bluuebunny/crossref_metadata_2025 huggingface dataset:
Entitlement in Higher Education: Evaluating the Measurement Invariance Properties of the Academic Entitlement Questionnaire
Authors: Khojasteh Jam , Keener Ashley
Published: April 2017

Self-report instruments are commonly used in the educational and behavioral sciences. The purpose of this study was to investigate the measurement invariance properties of the Academic Entitlement Questionnaire (AEQ) developed by Kopp, Zinn, Finney, and Jurich, across gender and college rank (i.e., lower classmen, upper classmen, and graduate students). Partial metric and scalar invariance was established for the AEQ across gender. In relation to college rank, partial metric invariance was met, but scalar invariance did not hold. The results of the study may benefit educational researchers who are interested in using the AEQ or examining attributes that may be associated with academic entitlement.
Intersectionality in Public Leadership Research: A Review and Future Research Agenda
Authors: Breslin Rachel A. , Pandey Sheela , Riccucci Norma M.
Published: April 2017

Intersectionality provides a critical analytic lens for expanding our knowledge of leadership in public organizations as well as highlighting barriers to leadership opportunities. By emphasizing multiple and simultaneous dimensions of social inequality—most commonly gender, race, class, and sexuality—intersectionality reveals the unique experiences of individuals who occupy multiple marginalized social categories. We reviewed literature on public leadership spanning the past 25 years to obtain a sense of whether and how scholars in public administration currently interpret and apply an intersectional perspective to leadership inquiries. We find that a majority of the research we reviewed relied upon a single dimension of social inequality—gender. We identify the contributions made by research that did apply intersectionality’s core concepts as well as the missed opportunities by neglecting it as an analytic tool. We conclude with an agenda for future research that includes a discussion of intersectionality’s methodological challenges and recommendations for overcoming those challenges.
The Dilemmas of Equity Planning in the Global South: A Comparative View from Bangkok and Medellín
Authors: Sotomayor Luisa , Daniere Amrita
Published: April 2017

This paper examines equity planning in the face of growing adversity in cities of the Global South. The literature broadly addresses this question from the perspective of empowered social movements and/or insurgent citizenship practice. The actual experience of how equity practitioners interface with grass-roots efforts, however, remains understudied. Using case study data from urban upgrading programs in Medellín and Bangkok, we show that equity planners can be effective advocates to marginalized communities as they become embedded in local systems of trust. The paper also evinces the limitations and dilemmas planners confront in two extremely complex institutional and political settings.
Multicomponent Reading Interventions for Students With Intellectual Disability
Authors: Afacan Kemal , Wilkerson Kimber L. , Ruppar Andrea L.
Published: April 2017

Reading instruction for students with intellectual disability (ID) has traditionally focused on single skill instruction such as sight word reading. Given that multicomponent reading interventions have been linked to improved reading skills across multiple reading components for students in general education, it is logical to examine the impact of multicomponent reading interventions for students with ID. The purpose of this literature review was to examine characteristics, outcomes, and quality of multicomponent reading interventions for students with ID. In this review, seven empirical articles fit the inclusionary criteria. Findings indicate that students with ID who were exposed to multicomponent reading programs significantly improved their reading skills compared to their peers with ID who received traditional sight word instruction or to their previous reading performance. This literature review highlights effective strategies used to provide multicomponent reading instruction to students with ID. Implications for reading instruction for students with ID are provided, along with implications for future research.
Incidence of Adverse Events During Peripheral Administration of Sodium Chloride 3%
Authors: Dillon Ryan C. , Merchan Cristian , Altshuler Diana , Papadopoulos John
Published: April 2017

Purpose:

Traditionally, sodium chloride 3% has been administered via a central venous line (CVL) because of the perceived risk of infiltration and tissue injury due to its high osmolarity. In clinical practice, sodium chloride 3% is commonly administered through peripheral venous catheters (PVCs) given the necessity of timely administration. However, there is no published data on the safety of administering sodium chloride 3% through PVCs in the adult population. The objective of this study was to evaluate the safety of peripheral venous administration of sodium chloride 3%.

Materials and Methods:

A retrospective review was conducted in patients who received sodium chloride 3% in the intensive care unit (ICU). Patients were excluded if they had a CVL for the entire duration of the infusion or younger than 18 years at the time of administration. Baseline patient and infusion characteristics were collected. Infusion-related adverse events (IRAEs) were recorded, graded, and interventions required were noted.

Results:

A total of 66 patients were included in the analysis. The most common indication was hyponatremia and majority of the patients were managed in the neurosurgical ICU. The most common risk factor for IRAEs was the presence of altered mental status. Four patients experienced an IRAE at an event rate of 6.1%. Patients who experienced an IRAE ranged from 38 to 82 years old. The IRAEs were grade 1 in severity, managed conservatively with removal of the PVC, and 2 of the 4 patients had their infusions restarted peripherally. The time to initial IRAE ranged from 2 to 94 hours. For the entire cohort, hospital and ICU length of stay were 8 and 4 days, respectively.

Conclusions:

The rate of IRAEs related to the infusion of sodium chloride 3% through PVCs appears to be similar to those reported with other hyperosmotic agents and could be considered for patients who need time-sensitive therapy.
Clinical Significance of Bioimpedance Spectroscopy in Critically Ill Patients
Authors: Yang Shang-Feng , Tseng Ching-Min , Liu I-Fan , Tsai Shin-Hung , Kuo Wein-Shung , Tsao Tien-Ping
Published: April 2017

Background:

Early fluid resuscitation is a key aspect in the successful management of critically ill patients, but the optimal goal for volume control after the acute stage of critical illness remains unclear. This study aimed to evaluate the prognostic value of bioimpedance spectrometry for fluid management in critically ill patients.

Methods:

In this prospective observational study, patients who consented to participate were screened within the first 24 hours of admission to a medical intensive care unit (ICU) from February 4, 2015, to January 31, 2016. Information on demographics, comorbidities, primary reasons for admission, baseline laboratory data, and ventilator or inotropic use were documented. Data of fluid intake, fluid output, and body weight were recorded for the first 3 days of ICU admission. Bioimpedance spectrometry was performed on the first and third days after ICU admission. All participants were followed until death or hospital discharge.

Results:

Of the 140 enrolled patients (median age: 70 years, interquartile range: 60-77 years), 23 (16.4%) patients died during hospitalization. Independent predictors of hospital mortality were Acute Physiology and Chronic Health Evaluation II scores (per 1 point increase, odds ratio [OR]: 1.101) and overhydration (OH) volume on the first day (per 1 L increase, OR: 1.216). Compared to normal OH status (OH volume between −1 and 1 L), hyper OH status (OH volume < −1 L) on the third day after ICU admission was an independent predictor of hospital death (OR: 7.609). Normal OH status on the third day was associated with greater numbers of ICU-free and ventilator-free days.

Conclusion:

Bioimpedance spectrometry can be used to predict outcomes in critically ill patients. Increased OH volume on day 1 and hyper OH volume on day 3 of ICU admission are associated with a greater risk of hospital mortality. Volume status on day 3 is associated with durations of ventilator use and ICU stay.
Woodland dynamics and use during the Bronze Age: New evidence from Irish archaeological charcoal
Authors: O’Donnell Lorna
Published: April 2017

Swathes of roads and pipelines cut through the Irish landscape during the ‘Celtic Tiger’ years (approximately 1994–2008) leading to an unprecedented number of archaeological excavations and creating a unique opportunity for extensive research of past landscapes on a broad scale. The vast quantities of bulk soil samples suddenly available necessitated the development and adaptation of new methodologies. Despite the huge volumes of these samples, of which charcoal is the most ubiquitous ecofact, to date charcoal analysis has been considerably under-utilised in the study of past Irish woodlands. This research presents one of the largest Bronze Age archaeological charcoal datasets in Europe. It provides new palaeoecological evidence contributing to the understanding of woodland cover transformation on the island of Ireland during the late-Holocene period. The most common taxa identified in the charcoal assemblage compare well with regional pollen diagrams, particularly the use of Quercus and Corylus. With intensifying human activity during the middle Bronze Age, the proportion of Maloideae, a light demanding family rose. This is the first clear evidence of anthropogenic influence during the middle Bronze Age in Ireland derived from archaeological charcoal. The size of the charcoal dataset makes it possible to evaluate woodland cover and resourcing from two perspectives – both archaeological and palaeoecological.
Mid- to late-Holocene paleoenvironmental changes inferred from organic geochemical proxies in Lake Tangra Yumco, Central Tibetan Plateau
Authors: Wang Yong , Wang Junbo , Zhu Liping , Lin Xiao , Hu Jianfang , Ma Qingfeng , Ju Jianting , Peng Ping , Yang Ruimin
Published: April 2017

Investigations of the paleoclimate and paleoenvironmental changes in the Tibetan Plateau in recent years have led to many significant achievements. However, high-resolution lake records from the mid- to late-Holocene have not been determined for the Central Tibetan Plateau, which is in the transition zone between the Indian summer monsoon (ISM) system and the westerlies. In this study, we analyzed the distribution and compound-specific carbon isotope compositions ( δ13C) of sedimentary n-alkanes and the bulk sediment total organic matter (TOC), total nitrogen (TN), and C/N ratios to reconstruct the paleoenvironmental changes over the past 6 cal. ka BP using a 376-cm sediment core from the southern basin of Tangra Yumco, Central Tibetan Plateau. Our results indicated that clear stepwise decreases in lake productivity and lake level occurred during the mid- to late-Holocene based on decreases in δ13C values of mid-chain n-alkanes and Paq (an n-alkane-based proxy). Additionally, the variations in the TOC, TN, and C/N ratios revealed generally increased inputs of allochthonous organic matter over the past 6 cal. ka BP. When our findings at Tangra Yumco were compared with records from the Central Tibetan Plateau and adjacent regions, we found generally consistent patterns of lake environmental changes over the past 6 cal. ka BP, suggesting that the climate of the Central Tibetan Plateau was primarily influenced by the ISM system at the millennial time scale. Therefore, our results depict the evolution of the ISM over the past 6 cal. ka BP in the Central Tibetan Plateau, which corresponds to summer solar insolation and the migrations of the Intertropical Convergence Zone (ITCZ). We also propose that the climate of the North Atlantics influenced the climate of the Central Tibetan Plateau through some indirect climatic mechanisms.
Exchange Rate Fixation between US, China, Japan and Eurozone
Authors: Quah Chee-Heong
Published: April 2017

This article assesses the feasibility of exchange rate fixation among the largest economies today, namely, the US, Japan, China and Germany/Eurozone, by reviewing variables according to the optimum currency areas framework. The hypothesis is that with greater interconnectedness in general through time there should be greater convergence in the monetary integration dimensions. The period examined spans from 1980 to 2012, an over-30-year period, encompassing the recent episode of global contraction. While the findings are mixed, economically they seem to suggest a general trend towards greater compatibility or at least one which is not in serious contradiction to exchange rate fixity, particularly for the US and Eurozone.

JEL Classification: E62, F31, F32, F41, F42, O53
Britain and Europe on the geopolitical roller-coaster
Authors: Callinicos Alex
Published: April 2017

This article analyses the geopolitical significance of Brexit. It argues that, together with Donald Trump’s election as President of the United States, it represents the historical moment when the twin crises that emerged in 2008 – the re-emergence of Russia as a geopolitical challenger to the United States and the financial crash that exposed the fragility of the neoliberal economic system – effectively fused. The article explores the double imperial constitution of the European Union, Britain’s peculiar positioning within global power structures, and the combined impact of the crash, the Great Recession of 2008–2009, and the policy reaction of seeking to recharge neoliberalism through austerity as creating the conditions for the Brexit vote. Now elites in Britain, the rest of the European Union, and the US must grapple with the direct circuit that has been established between domestic socio-political tensions and geopolitical antagonisms.
Six years of national mental health seclusion data: the Australian experience
Authors: Allan John A , Hanson Gary D , Schroder Nicole L , O’Mahony Anna J , Foster Roxanne M P , Sara Grant E
Published: April 2017

Objectives:

Reducing or eliminating seclusion from mental health care settings has been a national priority for Australia since 2005. This paper describes Australia’s national seclusion data collection, and summarises changes in seclusion rates in Australian public mental health services.

Methods:

Seclusion events per 1000 patient days were calculated from 2009–2010 to 2014–2015 utilising state and territory administrative data sources. Combined national data were used to calculate results for a number of service characteristics, such as target population and location of the service.

Results:

The rate of seclusion events decreased by 43% over the 6 years. Child and adolescent services reported consistently higher rates of seclusion, but a shorter duration of seclusion episodes, compared with other service types. There is high variation in seclusion rates between individual services (range 0.0–53.0 seclusion events per 1000 bed days in 2014–2015).

Conclusions:

Seclusion event rates in Australia’s specialised public acute mental health hospital services are declining. The use of existing administrative data was instrumental in establishing a national data source to facilitate the monitoring and reporting of progress of seclusion reduction strategies.
Genetic diversity of bovine viral diarrhea virus in cattle from Mexico
Authors: Gómez-Romero Ninnet , Basurto-Alcántara Francisco J. , Verdugo-Rodríguez Antonio , Bauermann Fernando V. , Ridpath Julia F.
Published: April 2017

Bovine viral diarrhea virus (BVDV) infects cattle populations worldwide, causing significant economic losses though its impact on animal health. Previous studies have reported the prevalence of BVDV species and subgenotypes in cattle from the United States and Canada. We investigated the genetic diversity of BVDV strains detected in bovine serum samples from 6 different Mexican regions. Sixty-two BVDV isolates from Mexico were genetically typed based on comparison of sequences from the 5′ untranslated region (5′-UTR) of the viral genome. Phylogenetic reconstruction indicated that 60 of the samples belonged to the BVDV-1 genotype and 2 to the BVDV-2 genotype. Comparison of partial 5′-UTR sequences clustered 49 samples within BVDV-1c, 8 samples within BVDV-1a, 3 samples within BVDV-1b, and 2 samples clustered with the BVDV-2a subgenotypes. Our study, combined with information previously published on BVDV field strain diversity in the United States and Canada, benefits the development of effective detection assays, vaccines, and control programs for North America.
Brain lesions associated with acute toxic hepatopathy in cattle
Authors: Wouters Angelica T. B. , Wouters Flademir , Boabaid Fabiana M. , Watanabe Tatiane T. N. , Fredo Gabriela , Varaschin Mary S. , Driemeier David
Published: April 2017

Samples of the liver, telencephalon, brainstem, and cerebellum were obtained from 22 bovids suffering from spontaneous or experimental acute toxic liver disease. Perreyia flavipes larvae, and leaves of Cestrum corymbosum, Cestrum intermedium, Dodonaea viscosa, Trema micrantha, and Xanthium cavanillesii were the causal agents in the disorders studied. Hematoxylin and eosin and periodic acid–Schiff staining, as well as anti-S100 protein (anti-S100), anti–glial fibrillary acidic protein (anti-GFAP), and anti-vimentin immunostaining were used to evaluate the brain sections. Astrocytic changes were observed in all samples and were characterized by swollen vesicular nuclei in gray (Alzheimer type II astrocytes) and white matter; and by abundant eosinophilic or vacuolated cytoplasm with pyknotic nuclei in the white matter. These changes were evidenced by anti-S100 and anti-GFAP immunostaining. Our study demonstrates major changes in astrocytes of cattle that died with neurologic clinical signs as the result of acute toxic liver disease.
Assessment of air sampling methods and size distribution of virus-laden aerosols in outbreaks in swine and poultry farms
Authors: Alonso Carmen , Raynor Peter C. , Goyal Sagar , Olson Bernard A. , Alba Anna , Davies Peter R. , Torremorell Montserrat
Published: April 2017

Swine and poultry viruses, such as porcine reproductive and respiratory syndrome virus (PRRSV), porcine epidemic diarrhea virus (PEDV), and highly pathogenic avian influenza virus (HPAIV), are economically important pathogens that can spread via aerosols. The reliability of methods for quantifying particle-associated viruses as well as the size distribution of aerosolized particles bearing these viruses under field conditions are not well documented. We compared the performance of 2 size-differentiating air samplers in disease outbreaks that occurred in swine and poultry facilities. Both air samplers allowed quantification of particles by size, and measured concentrations of PRRSV, PEDV, and HPAIV stratified by particle size both within and outside swine and poultry facilities. All 3 viruses were detectable in association with aerosolized particles. Proportions of positive sampling events were 69% for PEDV, 61% for HPAIV, and 8% for PRRSV. The highest virus concentrations were found with PEDV, followed by HPAIV and PRRSV. Both air collectors performed equally for the detection of total virus concentration. For all 3 viruses, higher numbers of RNA copies were associated with larger particles; however, a bimodal distribution of particles was observed in the case of PEDV and HPAIV.
Histological Analysis of Early Osteolysis in Total Ankle Arthroplasty
Authors: Schipper Oliver N. , Haddad Steven L. , Pytel Peter , Zhou Ying
Published: April 2017

Background:

The purpose of this study was to perform a histological comparative analysis of tibiotalar joint samples taken from areas of osteolysis adjacent to total ankle arthroplasties vs control synovial specimens to determine the reaction to and presence of polyethylene (PE) particles.

Methods:

A total of 57 pathology samples were identified in the osteolysis group, while 11 were identified in the control group. For each sample, hematoxylin and eosin, Oil Red O (ORO), and macrophage marker CD163-stained slides were created. Polarized light and ORO stain were used to identify PE particles. The presence of metal particles and giant cell reaction to PE particles were also scored.

Results:

Macrophages, PE particles, metallosis, and foreign body giant cell reaction scores were significantly higher in the osteolysis group compared with the control group. In the osteolysis group, ORO staining was positive in 93% (53/57), birefringent material was present in 96.5% (55/57), and macrophage infiltrates were present in 96.5% (55/57). Foreign body giant cell reaction with giant cells surrounding PE particles was present in 49.1% (28/57) of osteolytic specimens. The presence of foreign body giant cell reaction was associated with significantly higher macrophage, ORO, and polarizable material scores. The average time to surgery for osteolysis from the index ankle replacement was 6.0 (range, 0-15) years for the 57 patients in the osteolysis group.

Conclusion:

This study is the largest ankle arthroplasty histological analysis to show that areas of osteolysis consist of abundant polyethylene wear particles, present both intracellularly and extracellularly. Furthermore, these areas were associated with a CD163+ macrophage infiltrate and frequently a foreign body reaction with giant cells engulfing PE particles. It is likely that implant wear particles play a significant role in osteolysis based on the histopathology.

Level of Evidence:

Level III, retrospective comparative series.
Operative Anatomy of the Medial Gastrocnemius Recession vs the Proximal Medial Gastrocnemius Recession
Authors: Kaplan Nathan , Fowler Xavier , Maqsoodi Noorullah , DiGiovanni Benedict , Oh Irvin
Published: April 2017

Background:

Isolated gastrocnemius contracture (IGC) is associated with various foot and ankle pathologies. To address the problem of IGC, a number of gastrocnemius lengthening procedures have been described. Although proximal medial gastrocnemius recession (PMGR) has shown to be an effective operative treatment for IGC, it poses risks to various anatomic structures around the knee joint and requires the patient to be positioned prone. As an alternative, we proposed to release the medial gastrocnemius at the division between the proximal one-third and distal two-thirds of the gastrocnemius muscle to correct equinus contracture, while minimizing risk to other structures. The aim of this study was to describe an anatomic basis for a medial gastrocnemius recession (MGR) and to investigate the anatomic structures at risk in comparison to PMGR.

Methods:

Eight cadaveric lower leg specimens were used in the study. The standard PMGR and the novel MGR were performed on each specimen. After completion of the 2 procedures, complete dissection was performed to investigate the distances between surgically released fascia margins and surrounding anatomic structures, including the greater saphenous vein, small saphenous vein, saphenous nerve, medial sural cutaneous nerve, semimembranosus tendon, tibial nerve, and popliteal artery. The mean distances were calculated and the shortest distances for each structure were reported.

Results:

Proximities of anatomic structures to surgically released gastrocnemius fascia at the medial and lateral margins were notably different between the 2 techniques. For the PMGR, the semimembranosus tendon (95% confidence interval of 2.4-7.4 mm), small saphenous vein (3.4-10.0 mm), popliteal artery (3.9-9.3 mm), and tibial nerve (5.0-11.1 mm) were in greater proximity to the operative margin. For the MGR, the greater saphenous vein (5.3-17.6 mm) and saphenous nerve (5.1-18.6 mm) were at greater risk.

Conclusions:

MGR at the proximal one-third of the gastrocnemius muscle may be a safe alternative for operative treatment of IGC.

Clinical Relevance:

We identified the major structures at risk when performing the proximal medial gastrocnemius release and propose a novel, possibly safer alternative for the medial gastrocnemius release.
Long-Term Follow-up of Arthrodesis vs Total Joint Arthroplasty for Hallux Rigidus
Authors: Stone Oliver D. , Ray Robbie , Thomson Colin E. , Gibson J. N. Alastair
Published: April 2017

Background:

The optimal operative management of hallux rigidus is still a matter for debate among surgeons. Despite arthrodesis widely considered to be the gold standard treatment, many surgeons advocate arthroplasty as a suitable alternative. There are, however, few long-term or high-quality studies evaluating these modalities. We present the 15-year follow-up of a randomized controlled trial.

Methods:

This data is the follow-up to the original study published in 2005. In the original study, 63 patients (77 toes) were recruited to and randomized to have either metatarsophalangeal joint (MTPJ) arthrodesis or arthroplasty. The primary outcome measure was a decrease in pain on a visual analog scale (VAS) at 24 months. In the present study, data were available for all surviving patients (52 patients, 66 toes). Data were collected in the form of satisfaction scores, VAS for pain, the VAS foot and ankle and survivorship data.

Results:

The results of the original study demonstrated that pain relief was greater following arthrodesis at 2 years. At 15 years, patients with an arthrodesis experienced less pain and were more satisfied compared to those with an arthroplasty. No functional differences were seen between these 2 groups. There were more revisions in the arthroplasty group.

Conclusion:

Despite the hope of better function, less pain, and greater satisfaction from MTPJ replacement, this was not found in our patient population. The long-term results of our study showed that arthrodesis outperformed arthroplasty. If an arthroplasty failed, then salvage was likely to be technically difficult, with significant potential for complications.

Level of Evidence:

Level I, randomized controlled trial.
Operative Wound Complications Following Total Ankle Arthroplasty
Authors: Gross Christopher E. , Hamid Kamran S. , Green Cynthia , Easley Mark E. , DeOrio James K. , Nunley James A.
Published: April 2017

Background:

Wound complications following total ankle replacement (TAR) potentially lead to devastating consequences. The aim of this study was to compare the operative and demographic differences in patients with and without major wound problems which required operative management. We hypothesized that increased tourniquet and operative time would negatively influence wound healing.

Methods:

We identified a consecutive series of 762 primary TARs performed between December 1999 and April 2014 whose data were prospectively collected. We then identified the subset of patients who required a secondary surgery to treat major wound complications (ie, operative debridement, split-thickness skin grafting, and soft tissue reconstruction). All patients requiring a second surgery had operative wound debridement. We then compared the demographics, operative characteristics, and functional scores to see if any differences existed between patients with and without major wound complications. Clinical outcomes including secondary procedures and implant failure rates were recorded.

Results:

Twenty-six patients (3.4%) had a total of 49 operative procedures to treat major wound issues. Eighteen patients had flaps and 14 had split-thickness skin grafts. The median time to operatively treating the wound was 1.9 (range: 0.5-12.5) months after the index TAR. The median follow-up time from the wound procedure was 12.7 (range: 1.2-170.8) months. Compared to the control group, patients with major wounds had a significantly longer mean surgery (214.8 vs 189.3 minutes, P = .041) time and trended toward a longer median tourniquet time (151 vs 141 minutes, P = .060). Patients without wound complications were more likely to have posttraumatic arthritis, whereas those with wound complications were more likely to have primary osteoarthritis ( P = .006). The control group trended toward having a higher mean BMI (29.5 vs 27.2, P = .056). There were 6 failures in the major wound complication cohort (23.1%), including 2 below the knee amputations.

Conclusion:

Ankle wounds that required operative management had high failure rates and some resulted in devastating outcomes. We did not find any increase in major wound complications in those with various risk factors as identified by other studies. Given our data, we recommend limiting operative time. While correcting hindfoot and midfoot alignment is important for improving patient functionality and survivorship of the implant, thought should be given to staging the TAR if multiple pathologies are to be addressed at the time of surgery to limit operative time.

Level of Evidence:

Level III, retrospective comparative series.
Comprehensive Support for Family Caregivers: Impact on Veteran Health Care Utilization and Costs
Authors: Van Houtven Courtney Harold , Smith Valerie A. , Stechuchak Karen M. , Shepherd-Banigan Megan , Hastings Susan Nicole , Maciejewski Matthew L. , Wieland Gilbert Darryl , Olsen Maren K. , Miller Katherine E. M. , Kabat Margaret , Henius Jennifer , Campbell-Kotler Margaret , Oddone Eugene Z.
Published: April 2017

This study aimed to examine the early impact of the Program of Comprehensive Assistance for Family Caregivers (PCAFC) on Veteran health care utilization and costs. A pre-post cohort design including a nonequivalent control group was used to understand how Veterans’ use of Veteran Affairs health care and total health care costs changed in 6-month intervals up to 3 years after PCAFC enrollment. The control group was an inverse probability of treatment weighted sample of Veterans whose caregivers applied for, but were not accepted into, PCAFC. Veterans in PCAFC had similar acute care utilization postenrollment when compared with those in the control group, but significantly greater primary, specialty, and mental health outpatient care use at least 30, and up to 36, months postenrollment. Estimated total health care costs for PCAFC Veterans were $1,500 to $3,400 higher per 6-month interval than for control group Veterans. PCAFC may have increased Veterans’ access to care.
Peripheral Hypoarousal but Not Preparation-Vigilance Impairment Endures in ADHD Remission
Authors: James Sarah-Naomi , Cheung Celeste H. M. , Rommel Anna-Sophie , McLoughlin Gráinne , Brandeis Daniel , Banaschewski Tobias , Asherson Philip , Kuntsi Jonna
Published: April 2017

Objective: This study investigates whether impairments associated with persistent ADHD—impaired attention allocation (P3 amplitude), peripheral hypoarousal (skin conductance level [SCL]), and adjustment in preparatory state (contingent negative variation [CNV])—reflect enduring deficits unrelated to ADHD outcome or are markers of ADHD remission. Method: Young people with childhood ADHD (73 persisters and 18 remitters) and 144 controls were compared on neurophysiological measures during two conditions (baseline and fast-incentive) of a four-choice reaction time task. Results: ADHD remitters differed from persisters, and were indistinguishable from controls, on baseline P3 amplitude and fast-incentive CNV amplitude ( p ≤ .05). ADHD remitters differed from controls ( p ≤ .01), and were indistinguishable from persisters ( p > .05), on baseline SCL. Conclusion: Preparation-vigilance measures were markers of ADHD remission, confirming previous findings with other measures. Yet, SCL-measured peripheral hypoarousal emerges as an enduring deficit unrelated to ADHD improvement. Future studies should explore potential compensatory mechanisms that enable efficient preparation-vigilance processes in ADHD remitters.
Prevalence of ADHD in Publicly Insured Adults
Authors: Zhu Yanmin , Liu Wei , Li Yan , Wang Xi , Winterstein Almut G.
Published: April 2017

Objective: To estimate the prevalence of adult ADHD diagnosis and treatment in U.S. Medicaid beneficiaries. Method: Using outpatient, inpatient, and pharmacy billing records for patients eligible for Medicaid fee-for-service benefits within 29 states from 1999 to 2010, we estimated the annual prevalence of ADHD diagnosis and treatment. Results: The prevalence of ADHD diagnosis increased from 2.20 per 1,000 patients in 1999 to 10.57 in 2010. Likewise, prevalence of ADHD treatment increased from 1.95 per 1,000 patients in 1999 to 13.16 in 2010. Between 40% and 65%, patients had ADHD drug prescription fills 6 months after ADHD diagnosis, whereas 45% to 55% of the beneficiaries with an ADHD drug prescription fill had ADHD diagnoses within 6 months before the prescription. Conclusion: In publicly insured adults, the prevalence of ADHD diagnosis and treatment increased dramatically over the years. Approximately half of the diagnosed patients are not treated, whereas half of the treated adults are not diagnosed.
Results From a Tailored SMS and Behavior-Tracking Pilot Study on Sun-Safe Behaviors in Young Women
Authors: Darlow Susan , Heckman Carolyn
Published: April 2017

Background. The elevated rates of ultraviolet radiation (UVR) exposure and low rates of sun protection in young adult women indicate a need for age- and gender-appropriate interventions that address these behaviors. Aims. To examine the effects of daily behavior tracking and individually tailored text messages on sun protection and UVR exposure behaviors in young adult women at moderate to high risk of developing skin cancer. Method. One hundred and four young adult women at risk of skin cancer were randomized to receive the behavior-tracking intervention only, tailored text messages only, both interventions, or neither. Outcomes were self-reported UVR exposure and sun protection behaviors. Results. Those who received the behavior-tracking intervention reported significantly fewer UVR exposure behaviors at 4-week follow-up, relative to those who did not receive behavior tracking. At 4-week follow-up, those who received daily tailored text messages reported significantly greater UVR exposure behaviors but were more likely to report wearing a hat as a form of sun protection, relative to those who did not receive tailored messages. Discussion. Daily behavior tracking may be repetitive, but repetition may facilitate cognitive processing and the development of healthy habits. Health messages that are less interactive, on the other hand, need to be adequately tailored and delivered with the most advantageous timing to be impactful. Conclusion. Future research should continue to examine how these interventions differentially affect behavior and how they can be adapted to apply to other health behaviors.
Prevalence of external ear disorders in Belgian stray cats
Authors: Bollez Anouck , de Rooster Hilde , Furcas Alessandra , Vandenabeele Sophie
Published: April 2017

Objectives

Feline otitis externa is a multifactorial dermatological disorder about which very little is known. The objective of this study was to map the prevalence of external ear canal disorders and the pathogens causing otitis externa in stray cats roaming around the region of Ghent, Belgium.

Methods

One hundred and thirty stray cats were randomly selected during a local trap–neuter–return programme. All cats were European Shorthairs. This study included clinical, otoscopic and cytological evaluation of both external ears of each cat. Prospective data used as parameters in this study included the sex, age and body condition score of each cat, as well as the presence of nasal and/or ocular discharge, and the results of feline immunodeficiency virus (FIV) and feline leukaemia virus (FeLV) Snap tests.

Results

Remarkably, very few (sub)clinical problems of the external ear canal were found in the stray cat population. Malassezia species was by far the most common organism found in the external ear canals of the 130 stray cats. A total of 96/130 (74%) cats were found to have Malassezia species organisms present in one or both ears based on the cytological examination. No correlation was found between the parameters of sex, age, body condition score, the presence of nasal and/or ocular discharge and FIV and FeLV status, and the presence of parasites, bacteria or yeasts.

Conclusions and relevance

This study provides more information about the normal state of the external ear canal of stray cats. The ears of most stray cats are relatively healthy. The presence of Malassezia species organisms in the external ear canal is not rare among stray cats.
Partnering to improve care: the case of the Veterans’ Health Administration’s Quality Enhancement Research Initiative
Authors: Bergman Alicia A , Delevan Deborah M , Miake-Lye Isomi M , Rubenstein Lisa V , Ganz David A
Published: April 2017

Background

Within many large health care organizations, researchers and operations partners (i.e., policymakers, managers, clinical leaders) join to conduct studies to improve the quality of patient care. Yet optimal approaches to conducting partnership research and evaluation are only beginning to be clearly defined. The Veterans’ Health Administration (VA) Quality Enhancement Research Initiative (QUERI), funded by operations leaders and administered by the VA’s research service, now has nearly two decades of experience in fostering research–operations partnerships for improving quality of VA care. The work reported here is part of a national evaluation of QUERI. Because individuals in research and operations often have differing backgrounds and perspectives, we aim to identify the main sources of tension in research–operations partnerships and strategies for maximizing partnership success, through the eyes of QUERI participants.

Methods

We conducted semi-structured interviews with 116 researchers and operations partners chosen randomly from within pre-identified key participant groups. We conducted inductive qualitative analysis of verbatim interview transcripts, limited to the 89 interviews of individuals reporting at least some familiarity with QUERI.

Results

Tensions in research–operations partnerships were primarily related to diverging incentives and to differing values placed on scientific rigor or integrity versus quick timelines. To alleviate these tensions, operations’ partners highlighted the importance of ‘perspective-taking’ (i.e., putting themselves into the shoes of the researchers) to ensure a mutually beneficial and attractive partnership, whereas researchers identified the importance of overcoming the need for recognition to be apportioned between either research or operations for achieved results. Both researchers and operations participants identified jointly designing each partnership from the beginning, minimizing research bureaucracy burdens, and prioritizing in-person communication and long-term relationships as key partnership building blocks.

Conclusions

QUERI research and operations participants had largely concordant views on partnership tensions and approaches for improving partnership success. The fact that only researchers mentioned moving beyond recognition for the results achieved and only operations staff mentioned the importance of ‘perspective-taking’ suggests, however, that there may be unresolved tensions. These results suggest that researchers may benefit from better aligning of academic incentives with contributions to the health care organization and establishing formal recognition of operational impacts of research, while preserving some flexibility and independence of the research process.
Economic evaluation of telephone-based concussion management for combat-related mild traumatic brain injury
Authors: Richardson John S , Guzauskas Gregory F , Fann Jesse R , Temkin Nancy R , Bush Nigel E , Bell Kathleen R , Gahm Gregory A , Smolenski Derek J , Brockway Jo Ann , Hansen Ryan N
Published: April 2017

Introduction

Mild traumatic brain injury (mTBI) is an unfortunately common repercussion of military service in a combat zone. The CONTACT study tested an individualized telephone support intervention employing problem solving therapy (PST) for mTBI in soldiers recently returned from deployment. We sought to determine the cost effectiveness of this intervention from a military healthcare system perspective.

Methods

We conducted an intent-to-treat post-hoc analysis by building a decision analytic model that evaluated the choice between using PST or education only (EO). The model included cost-minimization and cost-effectiveness analyses. The incremental cost-effectiveness ratios (ICERs) were calculated as the differences in costs of PST versus EO relative to the differences in the outcomes of participants.

Results

The PST intervention resulted in an annual per-enrolee cost of $1027 (95% CI: $836 to $1248), while EO costs were $32 (95% CI: $25 to $39), resulting in a net incremental cost of $996 per enrolee (95% CI: $806 to $1,217). The ICERs were $68,658/QALY based on EQ-5D (95% CI: -$463,535 to $596,661) and $49,284/QALY based on SF-6D (95% CI: $26,971 to $159,309). Estimates of treatment costs in a real-world setting were accompanied by substantially lower ICERs that are within accepted thresholds for willingness-to-pay.

Discussion

Although the intervention had short-term benefits sufficient to yield acceptable ICERs, there was no long-term effect of PST over EO observed in the study. Consequently, we suggest that future studies examine the use of low-cost approaches, such as booster relapse-prevention calls, that may lead to a sustained treatment benefit for this population.
Longitudinal study of driver licensing rates among adolescents and young adults with autism spectrum disorder
Authors: Curry Allison E , Yerys Benjamin E , Huang Patty , Metzger Kristi B
Published: April 2017

Driving may increase mobility and independence for adolescents with autism without intellectual disability (autism spectrum disorder); however, little is known about rates of licensure. To compare the proportion of adolescents with and without autism spectrum disorder who acquire a learner’s permit and driver’s license, as well as the rate at which they progress through the licensing system, we conducted a retrospective cohort study of 52,172 New Jersey residents born in the years 1987–1995 who were patients of the Children’s Hospital of Philadelphia healthcare network ⩾12 years of age; 609 (1.2%) had an autism spectrum disorder diagnosis. Electronic health records were linked to New Jersey’s driver licensing database (2004–2012). Kaplan–Meier curves and log-binomial regression models were used to determine the age at and rate of licensure, and estimate adjusted risk ratios. One in three adolescents with autism spectrum disorder acquired a driver’s license versus 83.5% for other adolescents and at a median of 9.2 months later. The vast majority (89.7%) of those with autism spectrum disorder who acquired a permit and were fully eligible to get licensed acquired a license within 2 years. Results indicated that a substantial proportion of adolescents with autism spectrum disorder do get licensed and that license-related decisions are primarily made prior to acquisition of a permit instead of during the learning-to-drive process.
Two Swedish screening instruments for exhaustion disorder: cross-sectional associations with burnout, work stress, private life stress, and personality traits
Authors: Persson Roger , Österberg Kai , Viborg Njördur , Jönsson Peter , Tenenbaum Artur
Published: April 2017

Aims: To examine the relationships of two screening instruments recently developed for assessment of exhaustion disorder (ED) with some other well-known inventories intended to assess ED-related concepts and self-reports of job demands, job control, job support, private life stressors, and personality factors. Methods: A cross-sectional population sample ( n = 1355) completed: the Karolinska Exhaustion Disorder Scale (KEDS), Self-reported Exhaustion Disorder Scale (s-ED), Shirom–Melamed Burnout Questionnaire (SMBQ), Utrecht Work Engagement Scale (UWES-9), Job Content Questionnaire (JCQ), Big Five Inventory (BFI), and items concerning family-to-work interference and stress in private life. Results: Compared to participants without any indication of ED, participants classified as having ED on KEDS or s-ED had higher scores on all four SMBQ subscales, lower scores on the UWES-9 subscales vigor and dedication, higher JCQ job demands scores, lower JCQ job support scores, higher degrees of family-to-work interference and stress in private life, and higher BFI neuroticism and openness scores. In addition, participants classified as having ED on KEDS had lower scores on the UWES-9 absorption subscale, the JCQ job control scale, and lower BFI extraversion, agreeableness and conscientiousness scores, compared to the subgroup not classified as having ED. Conclusions: As expected, we observed an overall pattern of associations between the ED screening inventories KEDS and s-ED and measures of burnout, work engagement, job demands-control-support, stress in private life, family-to-work interference, and personality factors. The results suggest that instruments designed to assess burnout, work engagement, and ED share common ground, despite their conceptual differences.
Sense of mastery differences between working-age Swedish- and Finnish-speaking Finns: a population-based study
Authors: Reini Kaarina , Nyqvist Fredrica
Published: April 2017

Aim: To examine the probability of a high sense of mastery in a population-representative sample of working-age people and to study the differences in mastery between Finnish-speaking and Swedish-speaking Finns in particular. Methods: The data originates from the Western Finland Mental Health Surveys (2008–2014). Associations between sense of mastery and language groups were analyzed with logistic regressions. Results: Swedish-speaking Finns have a higher sense of mastery and the association is mediated by social support. Moreover, a difference in a high sense of mastery is found between Swedish- and Finnish-speaking married women that are outside the labor market. Conclusions: Our findings imply that Finnish-speaking women that are outside the labor market, e.g. on maternity leave or taking care of the household, should be recognized in health and social care services as a group that can benefit from additional support.
Early life characteristics, social mobility during childhood and risk of stroke in later life: findings from a Swedish cohort
Authors: Heshmati Amy , Chaparro M. Pia , Goodman Anna , Koupil Ilona
Published: April 2017

Aims: To investigate if early life characteristics and social mobility during childhood are associated with incident thrombotic stroke (TS), haemorrhagic stroke (HS) and other stroke (OS). Methods: Our study population consists of all live births at Uppsala University Hospital in 1915–1929 (Uppsala Birth Cohort; n = 14,192), of whom 5532 males and 5061 females were singleton births and lived in Sweden in 1964. We followed them from 1 January 1964 until first diagnosis of stroke (in the National Patient Register or Causes of Death Register), emigration, death, or until 31 December 2008. Data were analysed using Cox regression, stratifying by gender. Results: Gestational age was negatively associated with TS and OS in women only. Women had increased risk of TS if they were born early preterm (<35 weeks) (HR 1.54 (95% CI 1.02–2.31)) or preterm (35–36 weeks) (HR 1.37 (95% CI 1.03–1.83)) compared to women born at term. By contrast, only women who were early preterm (HR 1.98 (95% CI 1.27–3.10) had an increased risk of OS. Men who were born post-term (⩾42 weeks) had increased risk of HS (HR 1.45 (95% CI 1.04–2.01)) compared with men born at term, with no association for women. TS was associated with social mobility during childhood in women: women whose families were upwardly or downwardly mobile had increased risk of TS compared to women who were always advantaged during childhood. Conclusions: Gestational age and social mobility during childhood were associated with increased risk of stroke later in life, particularly among women, but there was some heterogeneity between stroke subtypes.