bluuebunny/crossref_metadata_2025 huggingface dataset:
The Value Paradox of Problem Structuring Methods
Authors: Tully Patrick , White Leroy , Yearworth Mike
Published: October 2018

The use of problem structuring method (PSM) interventions leads to outcomes unique to the circumstances of the problem context. Given the singular nature of these outcomes, a consultant attempting to sell a PSM intervention will struggle to articulate value to clients in terms that are commercially meaningfulpriorto the intervention being enacted. Thus, in order to win a contract to deliver a PSM intervention, the consultant must first resolve this puzzle. We explore this question by (i) reviewing how the value of PSMs has been assessed previously, (ii) setting out a suitable theoretical position to explore the problem and (iii) presenting empirical data from a commercial organization to build our theoretical position. This starts with agreement with Checkland and Scholes that attempting to sell the (financial) value of a PSM intervention a priori is unlikely to ever succeed. Our theoretical development through analysis of empirical data leads to the recognition that theprocess of sellinga PSM intervention is bound to the interposition of the processes of problematization and interessement and the issue of trust. The recognition of a distinction between these and the actual enactment of a PSM intervention leads us to conclude that the process of selling the consulting engagement is entirely associated with the temporal ordering between them. We thus avoid the bind of the original puzzle only by articulating a paradox. To resolve the paradox, we shift analytical focus to thepre‐contractual phaseof the relationship between a consultant and client and discuss implications of this paradox for soft OR practice. © 2018 The authors. Systems Research and Behavioral Science published by International Federation for Systems Research and John Wiley & Sons Ltd
Carbon‐Carbon and Carbon‐Heteroatom Bond Formation Reactions Using Unsaturated Carbon Compounds
Authors: Sultan Shaista , Shah Bhahwal Ali
Published: October 2018

The carbon‐carbon and carbon‐heteroatom bond formation reactions are considered as a fundamental tool in synthetic organic chemistry. They have been effectively utilized in the synthesis of medicinally significant molecules, agrochemicals and valuable compounds in material sciences. This has been primarily enabled by highly efficient protocols arising from divergent mechanistic pathways. In this personal account, we aim to discuss some recent advances in carbon‐carbon or carbon‐heteroatom bond formation reactions to which our group has actively contributed. More specifically, this record focuses on the use of unsaturated carbon compounds for the construction of C−C and C−X bonds.
Perfluorooctanoic acid disrupts gap junction intercellular communication and induces reactive oxygen species formation and apoptosis in mouse ovaries
Authors: López‐Arellano Patricia , López‐Arellano Keila , Luna Jaquelinne , Flores Diana , Jiménez‐Salazar Javier , Gavia Graciela , Teteltitla Mario , Rodríguez Juan José , Domínguez Alejandro , Casas Eduardo , Bahena Ivan , Betancourt Miguel , González Cristina , Ducolomb Yvonne , Bonilla Edmundo
Published: October 2018

Perfluorooctanoic acid (PFOA) is a member of the perfluoroalkyl acid family of compounds. Due to the presence of strong carbon–fluorine bonds, it is practically nonbiodegradable and highly persistent in the environment. PFOA has been detected in the follicular fluid of women, and positively associated with reduced fecundability and infertility. However, there are no reports concerning the experimental evaluation of PFOA on oocyte toxicity in mammals. The aim of the present study was to determine if PFOA is able to induce oxidative stress in fetal ovaries and cause apoptosis in oocytes in vitro. In addition, since inhibition of the gap junction intercellular communication (GJIC) by PFOA has been demonstrated in liver cells in vivo and in vitro, the effect of PFOA on the GJIC between the oocyte and its supportive cumulus cells was studied. Results show that PFOA induced oocyte apoptosis and necrosis in vitro (medium lethal concentration, LC50 = 112.8 μM), as evaluated with Annexin‐V‐Alexa 508 in combination with BOBO‐1 staining. Reactive oxygen species (ROS) levels, as assessed by DCFH‐DA, increased significantly in fetal ovaries exposed to ¼ LC50 (28.2 μM, a noncytotoxic and relevant occupational exposure concentration) and LC50 PFOA ex vivo. This perfluorinated compound also caused the blockage of GJIC in cumulus cells‐oocyte complexes (COCs) obtained from female mice exposed in vivo, as evaluated by calcein transfer from cumulus cells to the oocyte. The ability of PFOA of disrupting the GJIC in COCs, generating ROS in the fetal ovary and causing apoptosis and necrosis in mammal's oocytes, might account for the reported association between increasing maternal plasma concentrations of PFOA with reduced fertility in women.
The phenomenon of lipid metabolism “cut” mutants
Authors: Zach Róbert , Převorovský Martin
Published: October 2018

Every cell cycle iteration culminates with the resolution of a mitotic nucleus into a pair of daughter nuclei, which are distributed between the two daughter cells. In the fission yeast Schizosaccharomyces pombe, the faithful division of a mitotic nucleus depends on unperturbed lipogenesis. Upon genetically or chemically induced perturbation of lipid anabolism, S. pombe cells fail to separate the two daughter nuclei and subsequently initiate lethal cytokinesis resulting in the so‐called “cut” terminal phenotype. Evidence supporting a critical role of lipid biogenesis in successful mitosis in S. pombe has been accumulating for almost two decades, but the exact mechanism explaining the reported observations had been elusive. Recently, several studies established a functional link between biosynthesis of structural phospholipids, nuclear membrane growth, and the fidelity of “closed” mitosis in S. pombe. These novel insights suggest a mechanistic explanation for the mitotic defects characteristic for some S. pombe mutants deficient in lipid anabolism and extend our knowledge of metabolic modulation within the context of the cell cycle. In this review, we cover the essential role of lipogenesis in “closed” mitosis, focusing mainly on S. pombe as a model system.
Dynamic stress intensity factors of an interfacial crack in orthotropic elastic strips under impact loading conditions
Authors: Singh Anuwedita , Mishra P. K. , Das S.
Published: October 2018

The present article deals with the investigation of elasto‐dynamic response of a finite crack under normal and shear impact loading situated at the interface of two semi‐infinite orthotropic strips. Laplace and Fourier Integral transforms are employed to reduce the transient problem to the solution of a pair of dual integral equations in the Laplace transform plane which are solved using iterations in the low frequency domain. The analytical expressions of stress intensity factors of the crack at the interface problem are found. To determine time dependence of the parameters, these equations are inverted to yield the dynamic stress intensity factors for some fiber‐reinforced orthotropic composite materials using Bellman method and the method given by H. Dubner and J. Abate. The results are depicted through graphs for different particular cases.
The Power of Microdata: An Introduction
Authors: Crato Nuno , Paruolo Paolo
Published: October 2018

Public organisations collect, supervise and keep track of extremely varied and extensive types of data. Modern technologies and better-organised civil lives have greatly facilitated the collection and custody of these data with a minute granularity and a scale previously unknown. This allows for a much more detailed and sound knowledge of economies and societies. Action should be taken to use these data for a better, easier and more cost-effective evaluation of policies while safeguarding confidentiality of data. At a moment of increasing attention to the efficacy of public spending, it is more important than ever to be able to learn what effects policy measures have on citizens’ lives and societies.
The Use of Administrative Data to Evaluate the Impact of Active Labor Market Policies: The Case of the Italian Liste di Mobilità
Authors: Rettore Enrico , Trivellato Ugo
Published: October 2018

Administrative data are a valuable source of information in several ways for the design of an impact evaluation. Conditional on providing the information required for the evaluation, they feature major advantages: they cover the whole (sub)population of reference for their administrative purposes, and not just a sample of individuals; very often they extend over long time periods; they are not susceptible to the typical measurement errors of survey data; and, finally, they are free of charge. The case of the Italian Liste di Mobilità, an Active Labor Market Policy (ALPM) to handle collective redundancies, illustrates how much empirical labor economics can benefit from having access to this kind of data. The accessibility of administrative archives for scientific purposes is a critical issue, as the history of this scheme demonstrates.
Negative Home Equity and Job Mobility
Authors: Morescalchi Andrea , van Veldhuizen Sander , Voogt Bart , Vogt Benedikt
Published: October 2018

This chapter investigates the impact of negative home equity on job mobility. Panel fixed-effects estimation is carried out by making use of a Dutch administrative data set for the period 2006–2011. Endogeneity of home equity is taken into account by considering homeowners who fall underwater because of an exogenous price decline. They are compared with homeowners with positive home equity. Negative home equity has a moderate negative effect on the probability of changing jobs. If a household plunges into negative home equity, the head of the household is about 5.2% less likely to change jobs.
Long-Term Effects of a Social Intervention for Vulnerable Youth: A Register-Based Study
Authors: Arendt Jacob Nielsen , Verner Mette
Published: October 2018

This chapter provides new evidence on the effects of multisystemic therapy (MST), which is a social intervention for youth with conduct disorder problems. New data are provided on young people receiving MST in the years 2007–2011. Register data enable the construction of a comparison group of youth who are receiving alternative social treatments but who have similar parental characteristics and a similar life-cycle profile of previous social interventions and health-care use. It is found that MST participants are more likely than similar youth in alternative interventions to take primary school exams, and fewer MST participants with previous convictions are placed outside their homes. However, MST participants have lower upper secondary education completion rates and lower employment rates, are more dependent upon welfare income, and are more often convicted of crimes.
Designing Evaluation of Modern Apprenticeships in Scotland
Authors: Bajgar Matej , Criscuolo Chiara
Published: October 2018

This chapter outlines how the impacts of a major vocational training programme can be evaluated with the use of linked administrative and survey data. To do so, it presents a strategy for future evaluations of Modern Apprenticeships in Scotland. Drawing on lessons from the existing literature, it describes the options and preferred choices for examined outcomes, data sources and evaluation approaches. It argues that future evaluations should focus mainly on individual employment and wages, and on firm productivity outcomes; they should rely mainly on existing administrative data and use two distinct control groups, consisting of non-participants and non-completers. The chapter also illustrates how the evaluator can use narrower control groups, matching techniques, regression analysis and changes over time to better identify causal effects.
Pay for Performance in Primary Care: The Use of Administrative Data by Health Economists
Authors: Santos Rita , Barsanti Sara , Seghieri Chiara
Published: October 2018

The purpose of this chapter is to report how researchers in health economics and management have benefited from the linkage of several administrative datasets to measure the performance and analyse pay for performance schemes in primary care (PC) in England and in Italy (Tuscany Region). The chapter firstly addresses pay for performance schemes at international level, focusing on performance indicators, incentive schemes and data sources. Secondly, it focuses on the English Quality and Outcomes Framework (QOF) and the Tuscany Region performance evaluation system (PES). In particular, it describes the impact of the QOF incentives to general practices (family medical surgeries) in improving chronic care conditions, measured through indicators of preventable emergency admissions. The chapter also describes how the PES for health care in Tuscany Region has been extended to the evaluation of primary care and discusses preliminary results in terms of improvements.
Access to European Statistical System Microdata
Authors: Bujnowska Aleksandra
Published: October 2018

The chapter presents the European microdata access system. This system allows eligible researchers to analyse detailed data transmitted to Eurostat by national statistical offices in the European Union. Eurostat is a single entry point of access to such data. Individual data collected by national statistical offices to produce official statistics are strictly confidential. The data are anonymised and further processed before they can be made available for scientific purposes. Statistical offices are legally obliged to protect information received from individual respondents. They use this information solely to produce official statistics. The entities collecting data for other purposes (e.g. administrative, commercial or health) fall into the scope of personal data protection legislation. Statistical confidentiality measures are stricter than those resulting from personal data protection measures.
Giving the International Scientific Community Access to German Labor Market Data: A Success Story
Authors: Müller Dana , Möller Joachim
Published: October 2018

Social security data are an important resource for labor market research. In Germany, the Institute for Employment Research (IAB) of the Federal Employment Agency is responsible for processing these data resources into microdata products and linking them to surveys on individuals and establishments. Since 2004, IAB’s standardized data products have been offered to external scholars by the Institute’s Research Data Center. The provision of data resources to the international scientific community is a great success story. The number of worldwide users is growing steadily. Furthermore, cooperation projects have significantly increased knowledge on the structures and processes of the German labor market. Today, the IAB is part of a worldwide network of top-tier labor market researchers and has substantially improved its evidence-based policy advice.
Hungary: A Case Study on Improving Access to Administrative Data in a Low-Trust Environment
Authors: Scharle Ágota
Published: October 2018

Hungary introduced a law ensuring access to anonymised personal data for research and policymaking in 2007. The law has forged a compromise between strict provisions on personal data protection and researchers’ needs for microdata that has passed the test of practical application. The Hungarian case may be a model for improving access to administrative data for research and policy analysis in a low-trust environment. The chapter explores stakeholder interests and the negotiation process leading to the new law and also highlights how particular features of the new law satisfied opponents while meeting the demands of data users.
In the Spirit of Oil: Unintended Flows and Leaky Lives in Northeastern Ecuador
Authors: Krøijer Stine
Published: October 2018

The chapter by Krøijer considers the devastating consequences of the penetration of the extractive frontier into indigenous territories in Ecuador. She examines the strategies followed by the Sieko-pai for dealing with the transformations to their world caused by decades of oil exploitation. Instead of assuming essences, Krøijer pursues the analytical implications of specific ontological enquiries about oil flows, and how indigenous communities make their lives in a world saturated by extractivism. Documenting the Sieko-pai’s similar considerations about the incorrect treatment of both oil and blood as potential disruptions of positive ‘flows’ between their territory‚ body‚ and powerful ‘others,’ she contributes to current debates around the ontological analogy between oil and the so-called blood of subterranean spirits. Krøijer describes how living with oil extraction hinges on and expresses the Sieko-pai’s flexible ability to deal with transformations and the leaky reality of resource enclaves.
Water as Resource and Being: Water Extractivism and Life Projects in Peru
Authors: Stensrud Astrid B.
Published: October 2018

While most studies focus on the boom in oil, minerals, and logging, Stensrud’s chapter explores another form of extractivism, which is growing in importance: the extraction of economic value from the water that flows to infrastructural megaprojects, which are damming the water for agribusiness. Focusing on the implications of the Majes Irrigation Project (MIP) for Quechua-speaking farmers in Peru, and how they make claims to the water springing from the mountains, Stensrud analyses the conditions that make land claims in Majes possible. Their claims are connected to notions of belonging and ownership that emerge from particular ontological compositions of water, mountains, personhood, and earth-beings that are not deliberately invented as part of an indigenous strategy to stop extractivism. Rather, these compositions form part of relationships that are continuously nurtured as part of ongoing life projects that conflict with the extractivist and modernising project of colonising water by turning it into an economic resource.
The Silent ‘Cosmopolitics’ of Artefacts: Spectral Extractivism, Ownership and ‘Obedient’ Things in Cañaris (Peru)
Authors: Rivera Andía Juan Javier
Published: October 2018

The chapter by Rivera Andía examines the terms by which the Cañaris Quechua-speaking people of the Northern Peruvian highlands establish their relationship with the land in a context marked by a ghostly extractivism. Leaving open the possibility of a radically distinct multiplicity of an environment with whom humans relate in social terms that exceed modern conceptions of private property, he describes local practices and conceptions relating to the production, access, and administration of land. What emerges is an entity that is less ‘natural’ and ‘indigenous’ than what is usually the focus of Andean ethnographies: the Iglisya (Quechua term for Spanish iglesia, church). Clandestinely built of earth and plants by eighteenth-century Indians, this land- and child-temple does not only represent the land but constitutes it. Rivera Andía considers the material and ritual aspects of the human-land relationship that produces the Iglisya as a truly cosmopolitical device with which Cañarenses are able to contend on their own terms with the threat of extractivism.
Stories of Resistance: Translating Nature, Indigeneity, and Place in Mining Activism
Authors: Li Fabiana , Paredes Peñafiel Adriana Paola
Published: October 2018

The chapter by Li and Paredes Peñafiel explores the manifold interconnections between community-based resistance and national as well as international activist networks. They trace the organised opposition to a proposed mining project in Peru’s Northern Highlands (the Conga mine) and how local activism travels through documentaries, news media, lawsuits, and networks. Analysing the international reverberations of the conflict and activist efforts, they interrogate the emergence of key leaders—particularly women—and how they and media actors represent the conflict. These representations of environmental conflict in Peru also gain importance elsewhere, and the authors explore how they both travel and translate into a situation of increasing resistance to extraction in Rio Grande do Sul, Brazil. Local resistance thus reverberates and spreads and may challenge the logic of extractivism by opening up a space for alternative life-making projects that both transcend and communicate between connections to a local landscape.
Brief report: A qualitative evidence synthesis of the psychological processes of school‐based expressive writing interventions with adolescents
Authors: Doucet Marie‐Hélène , Farella Guzzo Maria , Groleau Danielle
Published: October 2018

Introduction

Expressive writing interventions consist of brief writing sessions on thoughts and emotions and are known to yield positive benefits on adolescents' mental health. However, the psychological mechanisms explaining these effects are not clear.

Method

This review explored the psychological processes underlying school‐based expressive writing interventions with adolescents. A thematic synthesis of qualitative research consisted of identifying, appraising and summarizing the qualitative evidence of eligible studies.

Results

Only six of the 510 identified studies met the inclusion criteria of this review. Results provide some validation for cognitive‐processing, emotion‐regulation, and disinhibition as psychological mechanisms underlying school‐based expressive writing with adolescents.

Conclusions

However, these conclusions are still preliminary because of the paucity of the qualitative evidence found, both in quantity and quality. We recommend that more rigorous and in‐depth qualitative research be undertaken to: 1) explore adolescents' subjective experience about the expressive writing intervention, using in‐depth individual interviews; 2) thoroughly assess the content of students' texts written during the intervention; and 3) document the process of expressive writing interventions through observational methods. The results of such investigations would support the development and implementation of school‐based expressive writing‐type of interventions adapted to adolescents.
Basic self-care in older acute medical in-patients: a retrospective cohort study
Authors: Rodrigues Cecília , Mendonça Denisa , Martins Maria Manuela
Published: October 2018

Background:

Older patients hospitalized for acute illness are vulnerable to decline in basic self-care. This functional decline determines future health needs and can lead to negative health outcomes.

Aim:

To compare basic self-care needs in older acute medical in-patients between admission and discharge using the Nursing Patient Classification System data.

Design:

Single-center, observational, and retrospective cohort study.

Methods:

Data were collected between April 2015 and April 2016 and included 384 patients aged 65 or older admitted to a medical ward of a 580-bed teaching hospital in Portugal. Significant differences between groups of patients were assessed by analysis of variance and Kruskal–Wallis for continuous variables and by chi-squared test for categorical variables. Significant changes in the level of dependence were analyzed using McNemar–Bowker test.

Results:

The mean age of the patients was 79.93 years (SD = 7.49) and the majority were women (57.3%). There were no gender differences in length of stay. Oldest-old patients presented higher percentages of dependence on basic self-care, both at admission and at discharge. Younger-old patients improves in hygiene and personal care, toilet use, and movement (P < .01). However, it is also this group of patients who have the highest percentages of deterioration in eating (P = .129), toilet use, and movement (P < .001).

Conclusion:

All patients are vulnerable to decline in basic self-care regardless their age. Use Nursing Patient Classification Systems to track progress in basic self-care between admission and discharge in older acute medical patients is an innovative and valid methodology. Based on the needs of nursing care, we were able to characterize older patients’ needs and achieve health outcomes.
The impact of using newborn bovine serum as fetal calf serum substitute in the in vitro bovine embryos production system
Authors: Abdel-Wahab Ahmed , Abdel Aziz Rabie L. , Helmy Nermeen A. , Ibrahim Shawky S.
Published: October 2018

This study was conducted to assess the effects of addition of 10% newborn bovine serum (NBS) in the maturation and culture media of bovine system on oocytes maturation and developed morula and blastocyst rates. For this purpose, 10% NBS was added to in vitro maturation (IVM) medium alone (Experiment I), in vitro culture (IVC) (Experiment II), and in IVM + IVC (Experiment III). In vitro bovine oocytes maturation and developmental rates of bovine embryos were then compared with control group where the basal maturation or culture media were supplemented with 10% fetal calf serum (FCS). Results revealed that maturation, cleavage, morula, and blastocyst formation rates of in vitro fertilized embryos were not significantly different in NBS and control groups in the 3 experiments. In conclusion, NBS is an efficient macromolecule in bovine system when added either to IVM or to IVC or to both stages. Thus, NBS could provide cheaper and more available treatment to be used as FCS substitute in the IVC system of bovines.
The construction of the health professional in palliative care contexts: a scoping review on caring for the person at the end of life
Authors: Parola Vitor , Coelho Adriana , Romero Álvaro A. , Peiró Roland P. , Blanco-Blanco Joan , Apóstolo João , Gea-Sánchez Montserrat
Published: October 2018

Aim:

The aim of the study was to map of the literature on the elements contributing to the construction of the health care professional in the context of palliative care.

Methods:

Scoping review based on Arksey and O’Malley framework. PubMed, Embase, CINAHL, Scopus databases, and gray literature were the sources searched (2005–2015), completed by reference searching, hand searching, and expert consultations. Primary studies focusing on different professionals working in palliative care units or hospice centers were eligible for inclusion.

Results:

From a total of 3632 articles, 22 met the inclusion criteria. The content of the studies was described and classified in 5 elements: (i) construction and application of the concept of care; (ii) psychosocial effects that the daily care produces; (iii) working conditions that influence the caregiving provided; (iv) knowledge mobilized in the provision of care; and (v) strategies adopted by health care professionals to build relationships. Data about nurses, physicians, and psychologists were found, but no data were found about social workers. Gaps identified in the publications were as follows: relationship competencies and strategies adopted; the real needs from educational programs; and the view of other professionals.

Conclusions:

Key elements identified in the concept of the construction of the health care professional should be addressed in future interventions: prevention of emotional exhaustion, depersonalization, and achievement of a greater personal accomplishment. In addition, none of the articles retrieved offered the different perspectives of all the disciplines in a multidisciplinary team.
Merkel cell carcinoma and the challenge in its approach: a review based on a clinical context of immunosuppression
Authors: Coutinho Filipe , Horta Miguel , Rocha Estrela , Vasconcelos Carlos , Araújo António
Published: October 2018

Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine cancer with high rate to local relapse and metastasis. Its connection to immunosuppression is well known, with reported association to human immunodeficiency virus (HIV).

The authors present an 87-year-old woman, infected by HIV type 2 at advanced stage of the disease, whom presented a painless papule on left cheek in 2011. After its total excision, the histopathology confirmed MCC “in situ,” with no regional or distant metastases. Simultaneously, she revealed a viral load of 2220 copies/mL and 224 CD4/mm3. Five months later, the patient presented a local and distance relapse with an aggressive behavior and positive regional lymph node. Stage IV disease was confirmed due to presence of liver metastases. Concurrently to the relapse, it was detected low CD4 levels.

In our multidisciplinary team decision meeting, it has been decided conservative treatment due to low Karnofsky status, comorbidities, and stage of disease.
Neuromodulating attention and mind-wandering processes with multi-session real-time electroencephalogram
Authors: Gonçalves Óscar F. , Carvalho Sandra , Mendes Augusto J. , Lema Alberto , Leite Jorge , Boggio Paulo S.
Published: October 2018

Previous studies showed the efficacy of a single session real-time electroencephalogram (rtEEG) protocols in sensorimotor rhythm (SMR) or Theta up-training. However, the impact of this training on sustained or mind-wandering attention was only modest. This could be explained by the lack of specificity in distinct rtEEG training protocols given their limitation in inhibiting or decreasing the amplitude of down-trained bands. Additionally, multiple sessions of rtEEG in up-training/down-training SMR (sensorimotor rhythm) and Theta along with better ways of tracking sustained and mind-wandering attention protocols may be required to achieve consistent effects. Here we describe the effects of a 10-session trial of up-training/down-training SMR or Theta (SMR⇑Theta⇓; Theta⇑SMR⇓), looking at the effects of 2 rtEEG training protocols in 2 n of 1 subject designs. We also tested to impact of this training in sustained and mind-wandering attention during the course of a Sustained Attention Response Task (SART). The present trial confirmed the potentiality of a multi-session protocol in up-training Theta or SMR and, as consequence, increasing sustained attention (Theta up-training) and mind-wandering attention (SMR up-training). However, the simultaneous increase of the Theta amplitude in the SMR⇑Theta⇓ (and the more modest increase of the SMR amplitude in Theta⇑SMR⇓) reduced the specificity of the rtEEG training. Future studies should build on the potentiality of extended rtEEG protocols on this attention paradigm but increasing the specificity of the trained EEG bands choosing less tedious/more motivating feedback instruments (SMR⇑Theta⇓) and conducting the Theta⇑SMR⇓ training eyes closed.
Diarrhea as a form of presentation of medullary thyroid carcinoma
Authors: Pais Mariana Canelas , Maia Tiago , Peixoto Armando , Meira Leonor , Albuquerque Andreia , Lopes Joanne , Capela João
Published: October 2018

A case is presented of a 57-year-old man consulting for chronic diarrhea. Based on subsequent findings (thyroid nodule and metastases), the possibility of metastatic medullary thyroid carcinoma (MTC) was raised. Thyroidectomy allowed diagnosing a multicentric left lobe MTC. MTC is a rare cause of diarrhea, but should be considered, especially in the presence of signs or symptoms of alarm or nonresponse to empirical therapy.
Individualized multimodal treatment strategy for metastatic rectal adenocarcinoma
Authors: Magalhães Helena , Fontes-Sousa Mário , Fernandes Manuel , Machado Manuela
Published: October 2018

Metastatic rectal cancer requires a multidisciplinary and individualized approach.

The authors describe a case report of a 48-year-old man with recurrence of rectal adenocarcinoma that underwent multimodal treatment, which included chemotherapy with biologic agents, cytoreduction surgery with hyperthermic intraperitoneal chemotherapy, and radiotherapy with improvement in progression-free survival and overall survival.
Assessment in pediatrics clerkships: impact of strategies to solve item-sharing problems
Authors: Faria-Costa Gabriel , Severo Milton , Ferreira Maria Amélia , Guimarães Hercília , Henriques-Coelho Tiago
Published: October 2018

Introduction:

Reusing multiple-choice questions in different examinations may lead to item sharing between students. Our aim was to analyze and solve an item-sharing problem during assessment of medical students in pediatrics clerkship.

Methods:

This is a 3 years prospective analysis of 5th year medical students, submitted to an examination at the end of their Pediatrics’ clerkship. In 2012, questions were reused across different clerkships. In 2013, no questions were reused in different clerkships. In 2014, no questions were reused and the review of the test was postponed to the end of the year, after all clerkships ended.

Results:

In 2012, the mean score increased 1.36 points (in a scale of 0–20) per clerkship rotation, with the last clerkship having a difference of 9.5 points regarding the first one (P < .001). Fifty percent of this variation was due to the repetition of questions. In 2013, with a new question bank, the mean score increased 0.8 points per clerkship rotation, with a difference of 5.6 points between the last and the first rotations (P < .024). Finally, in 2014 there was no significant variation between clerkships.

Tests’ scores had a significant moderate correlation with students’ average course grade (r = 0.39, r = 0.30, r = 0.48, for 2012, 2013, and 2014, respectively). The students’ average course grade, however, did not confound the increase in tests’ scores across different clerkships.

Conclusion:

The present work demonstrated an item-sharing problem among students during pediatric clerkships. An effective approach to correct this bias assessment was achieved by restricting the reuse of questions, by changing the time-point of test revision and by progressively adapting equating strategies.
Effects of a nursing care program on functional outcomes in older acute medical in-patients: protocol for a randomized controlled trial
Authors: Rodrigues Cecília , Mendonça Denisa , Martins Maria Manuela
Published: October 2018

Background:

Hospitalization often leads to long periods of bed rest and inactivity which is associated with an increase in length of hospital stay, loss of capacity for basic self-care and discharge into a nursing home.

Objective:

This trial aims to verify if a nursing care program centered on basic self-care and predefined physical activity, improves functional outcomes in older hospitalized patients.

Methods:

This is a 2-group randomized controlled trial with repeated measures: 182 older acute medical patients will be blindly randomly allocated to the control group (n = 91) or intervention group (n = 91). The intervention will consist of nursing care intervention centered on basic self-care that includes a twice daily walking training, plus privileging pre-established trips to the toilet by walking and all daytime meals seated, off the bed. The main outcome was changes in the number of independent activities of daily living from 2 weeks before admission (baseline) to discharge. Trial registration: ClinicalTrials.gov (Identifier NCT03106064).

Results:

This intervention has the potential to change the outcomes of the older patient in the acute setting.

Conclusion:

The loss of independence in self-care is determinant in future health care needs. If our hypothesis is correct and demonstrate that this nursing care program centered on basic self-care for older acute medical patients improves functional outcomes, a change in the paradigmatic organization of hospital care may be justifiable.
Incidence and mortality due to cervical cancer in 4 south European countries
Authors: Teixeira Cristina , Afonso Ana , Rodrigues Luciana , Madureira Muriela , Nogueira António
Published: October 2018

Objective:

To describe variation in incidence and mortality rates of cervical cancer (CC), between 4 Southern European countries that share similar cultural characteristics.

Methods:

Data on CC incidence and mortality reported in Portugal, Spain, Italy, and Greece for the year 2012 were obtained through the International Agency of Research on Cancer. Expected numbers of incident cases and deaths were obtained based on age-specific rates in European region. Standardized incidence rate (SIR) and standardized mortality rate (SMR) and respective 95% confidence interval (95% CI) were computed for each country by age group (15–39, 40–54, 55–64, and ≥65 years old).

Results:

The number of incident cases of and deaths due to CC observed in Greece, Italy, and Spain were significantly lower than expected, whichever the age group. In Portugal such pattern was, however, only found for incident cases among women aged up to 54 years. The number of incident cases observed in Portugal did not differ from that expected among women aged 55 to 64 (SIR = 90.8; 95% CI: 76.8–106.7) and aged 65 or more years (SIR = 110.0; 95% CI: 95.9–125.0). Also, the number of deaths observed in Portugal did not differ from that expected among women aged 15 to 39 (SMR = 70.0; 95% CI: 43.3–100.8), 40 to 54 (SMR = 93.6; 95% CI: 74.9–115.4), and 55 to 64 years (SMR = 93.6; 95% CI: 73.4–117.7) but was significantly higher than that expected among women aged 65 or more years (SMR = 126.7; 95% CI: 110.1–144.4).

Conclusions:

There is variability in CC incidence and mortality between 4 South European countries. To understand the reasons underlying such variability could improve approach to preventive care.
Correlation between apparent diffusion coefficient values in breast magnetic resonance imaging and prognostic factors of breast invasive ductal carcinoma
Authors: Moutinho-Guilherme Ricardo , Oyola Janeth Hercilia , Sanz-Rosa David , Vassallo Israel Thuissard , García Raquel Murillo , Pisco Joana Martins , de Vega Vicente Martínez
Published: October 2018

Background:

We wanted to examine whether the apparent diffusion coefficient values obtained by diffusion-weighted imaging techniques could indicate an early prognostic assessment for patients with Invasive Ductal Carcinoma and, therefore, influence the treatment decision making.

Objective:

The main objective was to evaluate the correlation between the apparent diffusion coefficient values obtained by diffusion-weighted imaging and the key prognostic factors in breast invasive ductal carcinoma. Secondary objectives were to analyze the eventual correlations between magnetic resonance imaging findings and prognostic factors in breast cancer; and to perform a comparison between results in 1.5 and 3.0 T scanners.

Methods:

Breast magnetic resonance imaging with diffusion-weighted imaging sequence was performed on 100 patients, who were proven histopathologically to have breast invasive ductal carcinoma. We compared the apparent diffusion coefficient values, obtained previous to biopsy, with the main prognostic factors in breast cancer: tumor size, histologic grade, hormonal receptors, Ki67 index, human epidermal growth factor receptor type 2, and axillary lymph node status. The Mann-Whitney U test and the Kruskal-Wallis analysis were used to establish these correlations.

Results:

The mean apparent diffusion coefficient value was inferior in the estrogen receptor-positive group than in the estrogen receptor-negative group (1.04 vs 1.17 × 10–3 mm2/s, P = .004). Higher histologic grade related to larger tumor size (P = .002). We found association between spiculated margins and positive axillary lymph node status [odds ratio = 4.35 (1.49–12.71)]. There were no differences in apparent diffusion coefficient measurements between 1.5 and 3.0 T magnetic resonance imaging scanners (P = .513).

Conclusions:

Low apparent diffusion coefficient values are related with positive expression of estrogen receptor. Larger tumors and spiculated margins are associated to worse prognosis. Rim enhancement is more frequently observed in estrogen receptor-negative tumors. There are no differences in apparent diffusion coefficient measurements between different magnetic resonance imaging scanners.
When glycosylated hemoglobin is a true roller coaster
Authors: Peixoto Fabiana Ribeiro , Martins Cátia Alexandra Ferreira , Couto Pedro Daniel Miranda
Published: October 2018

Corticosteroids negatively interfere with glycemic control. We report a case of a patient with type 2 diabetes mellitus with poor glycemic control caused by coercion to intramuscular corticosteroid administration at work. The relationship established with the patient allowed her to speak openly about her working environment, allowing her to trust the information provided by her family physician ensuring that she rejected new attempts to medicate her with that drug.
Ritual and Region
Authors: Davies Mathew
Published: October 2018

Why has ASEAN endured and why do members, many of whom remain comparatively weak and poor, continue to invest in the regional project? Existing answers, either that ASEAN is meaningless or that it has transformed regional affairs through the creation of shared values are both misplaced. Neither argument is empirically plausible. Instead, this Element argues that ASEAN has and continues to serve state interest through the creation of a shared ritual and symbolic framework. This framework has mitigated regional tension through the performance of regionalism, but has not fundamentally addressed the sources of that tension.
Retrospective evaluation of a clinical decision support tool for effective computed tomography angiography utilization in urgent brain imaging of suspected TIA/minor stroke in the emergency department
Authors: Bibok Maximilian B. , Votova Kristine , Balshaw Robert F. , Penn Melanie , Lesperance Mary L. , Harris Devin R. , Sedgwick Colin , Nealis Madeline , Farrell Brian , Mathieson John R. , Penn Andrew M.
Published: October 2018

Objectives

The Canadian Stroke Best Practice Recommendations suggests that patients suspected of transient ischemic attack (TIA)/minor stroke receive urgent brain imaging, preferably computed tomography angiography (CTA). Yet, high requisition rates for non-cerebrovascular patients overburden limited radiological resources, putting patients at risk. We hypothesize that our clinical decision support tool (CDST) developed for risk stratification of TIA in the emergency department (ED), and which incorporates Canadian guidelines, could improve CTA utilization.

Methods

Retrospective study design with clinical information gathered from ED patient referrals to an outpatient TIA unit in Victoria, BC, from 2015-2016. Actual CTA orders by ED and TIA unit staff were compared to hypothetical CTA ordering if our CDST had been used in the ED upon patient arrival.

Results

For 1,679 referrals, clinicians ordered 954 CTAs. Our CDST would have ordered a total of 977 CTAs for these patients. Overall, this would have increased the number of imaged-TIA patients by 89 (10.1%) while imaging 98 (16.1%) fewer non-cerebrovascular patients over the 2-year period. Our CDST would have ordered CTA for 18 (78.3%) of the recurrent stroke patients in the sample.

Conclusions

Our CDST could enhance CTA utilization in the ED for suspected TIA patients, and facilitate guideline-based stroke care. Use of our CDST would increase the number of TIA patients receiving CTA before ED discharge (rather than later at TIA units) and reduce the burden of imaging stroke mimics in radiological departments.
Burden of depressive symptoms and non-alcohol substance abuse; and their association with alcohol use and partner violence: a cross-sectional study in four sub-Saharan Africa countries
Authors: Bajunirwe F. , Maling S. , Adami H.-O. , Ajayi I. O. , Volmink J. , Adebamowo C. , Laurence C. , Reid T. , Nankya-Mutyoba J. , Chiwanga F. S. , Dalal S. , Njelekela M. , Guwatudde D. , Holmes M. D.
Published: October 2018

In sub-Saharan Africa, there are limited data on burden of non-alcohol substance abuse (NAS) and depressive symptoms (DS), yet potential risk factors such as alcohol and intimate partner violence (IPV) are common and NAS abuse may be the rise. The aim of this study was to measure the burden of DS and NAS abuse, and determine whether alcohol use and IPV are associated with DS and/or NAS abuse. We conducted a cross-sectional study at five sites in four countries: Nigeria (nurses), South Africa (teachers), Tanzania (teachers) and two sites in Uganda (rural and peri-urban residents). Participants were selected by simple random sampling from a sampling frame at each of the study sites. We used a standardized tool to collect data on demographics, alcohol use and NAS use, IPV and DS and calculated prevalence ratios (PR). We enrolled 1415 respondents and of these 34.6% were male. DS occurred among 383 (32.3%) and NAS use among 52 (4.3%). In the multivariable analysis, being female (PR  =  1.49,p  =  0.008), NAS abuse (PR  =  2.06,p  =  0.02) and IPV (PR  =  2.93,p < 0.001) were significantly associated with DS. Older age [odds ratio (OR) = 0.31,p < 0.001)], female (OR = 0.48,p  =  0.036) were protective of NAS but current smokers (OR = 2.98,p < 0.001) and those reporting IPV (OR  =  2.16,p  =  0.024) were more likely to use NAS. Longitudinal studies should be done to establish temporal relationships with these risk factors to provide basis for interventions.
Transient energy growth of a swirling jet with vortex breakdown
Authors: Muthiah Gopalsamy , Samanta Arnab
Published: October 2018

We investigate the existence of short-time, local transient growth in the helical modes of a rapidly swirling, high-speed jet that has transitioned into an axisymmetric bubble breakdown state. The time-averaged flow consisting of the bubble and its wake downstream constitute the base state, which we show to exhibit strong transient amplification owing to the non-modal behaviour of the continuous eigenspectrum. A pseudospectrum analysis mathematically identifies the so-called potential modes within this continuous spectrum and the resultant non-orthogonality between these modes and the existing discrete stable modes is shown to be the main contributor to such growth. As the swirling flow develops post the collapsed bubble, the potential spectrum moves further toward the unstable half-plane, which along with the concurrent weakening of exponential growth from the discrete unstable modes, increases the dynamic importance of transient growth inside the wake region. The transient amplifications calculated at several locations inside the bubble and wake confirm this, where strong growths inside the wake far outstrip the corresponding modal growths (if available) at shorter times, but especially at the higher helical orders and smaller streamwise wavenumbers. The corresponding optimal perturbations at initial times consist of streamwise streaks of azimuthal velocity, which if concentrated inside the core vortical region, unfold via the classical Orr mechanism to yield structures resembling core (or viscous) Kelvin waves of the corresponding Lamb–Oseen vortex. However, in contrast to that in Lamb–Oseen vortex flow, where critical-layer waves are associated with higher transient gains, here, such core Kelvin modes with the more compact spiral structure at the vortex core are seen to yield the maximum transient amplifications.
THE FIRST MAYA TRADE WARE? NEW DATA ON MIDDLE PRECLASSIC-PERIOD MARS ORANGE PASTE WARE FROM HOLTUN, GUATEMALA
Authors: Callaghan Michael G. , Pierce Daniel E. , Gilstrap William D.
Published: October 2018

This study reports on type: variety-mode classification, digital stereomicroscopy, petrography, neutron activation analysis, and previously published reports and characterizes production and distribution of Mars Orange Paste Ware in the Middle Preclassic-period Maya Lowlands. The sample consists of 2028 sherds of Mars Orange Paste Ware from Holtun, Guatemala, and 4105 sherds reported from sites in Central Belize and Peten Guatemala. The combined data suggest Mars Orange Paste Ware was a “short-distance” trade ware produced in the northeastern Maya Lowlands and distributed from Central Belize to the west.