bluuebunny/crossref_metadata_2025 huggingface dataset:
Tourism Experiences as a Stress Reliever
Authors: Chen Chun-Chu , Petrick James F. , Shahvali Moji
Published: August 2014

The effect-recovery theory (Meijman and Mulder 1998) and the conservation of resources theory (Hobfoll 1998) suggest that taking a leisure trip provides opportunities for relaxation, detachment from work, mastery experience, and personal control. This research examined the role of tourism experiences as a stress reliever, particularly focusing on the underlying psychological experiences associated with recovery. Further, this research examined how these recovery experiences during a leisure trip influence perceived life satisfaction after the trip. It was found that all four dimensions of tourism recovery experiences had positive effects on life satisfaction. The results also revealed that even a weekend getaway can help people to recover from work stress, while longer trips provide more opportunities for recovery experiences.
Pathway Analysis and the Search for Causal Mechanisms
Authors: Weller Nicholas , Barnes Jeb
Published: August 2014

The study of causal mechanisms interests scholars across the social sciences. Case studies can be a valuable tool in developing knowledge and hypotheses about how causal mechanisms function. The usefulness of case studies in the search for causal mechanisms depends on effective case selection, and there are few existing guidelines for selecting cases to study causal mechanisms. We outline a general approach for selecting cases for pathway analysis: a mode of qualitative research that is part of a mixed-method research agenda, which seeks to (1) understand the mechanisms or links underlying an association between some explanatory variable, X1, and an outcome, Y, in particular cases and (2) generate insights from these cases about mechanisms in the unstudied population of cases featuring the X1/ Y relationship. The gist of our approach is that researchers should choose cases for comparison in light of two criteria. The first criterion is the expected relationship between X1/ Y, which is the degree to which cases are expected to feature the relationship of interest between X1 and Y. The second criterion is variation in case characteristics or the extent to which the cases are likely to feature differences in characteristics that can facilitate hypothesis generation. We demonstrate how to apply our approach and compare it to a leading example of pathway analysis in the so-called resource curse literature, a prominent example of a correlation featuring a nonlinear relationship and multiple causal mechanisms.
Two-Dimensional Ultrasound and Ultrasound Elastography Imaging of Trigger Points in Women with Myofascial Pain Syndrome Treated by Acupuncture and Electroacupuncture
Authors: Müller Cristina Emöke Erika , Aranha Maria Fernanda Montans , Gavião Maria Beatriz Duarte
Published: August 2014

Chronic pain has been often associated with myofascial pain syndrome (MPS), which is determined by myofascial trigger points (MTrP). New features have been tested for MTrP diagnosis. The aim of this study was to evaluate two-dimensional ultrasonography (2D US) and ultrasound elastography (UE) images and elastograms of upper trapezius MTrP during electroacupuncture (EA) and acupuncture (AC) treatment. 24 women participated, aged between 20 and 40 years (M ± SD = 27.33 ± 5.05) with a body mass index ranging from 18.03 to 27.59 kg/m2 (22.59 ± 3.11), a regular menstrual cycle, at least one active MTrP at both right (RTPz) and left trapezius (LTPz) and local or referred pain for up to six months. Subjects were randomized into EA and AC treatment groups and the control sham AC (SHAM) group. Intensity of pain was assessed by visual analogue scale; MTrP mean area and strain ratio (SR) by 2D US and UE. A significant decrease of intensity in general, RTPz, and LTPz pain was observed in the EA group (p = 0.027; p < 0.001; p = 0.005, respectively) and in general pain in the AC group (p < 0.001). Decreased MTrP area in RTPz and LTPz were observed in AC (p < 0.001) and EA groups (RTPz, p = 0.003; LTPz, p = 0.005). Post-treatment SR in RTPz and LTPz was lower than pre-treatment in both treatment groups. 2D US and UE effectively characterized MTrP and surrounding tissue, pointing to the possibility of objective confirmation of subjective EA and AC treatment effects.
Maternal Emotion Regulation
Authors: Morelen Diana , Shaffer Anne , Suveg Cynthia
Published: August 2014

This study examined the link between maternal emotion regulation (ER) and emotion parenting behaviors and child ER, particularly emphasizing the previously understudied potential associations between mothers’ ER and concurrent emotion parenting behaviors. Community-recruited participants included 64 mother–child ( M = 9.5 years, 38 girls) dyads. Mothers completed measures on their own ER, their child’s ER, and their emotion parenting strategies. Children completed measures on their ER and mother–child dyads engaged in a conflict discussion task that was coded using an ER behavioral observation scale. Results indicated that observed maternal ER was negatively associated with unsupportive emotion parenting, whereas self-reported maternal emotion dysregulation was positively associated with unsupportive parenting and child emotion dysregulation and negatively associated with child adaptive ER. Partial support was provided for the mediating role of emotion parenting behaviors on the link between maternal and child ER. Implications regarding parenting programs and intervention efforts are discussed.
Long‐term Sinonasal Outcomes of Aspirin Desensitization in Aspirin Exacerbated Respiratory Disease
Authors: Cho Kyu‐Sup , Soudry Ethan , Psaltis Alkis J. , Nadeau Kari C. , McGhee Sean A. , Nayak Jayakar V. , Hwang Peter H.
Published: August 2014

Objective

This study aimed to assess sinonasal outcomes in patients with aspirin exacerbated respiratory disease (AERD) undergoing aspirin desensitization following endoscopic sinus surgery (ESS).

Study Design

Case series with chart review.

Setting

University hospital.

Subjects and Methods

A retrospective review of sinonasal outcomes was conducted for 30 AERD patients undergoing aspirin desensitization and maintenance therapy following ESS. Sinonasal outcomes were prospectively assessed by the Sinonasal Outcomes Test‐22 (SNOT‐22) and endoscopic polyp grading system. Data were collected preoperatively, 1 and 4 weeks postsurgery (before desensitization), and 1, 6, 12, 18, 24, and 30 months after aspirin desensitization.

Results

Twenty‐eight of 30 patients (93.3%) successfully completed aspirin desensitization, whereas 2 of 30 (6.7%) were unable to complete desensitization due to respiratory intolerance. Of the 21 patients who successfully completed a minimum of 24 weeks of follow‐up, 20 (95.2%) patients demonstrated sustained endoscopic and symptomatic improvement for a median follow‐up period of 33 months. After surgical treatment but before desensitization, patients experienced significant reductions in SNOT‐22 and polyp grade scores. In the first 6 months after aspirin desensitization, patients experienced further significant reductions in SNOT‐22 scores, whereas polyp grade remained stable. The improvements in symptom endoscopic scores were preserved throughout the follow‐up period after desensitization. No patients required additional sinus surgery. One patient had to discontinue aspirin therapy due to gastrointestinal side effects. No other adverse reactions to aspirin were noted.

Conclusion

Aspirin desensitization following ESS appears to be a well‐tolerated and effective adjunctive therapy for long‐term control of nasal polyposis in patients with AERD.
Mortal questions
Authors: Romanillos José L.
Published: August 2014

Drawing upon resources from philosophy, sociology, history, and anthropology, this paper explores the possibilities of attending to geographies on the other side of life. After an introductory review of work on deathscapes and extant geographical reflections on absence and loss, the paper turns to consider three horizons in which geographers might extend their interrogations of different mortal conditions: mourning, the spatial politics of the dead, and corporeality. The paper concludes by reflecting on the disciplinary possibilities of responding to these empirical concerns at a time when we are often asked to cultivate all manner of lively geographies.
The Arthroscopic Latarjet Procedure for Anterior Shoulder Instability
Authors: Dumont Guillaume D. , Fogerty Simon , Rosso Claudio , Lafosse Laurent
Published: August 2014

Background:

The arthroscopic Latarjet procedure combines the benefits of arthroscopic surgery with the low rate of recurrent instability associated with the Latarjet procedure. Only short-term outcomes after arthroscopic Latarjet procedure have been reported.

Purpose:

To evaluate the rate of recurrent instability and patient outcomes a minimum of 5 years after stabilization performed with the arthroscopic Latarjet procedure.

Study Design:

Case series; Level of evidence, 4.

Methods:

Patients who underwent the arthroscopic Latarjet procedure before June 2008 completed a questionnaire to determine whether they had experienced a dislocation, subluxation, or further surgery. The patients also completed the Western Ontario Shoulder Instability Index (WOSI).

Results:

A total of 62 of 87 patients (64/89 shoulders) were contacted for follow-up. Mean follow-up time was 76.4 months (range, 61.2-100.7 months). No patients had reported a dislocation since their surgery. One patient reported having subluxations since the surgery. Thus, 1 patient (1.59%) had recurrent instability after the procedure. The mean ± standard deviation aggregate WOSI score was 90.6% ± 9.4%. Mean WOSI domain scores were as follows: Physical Symptoms, 90.1% ± 8.7%; Sports/Recreation/Work, 90.3% ± 12.9%; Lifestyle, 93.7% ± 9.8%; and Emotions, 88.7% ± 17.3%.

Conclusion:

The rate of recurrent instability after arthroscopic Latarjet procedure is low in this series of patients with a minimum 5-year follow-up. Patient outcomes as measured by the WOSI are good.
Three-Dimensional Analysis of Acromial Morphologic Characteristics in Patients With and Without Rotator Cuff Tears Using a Reconstructed Computed Tomography Model
Authors: Fujisawa Yukitaka , Mihata Teruhisa , Murase Tsuyoshi , Sugamoto Kazuomi , Neo Masashi
Published: August 2014

Background:

The relationship between rotator cuff tears and acromial shape has yet to be clarified. As a result, the most suitable location for acromioplasty for the treatment of rotator cuff tears is not known.

Purpose:

To determine whether any particular change in acromial shape is significantly associated with the presence of rotator cuff tears.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

From 2007 to 2010, we examined 25 consecutive patients with unilateral full-thickness rotator cuff tears who underwent arthroscopic repair and 17 consecutive patients with adhesive capsulitis but intact rotator cuffs who underwent arthroscopic capsular release. Before surgery, a reconstructed 3-dimensional computed tomography model was used to evaluate the acromial structure. Changes in the shape of the affected scapula were qualitatively evaluated relative to the unaffected, contralateral scapula by use of proximity mapping. Differences in acromial structure between affected and unaffected shoulders were assessed at the anterior, lateral, and medial edges and the inferior surface. The association between rotator cuff tear size and change in acromial structure was also evaluated.

Results:

Rates of bony projection at the anterior (>2 mm) and lateral (>3 mm) edges of the acromion in patients with rotator cuff tears were significantly greater compared with rates in patients without rotator cuff tears ( P < .01). Tear size was not correlated with changes in acromial structure ( P = .37-.73).

Conclusion:

Bone spurs at the anterior and lateral edges of the acromion are associated with the presence of full-thickness rotator cuff tears in symptomatic patients.
Use of Self-Monitoring to Maintain Program Fidelity of Multi-Tiered Interventions
Authors: Nelson J. Ron , Oliver Regina M. , Hebert Michael A. , Bohaty Janet
Published: August 2014

Multi-tiered system of supports represents one of the most significant advancements in improving the outcomes of students for whom typical instruction is not effective. While many practices need to be in place to make multi-tiered systems of support effective, accurate implementation of evidence-based practices by individuals at all tiers is critical to obtain student outcomes. Effective strategies to achieve program fidelity are available; however, maintaining program fidelity at the individual level remains elusive. Lessons drawn from medicine indicate strategies to maintain program fidelity should address the implementer. Medical practitioners have used self-monitoring checklists to maintain fidelity with striking results. Research evaluating strategies to maintain program fidelity at the individual level represents an important next step in the field of education. Recommendations for a systematic research agenda focused on self-monitoring checklists are presented.
Perinatal Medical Variables Predict Executive Function Within a Sample of Preschoolers Born Very Low Birth Weight
Authors: Duvall Susanne W. , Erickson Sarah J. , MacLean Peggy , Lowe Jean R.
Published: August 2014

The goal was to identify perinatal predictors of early executive dysfunction in preschoolers born very low birth weight. Fifty-seven preschoolers completed 3 executive function tasks: Dimensional Change Card Sort-Separated (inhibition, working memory, and cognitive flexibility), Bear Dragon (inhibition and working memory), and Gift Delay Open (inhibition). Relationships between executive function and perinatal medical severity factors (gestational age, days on ventilation, size for gestational age, maternal steroids, and number of surgeries) and chronological age were investigated by multiple linear regression and logistic regression. Different perinatal medical severity factors were predictive of executive function tasks, with gestational age predicting Bear Dragon and Gift Open; and number of surgeries and maternal steroids predicting performance on Dimensional Change Card Sort-Separated. By understanding the relationship between perinatal medical severity factors and preschool executive outcomes, we can identify children at highest risk for future executive dysfunction, thereby focusing targeted early intervention services.
A 5-Year-Old Male Child With Late Infantile Metachromatic Leukodystrophy
Authors: Mahmood Afreen , Chacham Swathi , Reddy Uppin Narayan , Rao Jillalla Narsing , Rao S. Pratap
Published: August 2014

Metachromatic leukodystrophy is a rare disorder of myelin metabolism. This degenerative disorder results from the accumulation of cerebroside sulfatide within the myelin sheath of central and peripheral nervous system, due to deficiency of aryl sulfatase A enzyme. We report a 5-year-old male child, who presented with regression of milestones, recurrent seizures and spasticity from second year of life. Initially neurodegenerative disorder was considered and the case was investigated with neuroimaging and enzyme levels. Computed tomography (CT) of the brain showed hypodensities in the corpus callosum and bilateral periventricular and deep cerebral white matter suggestive of neurodegenerative disorder. Subsequently, magnetic resonance imaging (MRI) of the brain was done, which showed symmetrical hyperintensities in the periventricular white matter with classical sparing of subcortical “U” fibers. The β-galactosidase enzyme activity was normal; however, the activity of aryl sulfatase A enzyme was undetectable, confirming the diagnosis of late infantile variant of metachromatic leukodystrophy.
The Vocational Goals and Career Development of Criminally Involved Youth
Authors: Bartlett Jennifer , Domene José F.
Published: August 2014

Little is known about the career development of youth with a history of criminal activity and the factors that influence their career development. The ability to secure employment is important in predicting successful outcomes for this population, but unfortunately youth who have been involved in crime are likely to face a myriad of obstacles to obtaining secure employment. This qualitative study used the enhanced critical incident technique to explore the incidents that 16 male and female youth with a history of criminal activity perceived as helping and hindering their short-term career goals and things that they did not experience but wish they had. Results revealed that criminally involved youth have career expectations of relatively low prestige and that their experiences with crime and the justice system have contributed to the development and achievement of these career goals in unique ways. The implications of these findings for career counseling and youth outreach programming are discussed.
Predictors of Injurious Falls and Fear of Falling Differ
Authors: Clemson Lindy , Kendig Hal , Mackenzie Lynette , Browning Colette
Published: August 2014

Objective: The objective of the study is to identify the intrinsic, psychosocial and lifestyle factors, which, over time, predict the incidence of having a fall requiring medical attention (injurious fall) or of acquiring a fear of falling (FOF). Method: Data from 1,000 participants in the Melbourne Longitudinal Studies on Healthy Ageing (MELSHA, 1994-2005) were analyzed using cox regressions and hazard ratios. Results: The predictors of injurious falls ( n = 900, events = 200) were increasing age, slower gait speed, and being depressed. Main predictors of developing a FOF ( n = 855, events =117) were increasing age, cognitive impairment, reduced social activity, and gender. A history of falls at baseline did not predict acquiring a FOF nor did FOF predict a future fall. Discussion: The profile of the person who will have an injurious fall differs from the profile of the person who develops a FOF and should be considered when designing interventions.
Grey relational analysis coupled with firefly algorithm for multiobjective optimization of wire electric discharge machining
Authors: Varun A , Venkaiah N
Published: August 2014

Complex engineering problems are often required to be addressed for multiobjective optimization. Wire electric discharge machining is one such multiobjective optimization problem. Conflicting objectives such as material removal rate, surface roughness and kerf have always been research interest for optimization. In this article, a novel optimization strategy has been formulated by coupling grey relational analysis with firefly algorithm to optimize the responses. Process parameters such as pulse-on time, pulse-off time, peak current and servo voltage are studied. Response parameters such as material removal rate, surface roughness and kerf are considered. Firefly algorithm is the main technique and grey relational analysis is used to generate a grey relational grade. This grade is further used in firefly algorithm for movement of firefly to the neighboring brighter and attractive firefly. In this process of self-organization, simultaneous optimal solution for material removal rate, surface roughness and kerf is obtained. Peak current is found to be the most influencing factor affecting all the three responses. Pareto surface plot is also plotted to recommend alternate solutions for various responses based on the priorities. As the proposed strategy is generalized, it can be customized and applied for any multiobjective optimization problem.
An on-line monitoring system for wire electrical discharge turning process
Authors: Yan Mu-Tian , Hsieh Pai-Hung
Published: August 2014

This article presents a new pulse discriminating system for process monitoring of wire electrical discharge turning. The pulse discriminating device, including a spark gap monitor and a digital signal processor card, has been developed to identify four major gap states classified as open circuit, normal spark, arc discharge and short circuit based on the characteristics of gap voltage waveform as well as compute ignition delay time for each open circuit and normal spark. By means of this system, the proportion of open circuit, normal spark, arc discharge and short circuit to total sparks and average ignition delay time within a time interval of 200 ms can be analyzed quantitatively during the wire electrical discharge turning process. It has been observed that thread cutting using wire electrical discharge turning exhibited more stable machining than cylindrical wire electrical discharge turning under a servo feed machining condition because servo feed control of the cylindrical wire electrical discharge turning process only focused on keeping forward sparking gap at a proper width, but it failed to respond to the variation of lateral gap width due to an independent motion of the rotary axis with respect to the translational axis. Experimental results also demonstrate that these pulse train data and average ignition delay time can substitute for average gap voltage as sensing parameters for on-line monitoring and control of the wire electrical discharge turning process.
Defamilization typology re-examined: Re-measuring the economic independence of women in welfare states
Authors: Cho Esther Yin-Nei
Published: August 2014

Defamilization typologies are a product of the feminist critique of the modelling of welfare states. A growing literature has employed the notion of defamilization and incorporated the gender dimension into the comparative examination of welfare state regimes. The purpose of this study is to further refine the defamilization typology by addressing the existing limitations and providing better operationalization. Based on previous work, this study uses cluster analysis to classify the same countries, but uses different measures and more up-to-date data. The article begins with a conceptual delineation of defamilization to reveal its important aspects in order to achieve better operationalization. A cluster analysis is then conducted, with preliminary efforts to validate the cluster solution. The findings suggest a fourfold typology according to the varying degree of defamilization. Implications for future research will also be discussed.
Physical and biological features of an active rock glacier in the Italian Alps
Authors: Gobbi Mauro , Ballarin Francesco , Compostella Chiara , Lencioni Valeria , Seppi Roberto , Tampucci Duccio , Caccianiga Marco
Published: August 2014

We report on the key physical features of an active rock glacier that influence the distribution of plants and arthropods. We also perform a comparison with neighboring scree slope and alpine grassland to test whether the environmental features of the rock glacier drive the presence of specific species assemblages. Compared with scree slope and grassland, the studied rock glacier provides particular physical features that determine the presence of unique species. Plant distribution is mainly driven by grain size. Arthropod distribution is linked to grain size, with cold-adapted species found on areas with coarse-grained deep debris, which also shows a distinctive temperature regime with very low values throughout the year. On the basis of these findings, we advance the hypothesis that rock glaciers provide specific ecological conditions creating potential refugia for cold-demanding species during warm climatic periods.
Terrigenous input to a fjord in central Norway records the environmental response to the North Atlantic Oscillation over the past 50 years
Authors: Faust Johan C , Knies Jochen , Milzer Gesa , Giraudeau Jacques
Published: August 2014

During the last century, both earth surface temperature and moisture transport towards high latitudes have increased rapidly. The response of the sub-arctic region to these changes in terms of weathering, transport and delivery of terrigenous material towards the coastal and deep ocean is both complex and poorly understood. Sediments accumulating in fjords offer an excellent opportunity for studying such land–ocean interactions and may provide ultra-high-resolution records of environmental response to short-term climate variability. As a basis for Holocene climate change studies, modern sources, supply and distribution of particular sediment components in the Trondheimsfjord have been investigated and imply lithogenic elements as a promising proxy for terrigenous input and river discharge. To better understand the impact of atmospheric variability on central Norwegian environment, we examine instrumental time series and show that the dominant mode of the atmospheric circulation in the North Atlantic region, the North Atlantic Oscillation (NAO), has a strong impact on river discharge, temperature and precipitation in central Norway. In addition, elemental composition analysis of a short sediment core reveals that from 1959 to 2010, winter precipitation and temperature changes are recorded by changes in the inorganic geochemical composition of Trondheimsfjord sediments. Elemental ratios of Al/Zr and K/Ni in the sediment core MC99-3 show a close relation to small-scale, high frequency climate variations and large-scale changes in the Northern Hemisphere climate. This implies that terrigenous input and related erosional processes in the fjord hinterland are highly sensitive to atmospheric circulation variability in the North Atlantic region. By comparing our results with NAO records derived from ice accumulation rates of Norwegian glaciers, western Greenland ice sheets and river discharge anomalies in the Eurasian Arctic, we show that it is possible to reconstruct the NAO from sedimentary archives in central Norwegian fjords.
Fossil shorelines at Corfu and surrounding islands deduced from erosional notches
Authors: Evelpidou Niki , Karkani Anna , Pirazzoli Paolo A
Published: August 2014

New geomorphological investigations along the coasts of Corfu, Othonoi, Paxoi, and Antipaxoi Islands allowed the identification of recent fossil shorelines. Former sea-level positions were deduced from sea-level indicators. A ‘modern’ tidal notch, submerged c. −20 cm, was observed in all studied islands. This notch is regarded to have been submerged by the global sea-level rise that occurred during the 19th and 20th centuries at a rate exceeding the possibilities of intertidal bioerosion. Its presence provides evidence that no vertical tectonic movements occurred since its formation. On Corfu, impacts of ancient earthquakes have left some marks of emergence at about ≥+130 ± 11, +110 ± 11, +65 ± 11, +40 ± 11, and +25 ± 11 cm, as well as marks of submergence at about −40 to −50, −85 ± 11, −120 ± 11, and −180 ± 11 cm. The emergence of +130 ± 11 cm, previously dated at about 790–400 cal. bc, was detected through erosion notches at various sites in the western part of Corfu and appears to continue even more west, at Othonoi Island. Tidal notches submerged at depths exceeding 0.4 m were observed in the northeastern part of the island and suggest the local occurrence of a sequence of four coseismic subsidences, with average vertical displacements of 40 cm, during at least the last few millennia. At Paxoi and Antipaxoi, Holocene vertical movements seem to have been mainly of subsidence. At Paxoi, the ‘modern’ notch was found at about −20 to −30 cm, while four more submerged tidal notches were distinguished at about −40 ± 11, −60 ± 11, −75 ± 11, and −90 ± 11 cm, while in Antipaxoi, three submerged tidal notches were distinguished at about −60 ± 11, −75 ± 11, and −120 ± 11 cm.
The indications, efficacy and adverse events of rituximab in a large cohort of patients with juvenile-onset SLE
Authors: Watson L , Beresford M W , Maynes C , Pilkington C , Marks S D , Glackin Y , Tullus K
Published: August 2014

Background

B cells drive antibody formation and T cell activation. This study aimed to describe the clinical indications, efficacy and adverse events (AEs) for the B-cell depleting agent, rituximab, in a large cohort of children with lupus.

Methods

Prescribing records and the UK JSLE Cohort Study database identified rituximab use.

Results

Sixty-three patients received 104 courses of intravenous rituximab over a 10-year period. Patients were aged 12.2 (IQR 9.0–13.9) years at diagnosis and 50 (79%) were female. They had disease for 1.4 (0.2–3.0) years at the time of rituximab. Lupus nephritis was the most common indication (36% of first courses). Clinical biomarkers, 2.5 (1.6–4.3) months after treatment, demonstrated a statistically significant improvement in ESR, C3, C4, creatinine, albumin, haemoglobin, anti-dsDNA titres and urine albumin:creatinine ratio. IgG, IgA and IgM levels decreased ( p < 0.01). Oral corticosteroid dose significantly reduced after rituximab (dose before 0.26 (0.09–0.44) mg/kg, after 0.17 (0.09–0.30) mg/kg; p = 0.01)). AEs occurred in 19 (18%) of all courses including; delayed second dose (8%), Ig replacement (2%) and infusion reactions (6%; anaphylaxis 2%). The global BILAG score showed a trend toward improvement (before 4.5 (2.0–9.0), after 3.0 (2.0–5.0); p = 0.16).

Conclusion

Rituximab improves disease activity in children with lupus and serious AEs are infrequent. Controlled studies are required.
Systemic lupus erythematosus-associated acute transverse myelitis: manifestations, treatments, outcomes, and prognostic factors in 20 patients
Authors: Saison J , Costedoat-Chalumeau N , Maucort-Boulch D , Iwaz J , Marignier R , Cacoub P , Vital-Durand D , Hot A , Tebib J , Aumaitre O , Schleinitz N , Sarrot-Reynauld F , Broussolle C , Sève P
Published: August 2014

Background

Transverse myelitis is a rare complication of systemic lupus erythematosus (SLE). This retrospective multicentre study identifies the prognostic factors in a relatively large patient series.

Patients and methods

Twenty patients fulfilled the SLE criteria of the ACR classification and the Transverse Myelitis Consortium Working Group. A severe neurological flare was defined as muscle strength grade <3/5 in more than half the muscle groups at the motor neurological level. Inability to run or another significant ambulation-unrelated disability was considered as ‘unfavourable neurological outcome’.

Results

Myelitis was the first SLE symptom in 12 patients; in the eight others, it occurred 8.6 years (median delay) after SLE onset. Eleven patients presented severe neurological impairments. The treatment included corticosteroids in all patients associated with intravenous cyclophosphamide in 11 and/or hydroxychloroquine in 14. Unfavourable outcomes were observed in 53% of the patients at six months and in 28% at end of follow-up (median: 5.9 years). An initial severe neurological impairment and no cyclophosphamide use were associated with unfavourable neurological outcomes at six months and at end of follow-up, respectively.

Conclusion

Transverse myelitis may reveal SLE or occur more than 10 years after SLE diagnosis. The initial severity of the neurological flare (with paraplegia) is the main prognostic marker. The study provides arguments for cyclophosphamide use.
Thrombopoietin levels in systemic lupus erythematosus are linked to inflammatory cytokines, but unrelated to thrombocytopenia or thrombosis
Authors: Lu C , Nossent J
Published: August 2014

Background

Thrombopoietin (TPO) is a liver-produced protein that drives megakaryocyte maturation. TPO regulates platelet production and can increase platelet and endothelial reactivity. We investigated the relationship between TPO and the occurrence of thrombocytopenia and thrombosis in patients with systemic lupus erythematosus (SLE).

Methods

We undertook a cohort study of SLE patients ( n = 98) with clinical data collected simultaneously with sampling for TPO, inflammatory cytokines and autoantibody detection. TPO levels were measured by sandwich ELISA with patients with rheumatoid arthritis (RA) ( n = 100) and controls ( n = 79) as comparators. Disease associations were evaluated using non-parametric methods.

Results

TPO levels in SLE (median 8 pg/ml, mean 326, range 8992) were moderately increased compared with RA (median 8 pg/ml, mean 100, range 1659, p = 0.07) and controls (median 8, mean 94, range 2088, p = 0.1). Among SLE patients, TPO levels did not correlate with platelet count or levels of antiphospholipid antibodies. The prevalence of thrombocytopenic episodes, thrombotic events or active disease was not increased in patients with high TPO levels. TPO levels correlated with MIP-1α ( Rs 0.56, p < 0.001), IL6 ( Rs 0.26, p = 0.02) and IL4 ( Rs 0.29, p = 0.01), and inversely correlated to C4 ( Rs −0.23, p = 0.04). MIP-1α was the strongest independent predictor of increased TPO levels.

Conclusion

TPO levels are elevated in 20% of patients, but are not closely related to the occurrence of thrombocytopenia or thrombosis in SLE. MIP1-alpha is the main factor driving higher TPO levels among patients with SLE, likely through its inhibitory effect on megakaryocyte function.
Geographic Variation in Radiologist Capacity and Widespread Implementation of Lung Cancer CT Screening
Authors: Smieliauskas Fabrice , MacMahon Heber , Salgia Ravi , Shih Ya-Chen Tina
Published: August 2014

Background

Newly released United States Preventive Services Task Force (USPSTF) recommendations for lung cancer screening are expected to increase demand for low-dose computed tomography scanning, but health system capacity constraints might threaten the scale-up of screening.

Objectives

To estimate the prevalence of capacity constraints in the radiologist workforce and resulting potential disparities in access to lung cancer screening.

Methods

We combined information from health interview surveys to estimate the numbers of smokers who meet the USPSTF eligibility criteria, and information from administrative datasets to estimate the numbers of radiologists and the numbers of scans they currently interpret in Health Service Areas (HSAs) nationwide. We estimated and mapped the prevalence of capacity constrained HSAs – those having a greater than 5% or greater than 25% projected increase in scans over current levels from scaling up screening – and used descriptive statistics and logistic regressions to identify HSA characteristics associated with capacity constraints.

Results

Scaling up lung cancer screening would increase imaging procedures by an average of 4% across HSAs. Of the 9.6 million eligible smokers, 1,023,943 lived in HSAs with increases of at least 5%. HSAs that were rural, with many eligible smokers, and disproportionately Hispanic or low-income smokers had significantly higher odds of facing capacity constraints.

Conclusions

Disparities in access to lung cancer screening appear likely unless policy makers target HSAs with few radiologists for additional resources. Radiologists should be able to absorb the workload imposed by lung cancer screening in most areas of the country.
Co-inheritance of α-thalassaemia and β-thalassaemia in a prenatal screening population in mainland China
Authors: Li Jian , Xie Xing-Mei , Liao Can , Li Dong-Zhi
Published: August 2014

Objective

To determine the prevalence of α-thalassaemia in β-thalassaemia individuals in a Chinese population.

Methods

The standard diagnostic marker for β-thalassaemia was elevation of the Hb A2 level (>3.5%) with low mean corpuscular volume. The common α-thalassaemia mutations were studied by molecular analysis in all identified β-thalassaemia carriers.

Results

A prevalence rate of 3.3% for β-thalassaemia was found in our population; α- and β-thalassaemia interactions were found to co-exist in 17.8% of the β-thalassaemia carriers. The -SEA deletion was the most common α-thalassaemia mutation co-inherited with β-thalassaemia, followed by the -α3.7 deletion, the -α4.2 deletion, Hb Quong Sze, and Hb Constant Spring.

Conclusion

Our results suggest that it could be valuable to study co-existing α-globin mutations in subjects with β-thalassaemia trait in a prenatal screening programme, especially in populations with a high prevalence of haemoglobinopathies.
An enhanced physics-based model to estimate the displacement of piezoelectric actuators
Authors: Miri Narges , Mohammadzaheri Morteza , Chen Lei
Published: August 2014

Piezoelectric actuators are the foremost actuators in the area of nanopositioning. However, the sensors employed to measure the actuator displacement are expensive and difficult, if not impossible, to use. Mathematical models can map the easy-to-measure electrical signals to the displacements of the actuators as the displacement sensors are replaced with the models. In addition, these models can be used in model-based control system design. Two main groups of mathematical models are used for this purpose: black box and physics-based models. As an advantage, the latter has a much smaller number of parameters reducing computational demand in real-time applications. However, physics-based models suffer from (1) the relatively low accuracy of the models and (2) non-standard and ad-hoc parameter identification methods. In this research, to improve the model accuracy, mathematical structure of a well-known physics-based model, the Voigt model, is enhanced by adding two complementary terms inspired by another model, the Preisach model. Then, a standard method based on the evolutionary algorithms is proposed to identify the model’s parameters. The proposed ideas are substantiated to increase the applicability and accuracy of the model, and they are easily extendable to other physics-based models of piezoelectric actuators. The newly proposed enhanced structure of the Voigt model doubles the estimation accuracy of the original model and results in accuracies comparable with black box models.
Variable-stiffness skin concept for camber-morphing airfoils
Authors: Raither Wolfram , Furger Emian , Zündel Manuel , Bergamini Andrea , Ermanni Paolo
Published: August 2014

Morphing airfoils promise advances in performance and efficiency when compared to conventional designs. However, the conflict of requirements between compliance and stiffness, which is characteristic of shape-adaptable structures, often leads to compromise-driven solutions. This article presents the concept of a variable-camber airfoil with adjustable stiffness. Smart elements in the airfoil skin permit to adapt the structural rigidity to the system’s operational states, resulting in more efficient morphing and potentially lighter designs. It is shown by a numerical study that with respect to a reference configuration, the actuation energy is reduced by up to 97% and the structural mass can be lowered by up to two thirds. Furthermore, experiments on a scaled airfoil structure with a variable-stiffness skin based on electro-bonded laminates demonstrate effectivity and integrability of the proposed structural concept, which permit changes in cambering stiffness by a factor of at least 70.
Integrating Research and Practice
Authors: Gambrill Eileen
Published: August 2014

Integrating practice and research is vital in all helping professions in order to offer the most ethical, evidence-informed interventions to clients. This article describes some avoidable distractions that hinder integration, discusses controversies related to integration, and describes options for moving forward, including making wasted resources visible, use of an Environmental Deprivation Scale, and courage training.
Outcome Results From Yo Veo
Authors: Chapman Mimi V. , Hall William J.
Published: August 2014

Objective:

This study reports results from the outcome evaluation of Yo Veo, a visual intervention with schoolteachers, which structures conversations about challenges that teachers face teaching Latino/Latina immigrant students.

Method:

The intervention was delivered to teachers at two middle schools in the southeastern United States, one with a large and another with a growing proportion of Latino/Latina students. Questionnaire data were collected from 46 teachers at baseline, posttest, and 9-month follow-up. Measures were adapted at the second school as part of the pilot process.

Results:

Results show improvements in teachers’ scores on cultural competency, multicultural teaching practices, positive classroom management strategies, beliefs about parental involvement, mental health competency, knowledge of barriers to mental health service access, and attitudes toward undocumented immigrants. Measures on which there was no change or changes in the negative direction are also discussed.

Conclusions:

Yo Veo is a promising approach for promoting awareness, attitudes, and understanding among teachers working with Latino/Latina immigrant students and families. Further research is required to prepare the intervention for wider testing and dissemination.
Addressing Parental Mental Health Within Interventions for Children
Authors: Acri Mary C. , Hoagwood Kimberly Eaton
Published: August 2014

Purpose:

Untreated parent mental health problems have deleterious effects upon the family, yet caregivers are unlikely to receive services for their emotional health. We conducted a review of treatments and services for children and adolescents that also offered services to parents.

Methods:

Child treatment and service studies were included in the present study if they analyzed parent symptoms or diagnoses over time, and the intervention contained a parent component.

Results:

Of 200 studies reviewed, 20 contained a component for the parent and assessed the parent’s emotional health at multiple time points. Depression and anxiety were the most commonly studied parental mental health problem; most parent components consisted of behavioral strategies in service of the child’s psychological health.

Conclusion:

Major shifts in health care policy affecting mental health services provide an opportunity to create integrated and coordinated health and behavioral health systems. Attention must be given to ensure that the workforce of providers, the administrative structures, and the reimbursement strategies are strengthened and connected to serve the needs of parents/caregivers and children in order to enhance family outcomes.
Digital Storytelling
Authors: Nesteruk Jeffrey
Published: August 2014

This essay recounts how a teaching experiment with digital storytelling unexpectedly revealed how this humanistic genre enabled by contemporary technology might contribute to a more creative integration of business study with the liberal arts.
Secretory Leukocyte Protease Inhibitor (SLPI)
Authors: Hannila Sari S.
Published: August 2014

At first glance, secretory leukocyte protease inhibitor (SLPI) would appear to have little relevance to the central nervous system (CNS). This serine protease inhibitor is most commonly found in mucosal fluids such as saliva and is best known for its anti-inflammatory and antimicrobial properties. It has been shown to promote wound healing by reducing expression of pro-inflammatory cytokines, and it can also inhibit bacterial growth and block HIV infection of macrophages. In the past 10 years, however, several studies have reported that SLPI is strongly up-regulated in response to CNS injury and that exogenous administration of SLPI is neuroprotective. It has also been shown that SLPI can overcome inhibition by CNS myelin and promote axonal regeneration. In this review, we will discuss these studies, examine the molecular mechanisms underlying SLPI’s effects, and consider SLPI’s potential for therapeutic use in cerebral ischemia, spinal cord injury, and multiple sclerosis.
Dabigatran Versus Warfarin in Atrial Fibrillation
Authors: Aslan Onur , Yaylali Y. T. , Yildirim S. , Yurtdas M. , Senol H. , Ugur-Yildiz M. , Ozdemir M.
Published: August 2014

Safety issues have been raised about dabigatran. We aimed to investigate the occurrence of safety outcomes in patients who had atrial fibrillation and a risk of stroke. We analyzed 439 patients prescribed dabigatran (n = 220) or warfarin (n = 219). Ischemic stroke occurred in 15 (6.8%) patients in the warfarin group versus 5 (5.2%) patients in the 110-mg group versus 1 (0.8%) patient in the 150-mg dabigatran group ( P = .015). Intracranial hemorrhage occurred in 6 (2.7%) patients in the warfarin group versus 3 (2.4%) patients in the 150-mg dabigatran group ( P = .104). Death from any cause occurred in 10 (4.6%) patients in the warfarin group versus 1 (1.0%) patient in the 110-mg dabigatran group ( P = .005). Dabigatran was associated with less ischemic stroke and death from any cause than warfarin. Dabigatran may be a better option for stroke prophylaxis, where recommended monitoring with warfarin is suboptimal.
Oxidative Stress and Spontaneous Reperfusion of Infarct-Related Artery in Patients With ST-Segment Elevation Myocardial Infarction
Authors: Börekçi Abdurrezzak , Gür Mustafa , Türkoğlu Caner , Selek Şahbettin , Baykan Ahmet Oytun , Şeker Taner , Harbalıoğlu Hazar , Özaltun Betül , Makça İlyas , Aksoy Nurten , Gözükara Yavuz , Çaylı Murat
Published: August 2014

In the pathogenesis of atherosclerosis, oxidative stress plays a major role in plaque instability, rupture, and erosion, which subsequently leads to thrombus formation and causes total infarct-related artery (IRA) occlusion. We investigated the relationship between spontaneous reperfusion (SR) of IRA and oxidative stress in patients with anterior ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. A total of 341 consecutive patients with anterior STEMI were prospectively included in the present study. Patients were divided into 2 groups according to their thrombolysis in myocardial infarction (TIMI) flow grade: SR group (66 patients, TIMI flow 3) and non-SR group (275 patients, TIMI flow 0-2). On multivariate logistic regression analysis, oxidative stress index (β = 0.868, 95% confidence interval [CI] = 0.806-0.934, P < .001), neutrophil to lymphocyte ratio, uric acid, mean platelet volume, Killip 2 to 4 class, and initial SYNTAX score were independently associated with SR. Oxidative stress as well as inflammation may play a pivotal role in the pathogenesis of SR in patients with STEMI.
Transportation Apartheid
Authors: Wellman Gerard C.
Published: August 2014

Transportation policy in the United States has historically been the locus of social change, playing a signifcant role in social policy – like the 20th century Civil Rights movement – and economic policy. This research suggests that current transportation policymaking practices favor certain groups, primarily automobile users and suburban commuters, at the expense of other groups, mostly poor and urban minority populations who rely on public transportation modes. Transportation policy in the United States is socially unjust because it does not reward the costs and benefits of public policy equally; current policies have negative implications for the efficacy of democracy. Public administrators are poised to play a significant role in ameliorating such injustices, and this research suggests a few ways all public agencies and their employees can contribute to a more just transportation policymaking environment.
Adaptive executions of hyperbolic block-structured AMR applications on GPU systems
Authors: Raghavan Hari K , Vadhiyar Sathish S
Published: August 2014

A block-structured adaptive mesh refinement (AMR) technique has been used to obtain numerical solutions for many scientific applications. Some block-structured AMR approaches have focused on forming patches of non-uniform sizes where the size of a patch can be tuned to the geometry of a region of interest. In this paper, we develop strategies for adaptive execution of block-structured AMR applications on GPUs, for hyperbolic directionally split solvers. While effective hybrid execution strategies exist for applications with uniform patches, our work considers efficient execution of non-uniform patches with different workloads. Our techniques include bin-packing work units to load balance GPU computations, adaptive asynchronism between CPU and GPU executions using a knapsack formulation, and scheduling communications for multi-GPU executions. Our experiments with synthetic and real data, for single-GPU and multi-GPU executions, on Tesla S1070 and Fermi C2070 clusters, show that our strategies result in up to a 3.23 speedup in performance over existing strategies.