bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of Opioid-Induced Constipation in Hospice Patients
Authors: Sera Leah , McPherson Mary Lynn
Published: November 2017

Background:

Constipation is a common symptom in patients with advanced disease taking opioids. Opioid-induced constipation (OIC) is commonly treated with laxatives and stool softeners. Recently, newer agents have come to market which broaden options for patients in whom first-line therapies are not effective.

Objective:

To determine what pharmacologic regimens are currently used in hospice programs to prevent and treat OIC, whether those regimens have changed with the introduction of newer agents and evidence discouraging the use of docusate, and whether hospice programs are standardizing the management of OIC.

Methods:

An online 10-item questionnaire was disseminated by the National Hospice and Palliative Care Organization. Questions addressed demographics; first-, second- and third-line pharmacologic treatments included in bowel protocols; whether prescribing practices have changed in the last 5 years; and percentage of patients receiving specific constipation therapies.

Results:

The majority of organizations (68.8%) responded that at least 90% of patients were prescribed a bowel regimen on admission to hospice and 84.4% stated that they have a guideline or protocol for managing OIC. The most commonly used preparations for the treatment of OIC for patients during their length of stay in hospice were senna plus docusate, senna alone, docusate alone, bisacodyl, polyethylene glycol 3350, and lactulose. Over 75% of hospice organizations claimed they never used methylnaltrexone, linaclotide, lubiprostone, or naloxegol.

Conclusion:

This survey provides insight into recent practices of hospice organizations in the treatment of OIC. As more agents come to market, it is likely that management of OIC will continue to evolve.
Evaluation of the Appropriate Washout Period Following Fan Therapy for Dyspnea in Patients With Advanced Cancer: A Pilot Study
Authors: Kako Jun , Morita Tatsuya , Yamaguchi Takuhiro , Sekimoto Asuko , Kobayashi Masamitsu , Kinoshita Hiroya , Ogawa Asao , Zenda Sadamoto , Uchitomi Yosuke , Inoguchi Hironobu , Matsushima Eisuke
Published: November 2017

Objectives:

To clarify the duration required for dyspnea to return to baseline severity after fan therapy, to evaluate whether fan-to-legs therapy or no fan therapy would be a suitable control therapy, and to investigate changes in patients’ face surface temperature after fan therapy.

Methods:

In this pilot study, all participants received 3 interventions in the following order: no fan, fan to legs, and fan to face. Participants used a fan for 5 minutes, and they scored their dyspnea at 10-minute intervals for 60 minutes or until the score had returned to its baseline value, whichever occurred first. Nine patients with advanced cancer admitted to a palliative care unit were included; they had dyspnea at rest and rated its severity as at least 3 points on a 0- to 10-point numerical rating scale. Descriptive statistics and the Wilcoxon signed rank test were used to analyze the data.

Results:

All patients completed the study. Of the 9 participants, 6 experienced a clinical benefit from using a fan to their faces. Of these patients, only 2 participants’ (2 of 6) dyspnea scores returned to baseline by the end of the 60-minute assessment period after exposure to fan-to-face therapy. In fan-to-legs and no fan settings, there was no change in the dyspnea scores. There were significant differences between the baseline face surface temperature and that after fan-to-face and fan-to-legs settings.

Conclusion:

When using a crossover design to investigate the effect of fan therapy on dyspnea, 1 hour is an insufficient washout period.
Occupational Variation in End-of-Life Care Intensity
Authors: Hyder Joseph A. , Haring R. Sterling , Sturgeon Daniel , Gazarian Priscilla K. , Jiang Wei , Cooper Zara , Lipsitz Stuart R. , Prigerson Holly G. , Weissman Joel S.
Published: November 2017

Background:

End-of-life (EOL) care intensity is known to vary by secular and geographic patterns. US physicians receive less aggressive EOL care than the general population, presumably the result of preferences shaped by work-place experience with EOL care.

Objective:

We investigated occupation as a source of variation in EOL care intensity.

Methods:

Across 4 states, we identified 660 599, nonhealth maintenance organization Medicare beneficiaries aged ≥66 years who died between 2004 and 2011. Linking death certificates, we identified beneficiaries with prespecified occupations: nurses, farmers, clergy, mortuary workers, homemakers, first-responders, veterinary workers, teachers, accountants, and the general population. End-of-life care intensity over the last 6 months of life was assessed using 5 validated measures: (1) Medicare expenditures, rates of (2) hospice, (3) surgery, (4) intensive care, and (5) in-hospital death.

Results:

Occupation was a source of large variation in EOL care intensity across all measures, before and after adjustment for sex, education, age-adjusted Charlson Comorbidity Index, race/ethnicity, and hospital referral region. For example, absolute and relative adjusted differences in expenditures were US$9991 and 42% of population mean expenditure ( P < .001 for both). Compared to the general population on the 5 EOL care intensity measures, teachers (5 of 5), homemakers (4 of 5), farmers (4 of 5), and clergy (3 of 5) demonstrated significantly less aggressive care. Mortuary workers had lower EOL care intensity (4 of 5) but small numbers limited statistical significance.

Conclusion:

Occupations with likely exposure to child development, death/bereavement, and naturalistic influences demonstrated lower EOL care intensity. These findings may inform patients and clinicians navigating choices around individual EOL care preferences.
Palliative Care Experience in the Last 3 Months of Life: A Quantitative Comparison of Care Provided in Residential Hospices, Hospitals, and the Home From the Perspectives of Bereaved Caregivers
Authors: Bainbridge Daryl , Seow Hsien
Published: November 2017

Objective:

This study captured the end-of-life care experiences across various settings from bereaved caregivers of individuals who died in residential hospice.

Methods:

A retrospective, observational design using the CaregiverVoice survey with bereaved caregivers of patients in 22 hospices in Ontario, Canada. The survey assessed various dimensions of the patient’s care experiences across multiple care settings in the last 3 months of life.

Results:

A total of 1153 caregivers responded to the survey (44% response rate). In addition to hospice care, caregivers reported that 74% of patients received home care, 61% had a hospitalization, 42% received care at a cancer center, and 10% lived in a nursing home. Most caregivers (84%-89%) rated the addressing of each support domain (relief of physical pain, relief of other symptoms, spiritual support, and emotional support) by hospice as either “excellent” or “very good.” These proportions were less favorable for home care (40%-47%), cancer center (46%-54%), and hospital (37%-48%). Significantly, better experiences were reported for the last week of life where hospice was considered the main setting of care, opposed to other settings ( P < .0001 across domains). Overall, across settings pain management tended to be the highest-rated domain and spiritual support the lowest.

Conclusion:

This is one of few quantitative examinations of the care experience of patients who accessed multiple care settings in the last months of life and died in a specialized setting such as residential hospice. These findings emphasize the importance of replicating the hospice approach in institutional and home settings, including greater attention to emotional and spiritual dimensions of care.
Primary Palliative Care Education: A Pilot Survey
Authors: Carroll Thomas , Weisbrod Neal , O’Connor Alec , Quill Timothy
Published: November 2017

The demand for palliative services is outpacing the availability of specialist palliative care clinicians. One strategy to fill this gap is to improve “primary palliative care” skills and knowledge of all clinicians who care for seriously ill patients. Previous educational efforts have shown mixed results, and one possible explanation is unrecognized discordance of educational goals between those offering education and potential primary palliative care learners. The article describes the results and feasibility of a needs assessment survey comparing interest in palliative care education topics and settings among both palliative care specialists (PCS) and nonpalliative care specialists (NPCS). This is the first attempt to measure the perceived importance of primary palliative care topics and preferences about learning settings from the perspectives of both NPCS and PCS. The results suggest substantial areas of both concordant and discordant opinions with respect to educational topics and learning settings. Such data are essential to guide primary palliative care educational efforts. Future work will be needed to determine whether these results are consistent across diverse health systems and what variables influence educational preferences.
Hip Fracture in the Elderly Patients: A Sentinel Event
Authors: Koso Riikka E. , Sheets Charles , Richardson William J. , Galanos Anthony N.
Published: November 2017

Importance:

Hip fracture in the elderly patients is associated with increased morbidity and mortality. There is great need for advance care planning should a patient fail to rehabilitate or experience an adverse event during or after recovery. This study was performed to evaluate for palliative care consultation and changes in code status and/or advance directives in elderly patients with hip fracture.

Methods:

We performed a retrospective review of 186 consecutive patients aged 65 years and older with a hip fracture due to a low-energy fall who underwent surgery at a large academic institution between August 1, 2013, and September 1, 2014. Risk factors assessed were patient demographics, home status, mobility, code status, comorbidities, medications, and hospitalizations prior to injury. Outcomes of interest included palliative care consultation, complications, mortality, and most recent code status, mobility, and home.

Results:

About 186 patients with hip fractures were included. Three patients died, and 12 (6.5%) sustained major complications during admission. Nearly one-third (51 patients) died upon final follow-up approximately 1.5 years after surgery. Of the patients who died, palliative care consulted on 6 (11.8%) during initial admission. Eleven (21.6%) were full code at death. Three patients underwent cardiopulmonary resuscitation (CPR) and 1 underwent massive transfusion and extracorporeal membrane oxygenation prior to changing their code status to do not attempt resuscitation.

Conclusion:

Hip fracture in elderly patients is an important opportunity to reassess the patient’s personal health-care priorities. Advance directives, goals of care, and code status documentation should be updated in all elderly patients with hip fracture, should the patient’s health decompensate.
Knowledge of Palliative Care Among Community-Dwelling Adults
Authors: Kozlov Elissa , McDarby Meghan , Reid M. Carrington , Carpenter Brian D.
Published: November 2017

Objective:

To identify what laypersons know about palliative care using the Palliative Care Knowledge Scale (PaCKS). A secondary aim was to establish preliminary normative data for the PaCKS.

Methods:

A sample of 301 adults were recruited via Amazon’s Mechanical Turk database. Participants were administered the PaCKS along with a demographic questionnaire.

Results:

The mean score on the 13-item PaCKS was 5.25 (standard deviation = 4.77, range: 0-13), the median was 5, and the mode was 0, with a significant proportion of participants selecting “I don’t know” for every item. Women scored significantly higher than men, and 45- to 54- and 55- to 64-year-olds scoring highest. The PaCKS was also significantly positively correlated with education.

Conclusion:

Broadly, laypersons lack knowledge about some key aspects of palliative care, though palliative care knowledge is highly variable across individuals and some groups. Targeted educational interventions are essential to improve knowledge of palliative care in order to increase access to this type of life-enhancing, supportive service.
Are Bereaved Family Members Satisfied With Information Provision About Palliative Care Units in Japan?
Authors: Sanjo Makiko , Morita Tatsuya , Miyashita Mitsunori , Sato Kazuki , Kamibeppu Kiyoko , Tsuneto Satoru , Shima Yasuo
Published: November 2017

This study clarified the evaluation of the information about palliative care units (PCUs) from the oncologists by the bereaved family members of Japanese patients with cancer at the time of their first referral. A multicenter questionnaire survey examining the amount, timing, and adequacy of information received about PCUs was conducted. Half of the respondents (N = 465, mean age = 60 years) were spouses. Findings showed that 55% of the respondents thought the amount of information was inadequate and 33% thought the timing of the information about PCU from the oncologist was inadequate. Greater perceived inadequacy of the amount of information was significantly associated with (1) obtaining information from other patients and/or family member who had no experience with PCUs and (2) not acquiring information about the availability of medical staff and medical treatments at PCUs. Greater perceived inadequacy of the timing of the information was significantly associated with acts by the oncologist and/or nurses, such as providing insufficient information or saying there is nothing more that can be done any longer; however, this was not significantly associated with the actual timing of the oncologists’ information. Medical staff should understand what information families desire and provide enough detail for patients to imagine accurately what time spent in a PCU would be like. Moreover, practitioners should strive to improve methods of communication and engagement after the information provision, rather than prioritizing the timing of the information.
The Comfort Measures Order Set at a Tertiary Care Academic Hospital: Is There a Comparable Difference in End-of-Life Care Between Patients Dying in Acute Care When CMOS Is Utilized?
Authors: Lau Christine , Stilos Kalli , Nowell Allyson , Lau Fanchea , Moore Jennifer , Wynnychuk Lesia
Published: November 2017

Background:

Standardized protocols have been previously shown to be helpful in managing end-of-life (EOL) care in hospital. The comfort measures order set (CMOS), a standardized framework for assessing imminently dying patients’ symptoms and needs, was implemented at a tertiary academic hospital.

Objective:

We assessed whether there were comparable differences in the care of a dying patient when the CMOS was utilized and when it was not.

Methods:

A retrospective chart review was completed on patients admitted under oncology and general internal medicine, who were referred to the inpatient palliative care team for “EOL care” between February 2015 and March 2016.

Results:

Of 83 patients, 56 (67%) received intiation of the CMOS and 27 (33%) did not for EOL care. There was significant involvement of spiritual care with the CMOS (66%), as compared to the group without CMOS (19%), P < .05. The use of CMOS resulted in 1.7 adjustments to symptom management per patient by palliative care, which was significantly less than the number of symptom management adjustments per patient when CMOS was not used (3.3), P < .05. However, initiating CMOS did not result in a signficant difference in patient distress around the time of death ( P = .11). Dyspnea was the most frequently identified symptom causing distress in actively dying patients.

Conclusions:

Implementation of the CMOS is helpful in providing a foundation to a comfort approach in imminently dying patients. However, more education on its utility as a framework for EOL care and assessment across the organization is still required.
“My Future is Now”: A Qualitative Study of Persons Living With Advanced Cancer
Authors: Cottingham Ann H. , Cripe Larry D. , Rand Kevin L. , Frankel Richard M.
Published: November 2017

Objectives:

Advance care planning (ACP) enables individuals to deliberate about future preferences for care based upon their values and beliefs about what is important in life. For many patients with advanced cancer, however, these critical conversations do not occur. A growing body of literature has examined the end-of-life wishes of seriously ill patients. Few studies have explored what is important to persons as they live with advanced cancer. The aim of the current study was to address this gap and to understand how clinicians can support patients’ efforts to live in the present and plan for the future.

Methods:

Transcriptions of interviews conducted with 36 patients diagnosed with advanced cancer were analyzed using immersion–crystallization, a qualitative research technique.

Results:

Four overarching themes were identified: (I) living in the face of death, (II) who I am, (III) my experience of cancer, and (IV) impact of my illness on others. Twelve subthemes are also reported.

Significance of Results:

These findings have significant implications for clinicians as they partner with patients to plan for the future. Our data suggest that clinicians consider the following 4 prompts: (1) “What is important to you now, knowing that you will die sooner than you want or expected?” (2) “Tell me about yourself.” (3) “Tell me in your own words about your experience with cancer care and treatment.” (4) “What impact has your illness had on others?” In honoring patients’ lived experiences, we may establish the mutual understanding necessary to providing high-quality care that supports patients’ priorities for life.
Visual Supports to Promote Science Discourse for Middle and High School Students With Autism Spectrum Disorders
Authors: Hart Barnett Juliet , Trillo Rebecca , More Cori M.
Published: November 2017

Students with high-functioning autism spectrum disorders (ASDs) are increasingly included in general education and are expected to access core content, including science. Development of science content knowledge, scientific literacy, and scientific thinking are areas emphasized in legislation as well as the National Science Education Standards as critical for all students, particularly as they progress to middle and high school. However, participation in science discourse is often challenging for students with ASD given their difficulties with communication. Moreover, evidence on teaching academic content, such as science, to students with disabilities is limited. In this article, the use of visual supports is described as an evidence-based practice to promote engagement in science discussions among students with high-functioning ASD.
Teaching Middle School Students With Learning Disabilities to Comprehend Text Using Self-Questioning
Authors: Joseph Laurice M. , Ross Kelsey M.
Published: November 2017

Middle school students with learning disabilities often struggle to gain meaning from text. Engaging in self-questioning is an effective strategy for comprehending text, however, middle school students with learning disabilities often do not naturally engage in self-questioning before, during, or after reading. These students may also have difficulty generating questions to ask themselves while reading text. This article presents evidence-based methods and specific instructional scaffolds for teaching middle school students with learning disabilities to generate questions on their own before, during, and after reading. A discussion of how to progress monitor students’ acquisition of self-questioning will also be provided.
Psychosocial Factors and Dietary Practices in Korean Americans
Authors: Shin Cha-Nam , Belyea Michael
Published: November 2017

This study was to identify the role of demographics and social support from family and friends in predicting self-efficacy for a healthy diet and healthy dietary practices. A descriptive, cross-sectional study was conducted with a sample of 112 Korean American adults in the southwestern United States. Most were college educated (85.3%), with mean age of 54.0 (± 10.6), and women (66.4%). The findings indicate that gender and education played a moderating role between family support and self-efficacy for a healthy diet, whereas age and education were moderators between support from family and friends and healthy dietary practices. Diet interventions tailored to demographic subgroups may increase self-efficacy, promote healthy dietary practices, and ultimately contribute to a reduction in the rates of critical health conditions and health costs in the community.
How Effective Are Patient Education Materials in Educating Patients?
Authors: Keçeci Ayla , Toprak Sadiye , Kiliç Seçil
Published: November 2017

The aim of this research was to evaluate the patient education materials prepared and published by nurses and physicians in terms of the qualitative properties of these materials, including readability, understandability, and actionability. A total of 38 patient education materials prepared by nurses and physicians in a university hospital in Turkey were evaluated. The readability of the materials was assessed using the formulas proposed by Atesman and Cetinkaya. The Patient Education Materials Assessment Tool (PEMAT) form was used for estimating the understandability and actionability. Data were analyzed using the percentile and mean values, and the Kendall’s Tau-c and correlation tests were used for interobserver agreement. According to the assessments based on the readability formulas, 55.3% of the materials were moderately difficult, while 81.6% had instructional-level readability (U.S. Grades 8 and 9) with a moderate to low level of understandability and actionability. Consequently, the patient education materials evaluated in our study had a moderate level of readability, understandability, and actionability.
Racial Change, Racial Threat, and Minority Representation in Cities
Authors: Shah Paru
Published: November 2017

As the racial complexion of cities has shifted over the last 20 years, the struggles for political power have become more complex. Some cities, like Ferguson, Missouri, have seen their Black population grow substantially, but their descriptive representation stall. Others, like Compton, California, have moved from predominantly Black to predominantly Latino, and are asking themselves if the two racial minorities can govern together. Building upon theories of racial threat, in this project, I examine explicitly the independent effects of racial change on the likelihood of Black and Latino representation across cities in the United States between 1981 and 2011, and the likelihood of minority candidate emergence in California between 1995 and 2010. Using three demographic profiles as a frame—majority White, majority–minority, and multiracial cities—the results suggest the intersections between racial context and shifting political and racial landscapes have important consequences of minority political power for the future.
Optimal Fiscal Policy in Overlapping Generations Models
Authors: Garriga Carlos
Published: November 2017

In this article, we explore the proposition that the optimal capital income tax is zero using an overlapping generations model. We prove that for a large class of preferences, the optimal capital income tax along the transition path and in steady state is nonzero. For a version of the model calibrated to the US economy, we find that the model could justify the observed rates of capital income taxation for an empirically reasonable intertemporal utility function and a robust demographic structure.
Feed People First
Authors: Baron Steve , Patterson Anthony , Maull Roger , Warnaby Gary
Published: November 2017

Service research highlights the utility of adopting a service ecosystem approach to studying service innovation. It suggests that service innovations can arise from challenging and developing the institutions (i.e., norms, rules, practices, meanings, and symbols) which underpin an ecosystem. Also, recent emphasis on consumer well-being posits that studies of service provision to poor consumers are needed. Reflecting these research priorities, the context of this case study on service innovation is the food waste ecosystem, whereby service innovations can contribute to the alleviation of food poverty for thousands of citizens. The central actor of the ecosystem is the leading UK charity organization fighting food waste. The paper’s contribution lies in using data from ecosystem actors to clarify the distinctions between institutions, thereby enhancing understanding of the application of institutional theory within the ecosystem and highlighting some theoretical implications for service innovation both within- and between-system levels. An actor institutions matrix is offered as a fruitful outcome of the analysis of the institutions, and suggested recommendations for operationalizing service ecosystem studies are outlined.
Computational Model of the Effect of a Surface-Binding Site on the Saccharomycopsis fibuligera R64 α-Amylase to the Substrate Adsorption
Authors: Yusuf *Muhammad , Baroroh *Umi , Hasan Khomaini , Rachman Saadah Diana , Ishmayana Safri , Subroto Toto
Published: November 2017

α-Amylase is one of the important enzymes in the starch-processing industry. However, starch processing requires high temperature, thus resulting in high cost. The high adsorptivity of α-amylase to the substrate allows this enzyme to digest the starch at a lower temperature. α-Amylase from Saccharomycopsis fibuligera R64 (Sfamy R64), a locally sourced enzyme from Indonesia, has a high amylolytic activity but low starch adsorptivity. The objective of this study was to design a computational model of Sfamy R64 with increased starch adsorptivity using bioinformatics method. The model structure of Sfamy R64 was compared with the positive control, ie, Aspergillus niger α-amylase. The structural comparison showed that Sfamy R64 lacks the surface-binding site (SBS). An SBS was introduced to the structure of Sfamy R64 by S383Y/S386W mutations. The dynamics and binding affinity of the SBS of mutant to the substrate were also improved and comparable with that of the positive control.
Internal colonisation: The intimate circulations of empire, race and liberal government
Authors: Turner Joe
Published: November 2017

This article proposes that ‘internal colonisation’ provides a necessary lens through which to explore the relationship between violence and race in contemporary liberal government. Contributing to an increasing interest in race in International Relations, this article proposes that while racism remains a vital demarcation in liberal government between forms of worthy/unworthy life, this is continually shaped by colonial histories and ongoing projects of empire that manifest in the Global North and South in familiar, if not identical, ways. In unpacking the concept of internal colonisation and its intellectual history from Black Studies into colonial historiography and political geography, I highlight how (neo-)metropolitan states such as Britain were always active imperial terrain and subjected to forms of colonisation. This recognises how metropole and colonies were bounded together through colonisation and how knowledge and practices of rule were appropriated onto a heterogeneity of racialised and undesirable subjects both within colonies and Britain. Bringing the argument up to date, I show how internal colonisation remains diverse and dispersed under liberal empire — enhanced through the war on terror. To do this, I sketch out how forms of ‘armed social work’ central to counterinsurgency in Afghanistan and Iraq are also central to the management of sub-populations in Britain through the counterterrorism strategy Prevent. Treating (neo-)metropoles such as the UK as part of imperial terrain helps us recognise the way in which knowledge/practices of colonisation have worked across multiple populations and been invested in mundane sites of liberal government. This brings raced histories into closer encounters with the (re)making of a raced present.
Characteristics of autism spectrum disorder in anorexia nervosa: A naturalistic study in an inpatient treatment programme
Authors: Tchanturia Kate , Adamson James , Leppanen Jenni , Westwood Heather
Published: November 2017

Previous research has demonstrated links between anorexia nervosa and autism spectrum disorder however, few studies have examined the possible impact of symptoms of autism spectrum disorder on clinical outcomes in anorexia nervosa. The aim of this study was to examine the association between symptoms of autism spectrum disorder and eating disorders, and other psychopathology during the course of inpatient treatment in individuals with anorexia nervosa. Participants with anorexia nervosa (n = 171) completed questionnaires exploring eating disorder psychopathology, symptoms of depression and anxiety, and everyday functioning at both admission and discharge. Characteristics associated with autism spectrum disorder were assessed using the Autism Spectrum Quotient, short version. Autism spectrum disorder symptoms were significantly positively correlated with eating disorder psychopathology, work and social functioning, and symptoms of depression and anxiety, but not with body mass index. Autism Spectrum Quotient, short version scores remained relatively stable from admission to discharge but there was a small, significant reduction in scores. There was no interaction between time and Autism Spectrum Quotient, short version scores on clinical symptom change. In anorexia nervosa, autism spectrum disorder symptoms appear to be associated with a more severe clinical presentation on admission to inpatient care. Autism spectrum disorder symptoms as assessed by self-report measures may be exacerbated by other mental health psychopathology, which warrants further investigation.
(Mis)understandings and uses of ‘culture’ in bioethics deliberations over parental refusal of treatment: Children with cancer
Authors: Gray Ben , Brunger Fern
Published: November 2017

We developed this study to examine the issue of parental refusal of treatment, looking at the issue through a cultural competence lens. Recent cases in Canada where courts have declined applications by clinicians for court orders to overrule parental refusal of treatment highlight the dispute in this area. This study analyses the 16 cases of a larger group of 24 cases that were selected by a literature review where cultural or religious beliefs or ethnic identity was described as important reasons behind the refusal. The most significant finding was that nearly all of the cases cited unacceptable side effects as the main reason for declining treatment. We then analysed the detail of the cases and concluded that in the first instance a skilled clinical approach to develop an agreed management plan is by far the best approach. In the event that agreement cannot be reached we recommend engaging a mediator to help the clinician and parents/child to find an agreeable way forward. We argue that the option of seeking a court order was of significant detriment to many of the children in our cases and that this option should be used sparingly. There is a need for empirical research on the outcome of cases where a court order is sought.
Evaluating Special Educators’ Classroom Performance: Does Rater “Type” Matter?
Authors: Lawson Janelle E. , Cruz Rebecca A.
Published: November 2017

Classroom observations remain the predominant data source used in teacher evaluations, but little is known about how rater characteristics may affect teachers’ scores. For special educators, whose instructional practice requires specialized knowledge and skills, school administrators (i.e., the raters) without experience in special education teaching may not be able to provide reliable and unbiased scores. This study included three school administrators who viewed and scored the classroom teaching of 19 special educators in California and Idaho; individuals with special education teaching experience also scored a subset of the instructional lessons. Generalizability study analyses revealed that the school administrators were not consistently reliable scorers of the special education teachers’ instruction. The school administrators were also more lenient on average in their ratings than peer teacher raters. Findings from this preliminary investigation suggest that rater background may matter, and future studies should explore how specific rater characteristics such as background and experience affect special educators’ performance ratings.
Changes in the metabolome and microRNA levels in biological fluids might represent biomarkers of neurotoxicity: A trimethyltin study
Authors: Imam Syed Z , He Zhen , Cuevas Elvis , Rosas-Hernandez Hector , Lantz Susan M , Sarkar Sumit , Raymick James , Robinson Bonnie , Hanig Joseph P , Herr David , MacMillan Denise , Smith Aaron , Liachenko Serguei , Ferguson Sherry , O’Callaghan James , Miller Diane , Somps Christopher , Pardo Ingrid D , Slikker Jr William , B Pierson Jennifer , Roberts Ruth , Gong Binsheng , Tong Weida , Aschner Michael , J Kallman Mary , Calligaro David , Paule Merle G
Published: November 2017

Neurotoxicity has been linked with exposure to a number of common drugs and chemicals, yet efficient, accurate, and minimally invasive methods to detect it are lacking. Fluid-based biomarkers such as those found in serum, plasma, urine, and cerebrospinal fluid have great potential due to the relative ease of sampling but at present, data on their expression and translation are lacking or inconsistent. In this pilot study using a trimethyl tin rat model of central nervous system toxicity, we have applied state-of-the-art assessment techniques to identify potential individual biomarkers and patterns of biomarkers in serum, plasma, urine or cerebral spinal fluid that may be indicative of nerve cell damage and degeneration. Overall changes in metabolites and microRNAs were observed in biological fluids that were associated with neurotoxic damage induced by trimethyl tin. Behavioral changes and magnetic resonance imaging T2 relaxation and ventricle volume changes served to identify animals that responded to the adverse effects of trimethyl tin.

Impact statement

These data will help design follow-on studies with other known neurotoxicants to be used to assess the broad applicability of the present findings. Together this approach represents an effort to begin to develop and qualify a set of translational biochemical markers of neurotoxicity that will be readily accessible in humans. Such biomarkers could prove invaluable for drug development research ranging from preclinical studies to clinical trials and may prove to assist with monitoring of the severity and life cycle of brain lesions.
The FDA Oncology Center of Excellence and precision medicine
Authors: Goldberg Kirsten B , Blumenthal Gideon M , McKee Amy E , Pazdur Richard
Published: November 2017

In January 2017, the U.S. Food and Drug Administration (FDA) formally established the Oncology Center of Excellence (OCE) to streamline the development of cancer therapies by uniting experts from FDA product centers to conduct expedited review of drugs, biologics, and devices. In May 2017, the FDA approved a cancer treatment based on a biomarker, without regard to the tumor’s site, by granting accelerated approval to pembrolizumab for patients with solid tumors that have the microsatellite instability-high or mismatch repair deficient biomarker. We describe here the OCE’s role in this first site-agnostic approval and OCE programs for further advancement of oncology-related regulatory science and policy. In addition, the FDA’s four expedited review programs that enable transformative therapies to reach patients with life-threatening malignancies earlier in the development process are key to the continued rapid development of safe and effective therapies for patients with few or no other treatment options. These changes at FDA are taking place in the context of recent progress in the understanding of the genetic and immunologic foundations of cancer, resulting in the development of targeted therapies and immunotherapies. The traditional system of phased clinical trials has evolved as early trials of breakthrough therapies use expansion cohorts in a process known as seamless drug development. Increasingly, FDA approvals of targeted therapies are likely to have contemporaneous approvals of companion diagnostics to identify patients whose cancers harbor actionable abnormalities.

Impact statement

This publication describes the U.S. Food and Drug Administration’s (FDA) first site-agnostic oncology drug approval, a landmark event in the history of cancer drug development. The role of the FDA’s newly established Oncology Center of Excellence (OCE) in this approval is described, as are several OCE programs to advance excellence in regulatory science in the era of precision medicine. Also provided is an overview of FDA’s expedited drug review programs, which are important to the continued acceleration of therapeutics development for patients with life-threatening diseases and few or no other treatment options.
Closing the 21st-Century Knowledge Gap
Authors: Longmore Anne-Liisa , Grant Ginger , Golnaraghi Golnaz
Published: November 2017

The 21st century is seeing dramatic shifts in the business environment. In order for organizations to adapt to these shifts, they must be more flexible and learning oriented. To thrive in this environment, organizational leaders must facilitate and build the capacity for learning throughout the organization. Organizational leadership is looking for employees to bring more than technical competencies or subject-matter expertise to their work; they are requiring specific learning-oriented competencies such as critical thinking, problem-solving, agility, adaptability, initiative, communication, and collaboration among others. To that end, business education is under heavy criticism for failure to produce the workforce needed to meet the demands of the 21st century. We set out to develop a conceptual teaching and learning model anchored in transformative and constructivist perspectives of learning that engages the whole learner in learning, reflective practice, and interactions with learning facilitators, other learning agents, and actors in a learning context.
Lower Trapezius Transfer for Patients With Brachial Plexus Injury
Authors: Crepaldi Bruno E. , Neto José Queiroz L. , Rezende Marcelo R. , Júnior Rames M. , Scarcella Daniele S.
Published: November 2017

Background: Brachial plexus injury is a complex entity that often results in partial recovery. Most studies to date have focused on improving shoulder abduction. However, a recent technique has been outlined—one that transfers the lower trapezius to improve the external rotation of the shoulder. The primary objective of this study was to evaluate the gains in external rotation of the shoulder in patients who have undergone transfer of the lower trapezius; secondarily, we assessed the range of motion in the elbow and shoulder joints, as well as the muscle strength and quality of life. Methods: This article presents a prospective cohort study of 10 patients who underwent transfer of the lower trapezius. During the preoperative period and at 6 months after the operation, both active and passive goniometric measurements were assessed, as were muscle strength, Mallet’s classification, and patients’ responses to the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Results: External rotation exhibited an improvement of 17° in the active range of motion and 14° the passive range, which was not statistically significant. Flexion and active abduction of the shoulder, as well as the responses to the DASH, showed positive results. The Mallet’s classification and muscle strength measurement results were not significant. Conclusions: The procedure might be an alternative for restoration of shoulder function and glenohumeral stabilization and mainly to improve quality of life. However, additional studies are required to define and refine this surgical technique.
Uncovering the Truth
Authors: Guthrie George E.
Published: November 2017

Finding the truth is important. In the field of lifestyle medicine the randomized controlled trial has significant limitations. Physicians and patients need to know the truth about the healthy lifestyle changes and their ability to prevent and reverse disease. To meet this challenge, the American College of Lifestyle Medicine has established a committee of experts (HEaLM), under the leadership of David Katz to create a level of evidence construct for ranking lifestyle medicine evidence that includes evidence from basic science and epidemiologic trials. This tool will be used by the new Expert Lifestyle Medicine Panel to create guidelines and standards of practice.
Comparative study of school principals’ leadership practices: Lessons for Chile from a cross-country analysis
Authors: Marfan Javiera , Pascual Javier
Published: November 2017

The article reports the results of a cross-country educational research project that uses quantitative methods to identify school leadership practices and contextual characteristics that contribute to explain student achievement in Chile, considering international comparisons. The results question previous evidence about a common repertoire of effective leadership practices and suggest that local context will affect the type of leadership that is required for a specific educational system to improve, and therefore the definition of principals’ effective practices. For Chile, the article points out that the principals’ leadership practices that contribute the most to improve teacher performance are those related to ensuring that teachers’ work and professional development are in accordance with the teaching goals of the school, as well as monitoring student work and classroom activities. Nevertheless, Chilean principals are more likely to get involved in the former practices (related to the school teaching goals) than in those related to teachers’ work in the classroom, resulting in their actions being more powerful in mobilizing teachers’ attitudes and professional practices than their teaching, which reduces their potential to promote teachers’ performance. The results have implications for educational leadership research and policy making, especially in non-Anglo-American countries.
Is ulipristal acetate the new drug of choice for the medical management of uterine fibroids? Res ipsa loquitur?
Authors: Odejinmi Funlayo , Oliver Reeba , Mallick Rebecca
Published: November 2017

Ulipristal acetate (Esmya©) has been hailed the new wonder drug with regard to the medical management of uterine fibroids, and many postulate that it will remove the need for surgical treatment in the future. While the results from the PEARL studies are certainly promising and its amenorrhoeic rates and reduction in fibroid size are unquestionable, there is still a paucity of data with regard to its long-term effects, the effects on its usage prior to surgery and its variable efficacy in different ethnic populations. To facilitate our knowledge further, independent studies with clear outcome measures evaluating the long-term effects of the drug in a wider, more representative, ethnic minority population as well as assessing its true cost-effectiveness compared to surgery are needed. The aim of this article is to review the historical aspects with regard to the management of uterine fibroids to gain an understanding of where we are now and to evaluate the wider use of ulipristal acetate, both its benefits and limitations and postulate where to go in the future in order to allow our women to make safe and informed choices regarding their treatment options.
Scaphoid nonunion: what is the role of the Zaidemberg 1,2 intercompartmental supraretinacular arterial flap?
Authors: Henry Mark
Published: November 2017

The reported results for the treatment of scaphoid nonunions with non-vascularized grafts are based on observational studies with a high variability in union rates from 38%–100% and time to union from 6–18 weeks, and there is also a lack of a standard classification. Meta-analyses and systematic reviews have been presented to better support conclusions from large pools of data (604 to 5246 cases), but their interpretation remains limited because of lack of uniformity in the studies analysed. Several authors have presented results from the Zaidemburg flap, with highly variable outcomes despite using the same technique; union rates have ranged from 27%–100% achieved between 6.5–19 weeks. Technical details that may be responsible for the discrepancies are discussed. There is a need for a validated prognostic classification system for scaphoid nonunions that can allow comparisons between outcome studies.
Cortical thickness analysis of the proximal humerus
Authors: Majed Addie , Thangarajah Tanujan , Southgate Dominic , Reilly Peter , Bull Anthony , Emery Roger
Published: November 2017

Background

Structural changes within the proximal humerus influence the mechanical properties of the entire bone and predispose to low-energy fractures with complex patterns. The aim of the present study was to measure the cortical thickness in different regions of the proximal humerus.

Methods

Thirty-seven proximal humeri were analyzed using novel engineering software to determine cortical thickness in 10 distinct anatomical zones.

Results

The cortical thickness values ranged from 0.33 mm to 3.5 mm. Fifteen specimens demonstrated a consistent pattern of progressive cortical thinning that increased between the bicipital groove (thickest), the lesser tuberosity and the greater tuberosity (thinnest). Fifteen humeri were characterized by a progressive increase in cortical thickness between the greater tuberosity (thinnest), the bicipital groove and lesser tuberosity (thickest). The diaphysis exhibited the thickest cortical zone in 27 specimens, whereas the articular surface possessed the thinnest cortex in 18 cases.

Conclusions

In conclusion, this is the first study to comprehensively assess cortical thickness of the humeral head. Our findings suggest that proximal humeral fractures occur along lines of cortical thinning and are displaced by the hard glenoid bone. The identification of specific areas of thick cortices may improve pre-operative planning and optimize fracture fixation.
Growing to give: Transforming learning via new pedagogies for the 21st century
Authors: van Haren Rita , Kiddy Robyn
Published: November 2017

This article reports on an Australian project involving preschool and kindergarten children learning about ‘giving’ and the environment. Teachers designed learning modules based on the Learning by Design framework, which views pedagogies as knowledge processes, and conducted action research to explore the impact of learning about ‘giving’ on student wellbeing and their literacy learning. From observations of students and analyses of students’ work samples, teachers agreed that students were more empathic, collaborative and felt more connected to their environments. Their engagement in authentic learning resulted in improved literacy outcomes as well as students taking action for the environment. Parent involvement also increased and strong connections were made between the schools and the wider community.
Thrombotic thrombocytopenic purpura presenting as a severe peripartum cardiogenic shock: Role of myocardial biopsy and assist device for diagnosis and resuscitation
Authors: Champion Sébastien , Belcour Dominique , Gaüzère Bernard Alex
Published: November 2017

We describe the case of a peripartum thrombotic thrombocytopenic purpura with fulminant cardiogenic shock treated with extracorporeal life support. Thrombotic thrombocytopenic purpura should be considered in the case of thrombotic microangiopathy with several or severe organ involvement and needs emergent treatment with plasmapheresis (with or without rituximab). In the case of cardiac involvement, aggressive treatment should be considered given the high mortality and the potential complete recovery.