqualini Valerio , Cianni Roberto , Gaspa Gianluigi , Manfrini Silvia , Pacella Claudio Maurizio
Published: July 2017

The majority of benign thyroid nodules are asymptomatic, remain stable in size and do not require treatment. However, a minority of patients with growing nodules may have local symptoms or cosmetic concerns, and thus demand surgical therapy. The timely use of ultrasound‐guided, minimally invasive thermal therapies has changed the natural history of benign, enlarging thyroid nodules (TNs). These procedures produce persistent shrinkage of TNs and an improvement of local symptoms. Among the various procedures, percutaneous ethanol injection represents the first‐line treatment for thyroid cysts, while in solid cold nodules, laser and radiofrequency ablation (RFA) have proven to be very effective and safe techniques in producing significant volume reduction that remains stable over several years. In particular, RFA seems to be suited for the management of small and medium nodules, while larger nodules may require repeated RFA treatments, and could be difficult to treat if they extend into the chest. RFA is performed in outpatient clinics and has a lower risk of complications compared to surgery. However, to date, there is still no unanimous consensus on the percutaneous treatment of benign nodules using such minimally invasive thermal techniques. In this review, we critically revise the literature to identify patients who are more likely to benefit from RFA treatment as an alternative to surgery.
Consumption Structure of Migrant Worker Families in China
Authors: Cao Guangzhong , Li Kai , Wang Ruimin , Liu Tao
Published: July 2017

This study draws on a survey of migrants in 12 cities across four major urbanizing areas in China and investigates the structure of migrant worker families' urban and rural consumption. The results show that the structure of migrant worker families' consumption has been dominated by survival consumption. These families tend to live frugally in cities while engaging in conspicuous consumption in their rural hometowns. The structure of migrant worker families' consumption is mainly shaped by their income stability and wealth levels rather than their current income level. Moreover, migrant worker families with high educational levels and those who intend to settle permanently in cities are likely to allocate substantial expenditure to status and hedonic consumption and to upgrade their urban consumption structure.
China's Internet Finance: A Critical Review
Authors: Xu Jianguo
Published: July 2017

China's Internet finance industry developed explosively from 2012 to 2015. Undersupply of financial services, progress of information technology and accommodative regulations for Internet finance jointly explain the explosive development. Regulation tightened after the small‐scale P2P lending crisis in 2015. The present paper discusses the role of information technology and mega data analysis in financial services, with particular attention paid to some popular misconceptions. The paper predicts that large financial institutions and information technology companies will play a dominant role in the future development of Internet finance.
The fine needle aspiration of translocation sarcomas
Authors: VandenBussche C. J. , Adams C. L. , McDonald O. G. , Whitworth S. A. , Ali S. Z.
Published: July 2017

Introduction

Soft tissue sarcomas comprise a heterogeneous group of clinically aggressive cancers that are often hard to classify on limited cytological samples. “Translocation sarcomas” (TS) are a diverse subset of such cancers, different from pleomorphic sarcomas, and characterised by unique single chromosomal translocations in each sarcoma subtype. Interestingly, despite their high‐grade biological behaviour, TS have deceptively monotonous and bland cytomorphology, therefore creating diagnostic issues on limited samples.

Materials and methods

A retrospective search was conducted of the cytopathology archives of The Johns Hopkins Hospital revealing 147 translocation sarcoma cases over a 25‐year period.

Results

The common morphological denominators for most translocation sarcomas were: hypercellularity, cellular monotony, mostly discohesive and single cells, round‐to‐oval or short spindled cells and a lack of necrosis. The exceptions were an inflammatory myofibroblastic tumour, in which cellular monotony was not present owing to the prominence of lymphocytes and plasma cells, and low‐grade fibromyxoid sarcoma, in which the specimens were generally hypocellular. Ancillary testing, especially immunoperoxidase staining, was often required for primary lesions.

Conclusion

Distinct morphological clues and subsequent ancillary testing (particularly immunoperoxidase staining) provide an accurate diagnosis on cytological interpretation of both, primary and recurrent/metastatic lesions.