bluuebunny/crossref_metadata_2025 huggingface dataset:
Sex-specific differences in the regulation of inducible nitric oxide synthase by bisphenol A in neutrophils
Authors: Ratajczak-Wrona W , Nowak K , Garley M , Tynecka M , Jablonska E
Published: August 2018

The aim of the study was to evaluate the effect of bisphenol A (BPA) on nitric oxide (NO) production and inducible nitric oxide synthase (iNOS) expression by neutrophils with regard to sex and nuclear factor-κB (NF-κB) pathway participation in this process. This study demonstrated that BPA intensifies the production of NO and the expression of iNOS in the cytoplasmic fraction of neutrophils of women as well as men. In addition, an enhanced expression of NF-κB in the cytoplasmic and nuclear fraction of neutrophils exposed to BPA was observed in the cells of both sexes. The lipopolysaccharide (LPS) stimulation of neutrophils of both sexes led to an intensification of NO production and expression of all tested proteins. However, simultaneous stimulation of neutrophils of both men and women with LPS and BPA decreased the production of NO and expression of iNOS and NF-κB in both fractions compared to the cells exposed only to xenoestrogen. Moreover, expression of iNOS and NF-κB was higher in female neutrophils than in male cells. This study demonstrated that BPA affects the production of NO with the participation of iNOS by human polymorphonuclear neutrophils. This process is associated with the activation of the NF-κB pathway. In addition, different activity of NF-κB in neutrophils, observed with respect to sex, indicates a different role of this pathway in female and male cells.
Psychometric validation of the Arthritis Helplessness Index in systemic lupus erythematosus
Authors: Gholizadeh S , Azizoddin D R , Mills S D , Zamora-Racaza G , Potemra H M K , Wallace D J , Weisman M H , Nicassio P M
Published: August 2018

Objective

Helplessness is a relevant construct in systemic lupus erythematosus (SLE), an unpredictable chronic illness with no known cure characterized by relapsing and remitting features. However, no measure of helplessness has been validated in this population. The present study examined the structural validity, reliability, and convergent validity of the Arthritis Helplessness Index, a measure initially developed for rheumatoid arthritis populations, in a sample of patients with SLE.

Methods

Patients with SLE ( N = 136) receiving medical care at a private hospital completed the Arthritis Helplessness Index and other self-report measures. The structural validity of the Arthritis Helplessness Index was examined using confirmatory factor analysis. Internal consistency reliability was evaluated with Cronbach’s coefficient alpha. Pearson product–moment correlations were used to examine convergent validity with measures of depression, anxiety and mastery.

Results

The five-item Arthritis Helplessness Index–Helplessness measure demonstrated a tenable factor structure (comparative fit index 0.98, root mean square error of approximation 0.06, standardized root mean residual 0.04). Internal consistency reliability was fair (α = 0.69). Convergent validity was evidenced by significant correlations with measures of depression, anxiety and mastery.

Conclusion

The five-item Arthritis Helplessness Index–Helplessness scale can confidently be used as a measure of helplessness in SLE.
Reorganizing value chains through foreign direct investment: Austria’s pharmaceutical industry international expansion
Authors: Zeller Christian , Van-Hametner Andreas
Published: August 2018

This article analyses the international expansion of the pharmaceutical industry in Austria. The pharmaceutical industry is a knowledge-based industry dominated by large global oligopolies, which also includes many small companies focused on specific market areas. The article examines the extent to which different stages of the value chain are affected by foreign direct investment and impact the organization and governance of the value chain specified by the type of firm. We argue that corporate motives to invest abroad are very specific to firm’s market power and position in the value chain of the industry. On the one hand, a few foreign owned pharmaceutical companies that operate production facilities as well as research and development are the key investors. On the other hand, Austrian firms expand internationally through foreign direct investment mainly destined for developing foreign markets.
Accounting and power in the society of Buddhism: An analysis of the income and expenditure reports of Toji Temple, 1427–1532
Authors: Sankoji Yumiko
Published: August 2018

In recent decades, many studies have examined the role of accounting in organizations, the relationship between accounting and power in modern society, and the use of accounting as an instrument to construct a social order and foster interaction within a social context. However, little is known about the use of accounting to exert power in religious organizations – despite these organizations being among the most socially influential entities of pre-modern times. This article seeks to help fill this gap by analyzing the income and expenditure reports of the Komyo-ko-gata of the Toji Temple (1427–1532) in Japan. Two distinctive contributions are made. First, instead of focusing on Christianity, the subject is a Buddhist organization during the Middle Ages. Second, both synchronic and diachronic approaches are applied in this analysis. The findings confirm that accounting can strengthen strained relationships within organizations by facilitating control over information related to money management.
The road back from Kafka’s castle: Towards a better system of visa application and review in Australia
Authors: Kline Victor
Published: August 2018

The processes for administrative, judicial and appellate challenges to a visa refusal are difficult, time consuming and costly. It is not uncommon for an applicant to be involved in processes in excess of five or 10 years. The cost to the public purse can be exorbitant. This article suggests a system whereby the process would be confined to a two-stage judicial process. As such it would be much more discernible to the litigant, many of whom are unrepresented. It would also result in significant savings to the litigant and to the taxpayer.
Freedom of information: User pays (and still faces delays)
Authors: Moon Danielle
Published: August 2018

This article considers freedom of information in Australia and examines some of the practical barriers to access that persist following the 2009–2010 changes to the Freedom of Information Act 1982 (Cth). It considers, by way of case study, the issues of practical refusal, charges and delays, and draws a brief comparison with UK law and practice. It concludes that the current model in Australia must change if greater transparency is to result.
The Postretirement Well-Being of Workers With Disabilities
Authors: Wu April Yanyuan , Schimmel Hyde Jody
Published: August 2018

Older workers who develop significant limitations in health or functioning face declines in income and consumption and an increased likelihood of poverty in the years prior to retirement. We assess the extent to which those differences persist after reaching retirement age. We use the Health and Retirement Study (HRS) linked to Social Security Administration (SSA) records to compare the postretirement financial well-being of workers who experienced disability onset during their working years with those who did not, based on their claiming behavior for Social Security disability and retirement benefits. We find that even after full retirement age, gaps that emerged prior to retirement persist; those who experienced disability prior to retirement had lower incomes, were more likely to be in poverty, and had significantly lower wealth. Workers with disabilities who claimed Social Security Disability Insurance (DI) fared better than those who were rejected for such benefits, yet both groups were worse off than those who delayed claiming benefits until they were eligible for Social Security Old Age and Survivors Insurance (OASI) benefits. Our findings indicate that any changes to the Social Security benefit structure must be mindful of the short- and longer term implications for already-vulnerable groups of workers.
Commentary on “Assessment of Health Risk From Historical Use of Cosmetic Talcum Powder”
Authors: Egilman David , Steffen Joan
Published: August 2018

In response to recent litigation, Colgate Palmolive hired Exponent to determine if various samples of their cosmetic talc products contained asbestos. Anderson et al., Exponent employees, claim to report the findings of these analyses in their paper “Assessment of Health Risk from Historical Use of Cosmetic Talcum Powder.” The microscopist who reviewed the samples found four anthophyllite fibers. One of the authors of Anderson et al., Patrick Sheehan, who is not a microscopist, directed the reviewing microscopist to alter the report and add the qualification that “…this classification was inconclusive due to the small number counted.” Deviations from the referenced analytical methods, however, would account for the small number of fibers counted relative to the limit of detection. Anderson et al., reported that “no asbestos fibers were detected in any of the eighteen samples analyzed” based on the report’s altered conclusions.
Tongue Reduction Surgery and Feeding Difficulties in Infants With Beckwith Wiedemann Syndrome: A Case Series
Authors: Prendeville Nicole , Sell Debbie
Published: August 2018

Objective:

To profile the pre- and post-operative feeding difficulties in infants with macroglossia in Beckwith Wiedemann Syndrome (m-BWS) who have had tongue reduction surgery (TRS) and to pilot a bespoke feeding rating scale.

Design:

Retrospective consecutive case series designed with two pre-operative and one 3-month post-operative feeding assessments. A 4-point Likert-type scale was developed and applied retrospectively to describe the feeding behaviors for liquids, purées, and solids. Descriptive and non-parametric statistics were used.

Setting:

National service for children with m-BWS at a pediatric hospital.

Patients:

Twenty-five infants, age range 4 to 12 months at initial assessment, underwent TRS (median age = 16 months).

Intervention:

Tongue reduction surgery.

Outcome Measure:

Oral and selected pharyngeal stage feeding behaviors on liquids, purées, and solids.

Results: Pre-operative profile:

Most feeding difficulties arose at the oral stage due to the macroglossia impacting important lingual movements. Difficulties were found with lip seal formation, biting, bolus manipulation and tongue lateralization. Aspiration risk was found in >75%. Texture modification was indicated for purées and solids.

Post-operative profile:

There were statistically significant differences for each consistency pre- and post-operatively. Eighty-four percent of infants had age-appropriate drinking and eating skills. Mild residual difficulties with biting, tongue lateralization, and bolus manipulation remained for solids in four infants.

Conclusions:

Feeding difficulties are common pre-operatively in m-BWS, putting infants at risk of aspiration if left unmanaged. TRS was effective in reducing or eliminating them. This is the first systematic report of infant feeding in m-BWS pre- and post-TRS.
Templating of Syndesmotic Ankle Lesions by Use of 3D Analysis in Weightbearing and Nonweightbearing CT
Authors: Burssens Arne , Vermue Hannes , Barg Alexej , Krähenbühl Nicola , Victor Jan , Buedts Kris
Published: August 2018

Background:

Diagnosis and operative treatment of syndesmotic ankle injuries remain challenging due to the limitations of 2-dimensional imaging. The aim of this study was therefore to develop a reproducible method to quantify the displacement of a syndesmotic lesion based on 3-dimensional computed imaging techniques.

Methods:

Eighteen patients with a unilateral syndesmotic lesion were included. Bilateral imaging was performed with weightbearing cone-beam computed tomography (CT) in case of a high ankle sprain (n = 12) and by nonweightbearing CT in case of a fracture-associated syndesmotic lesion (n = 6). The healthy ankle was used as a template after being mirrored and superimposed on the contralateral ankle. The following anatomical landmarks of the distal fibula were computed: the most lateral aspect of the lateral malleolus and the anterior and posterior tubercle. The change in position of these landmarks relative to the stationary, healthy fibula was used to quantify the syndesmotic lesion. A control group of 7 studies was used.

Results:

The main clinical relevant findings demonstrated a statistically significant difference between the mean mediolateral diastasis of both the sprained (mean [SD], 1.6 [1.0] mm) and the fracture group (mean [SD], 1.7 [0.6] mm) compared to the control group ( P < .001). The mean external rotation was statistically different when comparing the sprained (mean [SD], 4.7 [2.7] degrees) and the fracture group (mean [SD], 7.0 [7.1] degrees) to the control group ( P < .05).

Conclusion:

This study evaluated an effective method for quantifying a unilateral syndesmotic lesion of the ankle. Applications in clinical practice could improve diagnostic accuracy and potentially aid in preoperative planning by determining which correction needs to be achieved to have the fibula correctly reduced in the syndesmosis.

Level of Evidence:

Level III, retrospective comparative study.
Endoscopic Flexor Hallucis Longus Transfer for Chronic Noninsertional Achilles Tendon Rupture
Authors: Vega Jordi , Vilá Jesus , Batista Jorge , Malagelada Francesc , Dalmau-Pastor Miki
Published: August 2018

Background:

Operative management of chronic Achilles tendon ruptures is challenging, and numerous techniques have been described. Risk of infection and wound breakdown have been described after open techniques, and minimally invasive methods have been proposed to avoid them. The aim of this study was to describe the clinical and radiological results obtained after endoscopic flexor hallucis longus (FHL) tendon transfer in patients with chronic Achilles tendon rupture.

Methods:

Between 2012 and 2015, a total of 22 patients were endoscopically treated for chronic Achilles tendon rupture. Mean age was 69 years (range, 59-84 years). Mean follow-up was 30.5 months (range, 18-46 months). Preoperative magnetic resonance imaging (MRI) was obtained and tendon gap measured. An MRI was obtained at 9 to 12 months following surgery to evaluate Achilles tendon changes.

Results:

Preoperative MRI examination showed a mean tendon gap of 6.3 cm (range, 3-10.7 cm). The MRI control was obtained only in 12 patients, and a normal or close to normal Achilles tendon was observed in all but 1 patient. The mean American Orthopaedic Foot & Ankle Society score increased from 55 preoperatively (range, 26-75) to 91 (range, 74-100) at final follow-up. All patients returned to their daily activities without difficulties. No patients reported complaints or symptomatic deficits of great toe flexion strength. No major complications were encountered.

Conclusion:

Chronic Achilles tendon ruptures were successfully treated by an all-endoscopic procedure. The endoscopically assisted FHL transfer provided excellent results while benefiting from the minimally invasive procedure advantages. However, it entailed some technical challenges and may not be suitable for less experienced surgeons.

Level of Evidence:

Level IV, retrospective case series.
Oligodendrocyte Bioenergetics in Health and Disease
Authors: Rosko Lauren , Smith Victoria N. , Yamazaki Reiji , Huang Jeffrey K.
Published: August 2018

The human brain weighs approximately 2% of the body; however, it consumes about 20% of a person’s total energy intake. Cellular bioenergetics in the central nervous system involves a delicate balance between biochemical processes engaged in energy conversion and those responsible for respiration. Neurons have high energy demands, which rely on metabolic coupling with glia, such as with oligodendrocytes and astrocytes. It has been well established that astrocytes recycle and transport glutamine to neurons to make the essential neurotransmitters, glutamate and GABA, as well as shuttle lactate to support energy synthesis in neurons. However, the metabolic role of oligodendrocytes in the central nervous system is less clear. In this review, we discuss the energetic demands of oligodendrocytes in their survival and maturation, the impact of altered oligodendrocyte energetics on disease pathology, and the role of energetic metabolites, taurine, creatine, N-acetylaspartate, and biotin, in regulating oligodendrocyte function.
Auto-regressive moving average with exogenous excitation model based experimental identification and optimal discrete multi-poles shifting control of a flexible piezoelectric manipulator
Authors: Chen Tehuan , Lou Junqiang , Yang Yiling , Ma Jianqiang , Li GuoPing , Wei Yanding
Published: August 2018

Auto-regressive moving average with exogenous excitation (ARMAX) model based experimental identification and vibration suppression of a flexible piezoelectric manipulator are conducted. Experimental identification based on ARMAX models with different orders is conducted. To remove the spurious modes that do not correspond to structural modes, a balanced model reduction method based on the Hankel singular value is employed. After balanced transformation and model reduction, the identified ARMAX model with a high order is transformed into a reduced-order controllable and observable system. Comparative experimental results show that the identified reduced-order model matches closely with the system dynamics. Therefore, an optimal discrete multi-poles shifting controller, which combines the multi-poles recursive shifting method and linear quadratic regulator (LQR) control, is proposed. The first complex conjugate poles pair of the system is shifted to some desired positions by solving a discrete algebraic equation. The weighting matrixes of the LQR are determined based on the solution of the discrete algebraic equation. Then, multi-poles of the identified model are shifted through recursive applications of the reduced-order poles shifting method. Experimental results show that vibrations of the manipulator are significantly diminished. Consequently, the effectiveness of the proposed controller is proven.
Gendered Vulnerabilities in Times of Natural Disasters: Male-to-Female Violence in the Philippines in the Aftermath of Super Typhoon Haiyan
Authors: Nguyen Huong Thu
Published: August 2018

The precarious situation faced by women and girls in the wake of climate-related disasters is illustrated through fieldwork conducted in Eastern Visayas in the Philippines, one of the regions most affected by Super Typhoon Haiyan in 2013. However, this article illustrates that these heightened levels of gendered violence faced by women and girls are not a result of the disaster alone; rather, they are rooted in the inequalities inherent in the social construction of gender prior to the catastrophe, which then become sharpened as efforts to survive become more urgent.
Response to alectinib oil-based suspension in anaplastic lymphoma kinase-positive non-small cell lung cancer in a patient unable to swallow: A case report
Authors: Bejarano Varas Maria Teresa , Gould Scott , Charlot Marjory
Published: August 2018

The emergence of oral targeted therapy in the management of non-small cell lung cancer with targetable oncogenes has led to significant improvements in progression-free survival, toxicity profile, and quality of life compared to intravenous chemotherapy. However, patients unable to swallow or with exclusive enteral feeding are left without alternative formulations for these targeted therapies given their availability only in tablet or capsule formulations. We report a case of a woman with metastatic anaplastic lymphoma kinase-positive non-small cell lung cancer who was unable to swallow and was successfully treated with an oil-based alectinib liquid suspension.
Needs and Challenges Related to Multilevel Interventions: Physical Activity Examples
Authors: Sallis James F.
Published: August 2018

The theme of this commentary is to discuss the need for, and challenges of, conceptualizing, implementing, and evaluating multilevel health behavior change interventions. Ecological models, recommendations from national and international authoritative groups, and growing evidence all support the need for interventions designed to change multiple levels of influence, including individuals, social environments, organizations, built environments, and policies, to achieve population improvements in public health. Though multilevel interventions are becoming more common in practice, they are still under-used, and research on multilevel interventions is relatively rare. Drawing on examples from physical activity, several types of evidence are summarized to demonstrate that multilevel interventions are feasible and can be effective. Serious challenges to implementing and evaluating multilevel interventions include the need for teams with diverse expertise, lack of control over intervention implementation, unpredictability of timelines, managing complex teams over extended periods, and need to apply unfamiliar and less-rigorous study designs and methods. Recommendations are offered for changes in training, funding priorities, and academic incentives that could lead to more and better multilevel interventions.
A compression shear mixed finite element model for vibration and damping analysis of viscoelastic sandwich structures
Authors: Huang Zhicheng , Qin Zhaoye , Chu Fulei
Published: August 2018

A finite element model is developed to investigate the vibration and damping of elastic–viscoelastic–elastic sandwich beams. Two energy dissipation mechanisms, namely the shear and compression damping, are combined in the finite element model. Numerical examples are provided to verify the finite element model. The vibration and damping characteristics of the viscoelastic sandwich beams are investigated in detail. The numerical results show that the present finite element model has a good accuracy in predicting the natural frequencies and loss factors of viscoelastic sandwich beam structures. Moreover, it shows good applicability for both the thin and relatively thick sandwich beams. Its comprehensive performance is much better than the traditional shear and compression damping models. The effect of the viscoelastic material and geometrical parameters on the natural frequencies and loss factors of elastic–viscoelastic–elastic sandwich beam is studied as well. The results obtained have some significance in engineering application.
Subclinical Left Ventricular Dysfunction is Influenced by Genotype Severity in Patients with Cystic Fibrosis
Authors: Pallin Michael , Keating Dominic , Kaye David M , Kotsimbos Tom , Wilson John W
Published: August 2018

Background and objective:

Over 2000 genotypes in the cystic fibrosis (CF) gene have been described. These genotypic differences result in variable clinical manifestations of CF, with severity of disease dependent on CF transmembrane conductance (CFTR) protein function. CFTR is widely distributed in nucleated cells, including cardiac myocytes, but the effect of genotype on cardiac function is not known.

Methods:

This retrospective review of echocardiographic data is from a single adult CF centre between 2000 and 2015. Patients were cohorted based on the functional classification of genotype. ‘Severe’ patients had both CF genes from functional classification groups 1-3; ‘mild’ patients had one or no gene from these groups, or in the event of the second gene being unknown were pancreatic sufficient.

Results:

Genotype and echocardiography were recorded during the inclusion period in 100 patients, 79 of whom were classified as having severe genotypes. Although the severe group were younger they had a lower fractional shortening (33.66 ± 6.6 vs 36.9 ± 6.3, P < .05), left atrial area (14.9 ± 3.6 versus 18.0 ± 4.2 cm2; P < .01) and volume (39.9 ± 18.7 versus 51.0 ± 18.7 mL; P < .05) and showed a trend to lower left ventricular ejection fraction.

Conclusions:

This study is the first to show that in CF, severity of genotype (functional classification) is associated with cardiac impairment. Patients with severe CF genotype and cardiac dysfunction should be identified to evaluate cardiac response to gene-modifying treatments prior to consideration for lung transplantation.
Vitamin D-binding protein and multiple sclerosis: Evidence, controversies, and needs
Authors: Gauzzi Maria Cristina
Published: August 2018

The vitamin D-binding protein (DBP) occupies a key node in the regulation of the vitamin D system. Being the main plasma carrier of vitamin D metabolites, it regulates their stability and bioavailability. However, DBP is also a multifunctional protein with roles in the organism’s actin scavenging system and immunomodulation. All these activities may affect multiple sclerosis (MS) pathophysiology. DBP can be measured in blood and cerebrospinal fluid, body fluids that have been investigated as sources of accessible biomarkers of MS. Yet, available data on DBP expression and function in MS are scattered and somewhat controversial. Aims of this review are to summarize current evidence from studies on DBP in MS patients, to discuss possible shortcomings and to highlight key points that need to be addressed to gain deeper insight into the role of DBP in MS.
Can we trust self-reported walking distance when determining EDSS scores in patients with multiple sclerosis? The Danish MS hospitals rehabilitation study
Authors: Skjerbæk Anders Guldhammer , Boesen Finn , Petersen Thor , Rasmussen Peter Vestergaard , Stenager Egon , Nørgaard Michael , Feys Peter , Kjeldgaard-Jørgensen Marie Louise , Hvid Lars Grøndahl , Dalgas Ulrik
Published: August 2018

Background:

In multiple sclerosis (MS), the Expanded Disability Status Scale (EDSS) reflects disease severity. Although parts of the EDSS are dependent on actual walking distance, self-reported statements are often applied.

Objectives:

The purpose of the present study was, therefore, to compare self-reported walking distance to actual walking distance to outline how this influences EDSS scoring.

Methods:

MS patients with EDSS 4.0–7.5 ( n = 273) were included from the Danish MS hospitals rehabilitation study ( n = 427). All patients subjectively classified their maximal walking distance according to one of seven categories (>500; 300–499; 200–299; 100–199; 20–99; 5–19; 0–4 m). Subsequently, actual maximal walking distance was assessed and EDSS was determined from both self-reported walking distance (EDSSself-report) and actual walking distance (EDSSactual).

Results:

In 145 patients (53%), self-reported walking distance was misclassified when compared to the actual walking distance. Misclassification was more frequent in patients using walking aids (64% vs. 44%, p < 0.05) and in patients with primary progressive MS (69%, p < 0.05). Misclassification of walking distance corresponded to incorrect EDSS scores (EDSSself-report vs EDSSactual) of ⩾0.5 point in 24%.

Conclusion:

In MS patients with EDSS 4.0–7.5, 53% misclassified their walking distance yielding incorrect EDSS scores in 24%. Therefore, correct EDSS determination must be based on measurement of actual walking distance.
Alcohol consumption in adolescence is associated with a lower risk of multiple sclerosis in a Danish cohort
Authors: Andersen Christina , Søndergaard Helle Bach , Bang Oturai Ditte , Laursen Julie Hejgaard , Gustavsen Stefan , Larsen Nanna Katrine , Magyari Melinda , Just-Østergaard Emilie , Thørner Lise Wegner , Sellebjerg Finn , Ullum Henrik , Oturai Annette Bang
Published: August 2018

Background and objective:

Due to the possible existence of a vulnerable period of multiple sclerosis (MS) susceptibility in adolescence and because Danish teenagers have a high alcohol consumption, we investigated the association between alcohol consumption at ages 15–19 and the risk of developing MS.

Methods:

A total of 1717 patients with MS and 4685 healthy blood donors filled in a comprehensive environmental and lifestyle questionnaire. Data were analysed by logistic regression models and adjusted for selected confounders.

Results:

We found an inverse association between alcohol consumption in adolescence and risk of developing MS in both women ( p < 0.001) and men ( p = 0.012). Women with low alcohol consumption had an odds ratio (OR) of 0.56 (95% confidence interval (CI): 0.47–0.66) compared with non-drinking women. The ORs were similar for women with moderate (OR = 0.49, 95% CI: 0.38–0.62) and high consumption (OR = 0.57, 95% CI: 0.38–0.84). Men with low alcohol consumption had an OR of 0.69 (95% CI: 0.53–0.89) compared with non-drinking men but no decreased risk was found for men with moderate and high consumption.

Conclusion:

Alcohol consumption in adolescence was associated with lower risk of developing MS among both sexes.
Revisiting the relationship between host attitudes and tourism development: A utility maximization approach
Authors: Fan Daisy XF , Liu Anyu , Qiu Richard TR
Published: August 2018

Host attitudes toward tourists are critical to the sustainable development of the tourism industry. Although numerous studies have focused on investigating host attitudes toward tourists and tourism development, the theoretical support from an economic perspective in this field is still underdeveloped. By following the social exchange theory and applying a utility maximization model, the current study not only explains Doxey’s Irridex model from an economic perspective but also complements the findings of the tourism area life cycle model proposed by Butler. Results show that the public resources at the destination, along with the ability of local community in channeling (foreign) tourism income into productivity advancement, influence the optimal level of tourism development in a destination.
Measuring the service system impact of a novel telediagnostic service program for young children with autism spectrum disorder
Authors: Stainbrook J Alacia , Weitlauf Amy S , Juárez A Pablo , Taylor Julie Lounds , Hine Jeffrey , Broderick Neill , Nicholson Amy , Warren Zachary
Published: August 2018

As prevalence of autism spectrum disorder continues to increase, so too does the need for timely, accessible diagnostic consultation. The present work extends from a previous study which provided preliminary evidence for the feasibility of expert clinicians to utilize telemedicine to triage autism spectrum disorder risk in young children. However, it did not examine whether a telediagnostic model had a demonstrable impact on tertiary care center referrals and usage. We therefore examined whether the introduction of telemedicine-based diagnostic consultation for families served by a rural medical facility affected referrals overall as well as to a metropolitan tertiary care diagnostic center. Results suggest that telemedicine diagnostic consultation in partnership with a referring early intervention system may positively impact referrals for diagnostic evaluation as well as the ability of families to schedule and attend appointments.
Some People May Need it, But Not Me, Not Now: Seeking Professional Help for Mental Health Problems in Urban China
Authors: Chen Juan
Published: August 2018

In recent years, various levels of the Chinese government have undertaken the task of developing new models of community-based mental health services. Greater availability and higher quality will not result in substantial improvements if those suffering from mental illnesses do not use the services. This article examines not only people’s cultural perception of mental health and help-seeking but also their practical concerns and preferences about mental health service provision in urban China. The study analyzes qualitative data from in-depth interviews with 50 respondents who belong to the most psychologically distressed subgroup (with the Kessler Psychological Distress Scale (K10) score ≥ 25) identified in a household survey in Beijing. While stigma about mental illness and help-seeking is real and well described, most interviewees are also not aware of the availability of professional mental health services. They believe that professional services target the upper-middle and upper classes, and are outside the sphere of their daily life and socio-economic status. The interviewees do not welcome the prospect of a mental health clinic or treatment center in their neighborhood due to concerns about stigma and confidentiality; instead, they support the creation of mental health referral services and promotion programs within the community or on the Internet. The findings suggest that the development of community-based mental health services in mainland China should take into account not only the cultural constraints that make people reluctant to seek professional help but also the structural inadequacies that deter potential user groups from accessing such services.
Practice perspectives and theoretical debates about social workers’ legal powers to protect adults
Authors: Stevens Martin , Manthorpe Jill , Martineau Stephen , Norrie Caroline
Published: August 2018

This paper explores arguments for and against increasing social workers’ legal powers in adult protection (safeguarding) in England, where there is no direct power of entry. It draws on a research study conducted in 2016–17 involving an international literature review, interviews with social workers (n = 22), managers (n = 15), older and disabled people (n = 6) and carers (n = 5) and a survey of adult safeguarding managers (n = 27). The paper contextualises findings by exploring concepts of vulnerability and autonomy.

Findings

Most participants were in favour of increased powers for social workers undertaking safeguarding enquiries. A power of entry was seen to strengthen the legal basis of safeguarding and provide legitimacy for social workers to act. However, many participants expressed reservations, arguing that cases could generally be resolved with good social work, there would be a risk of negative impact on adults at risk and their families, the power of entry conflicted with social work practice and values and it could negatively affect social work relationships. Such arguments indicate a nuanced view of autonomy and vulnerability, which allow for doubt about the autonomy of people with capacity in certain circumstances.

Applications

The paper suggests the need for investment in the processes of implementation of risk management if increased legal powers are introduced. There could be a value in encouraging social workers to make explicit their assumptions about the definitions of vulnerability and its impact on autonomy and to explore the subjective experience of vulnerability in their judgements about intervening in these kinds of situations.
Predictors of empathy in women social workers
Authors: Stanley Selwyn , Mettilda Buvaneswari G , Meenakshi A
Published: August 2018

This study explored the manifestation of reflective ability, emotional intelligence and empathy in 120 women social workers in Tiruchirappalli, India. A cross-sectional quantitative design was used and the Emotional Intelligence Scale, Groningen Reflective Ability Scale and the Empathy Assessment Index were administered to assess the manifestation of these dimensions. Multiple regression analysis was used to identify predictors of empathy.

Findings

Based on mean scores, the majority of respondents were classified as being ‘high’ in terms of emotional intelligence and reflective ability. Respondents of different age groups showed a significant difference in terms of the manifestation of empathy. Age, self-reflection and appraisal and expression of emotions were extracted as significant predictors of empathy.

Application

The article discusses the importance of these professional attributes for effective practice and the role of academic institutions and social work organisations in fostering the development of these dimensions in social work practitioners.
Sage or guide? Student perceptions of the role of the instructor in a flipped classroom
Authors: McLean Sarah , Attardi Stefanie M
Published: August 2018

Higher education has begun to shift from a teacher-centred instructional approach to a student-centred learning approach; many instructors have embraced this change by developing flipped classrooms. In the flipped classroom, students complete pre-work prior to attending class; this pre-work is often in the form of a video recording, lecture recording or reading. Class time is then repurposed to focus on knowledge application and synthesis rather than delivery. As such, it is suggested that instructors become less sage- and more guide-like in their teaching approach. The impact of the flipped classroom has been mostly positive in research; however, it is unclear whether students actually note and/or value the change in the role of the instructor in the flipped classroom. This study sought to evaluate the perception of the ideal instructor according to students following their experience in a flipped classroom course. Data were collected on students’ perceptions of the instructor prior to, during, and following a flipped classroom experience. Overall, students valued the instructor’s role as a moderator rather than information-deliverer; however, the most important aspect of the flipped classroom, according to the students in this study, was the ability of the flipped classroom to foster greater interaction and learning between students.
Exploring the experiences of adult learners in a transition program
Authors: Karmelita Courtney E
Published: August 2018

Transition programs have emerged as a support for adult learners seeking college education. Adult learners’ perspectives are missing in the literature on transition programs. To better support adult learners in transition programs, it is essential to understand their experiences and perspectives. Using Schlossberg’s Transition Theory (Anderson, Goodman, & Schlossberg, 2012) and Cross’s (1991) student barrier categorizations as a framework, this narrative study investigates the experiences of five adult learners enrolled in a transition program. The findings indicate that the relationships the participants formed through the program served as a support system, and that participation in the program led to a shift in self-perception. The participant narratives also highlight barriers to college enrollment for adult learners, such as difficulty using technology and health related issues.
Still Looking for Mechanisms: A Realist Review of Batterer Intervention Programs
Authors: Velonis Alisa J. , Mahabir Debbie Finn , Maddox Raglan , O’Campo Patricia
Published: August 2018

Introduction:

Complex interventions, including batterer intervention or treatment programs (BIPs), require that program strategies interact with contextual factors to trigger often unseen mechanisms in individuals or communities. Although hundreds of evaluations of BIPs have been published, few identify mechanisms or explain for whom, under what conditions, and why programs are effective. The goal of this realist review is to identify evidence of the mechanisms that contribute to successful immediate outcomes in BIPs.

Methods:

In accordance with published realist review standards, we defined the review questions and rational, defined outcomes and formulating initial theories, searched the literature, applied inclusion and exclusion criteria, and analyzed and synthesizing data. An initial search yielded 5,149 citations, and after a systematic process using realist principles, six articles with sufficient information were included.

Results:

Few evaluations contain the detail necessary to discern clear generative explanations of program processes. Evidence suggested that under some contextual conditions, strategies that trigger a self-reflexive process in participants may lead to changes in attitudes about violence, which may lead to the development of empathy for their partner. Additionally, programs that help participants differentiate between shame and guilt appear to increase both acceptance of responsibility and empathy.

Discussion:

This realist synthesis illustrates several gaps in the evaluative literature. Few evaluations captured sufficient detail to examine the influence of contextual factors. Likewise, most evaluations only describe if specific outcomes were achieved, not how, or through what mechanisms, those outcomes were accomplished. Recommendations to strengthen program theory and further examine self-reflection as a mechanism are discussed.
Characteristics of Nurse Practitioner Practice in Family Health Teams in Ontario, Canada
Authors: Heale Roberta , Dahrouge Simone , Johnston Sharon , Tranmer Joan E.
Published: August 2018

Nurse practitioners (NPs) in Ontario work in a number of settings, including physician-led, interprofessional Family Health Teams (FHTs). However, many aspects of NP practice within the FHTs are unknown. Our study aimed to describe the characteristics of NP practice in FHTs and the relationships between NPs and physicians within this model. This cross-sectional descriptive study analyzed NP service and diagnostic code data collected for every NP patient encounter from 2012 to 2015. Encounter data were linked to health administrative data housed at the Institute for Clinical Evaluative Sciences to allow for comparison with physician service and diagnostic codes. Findings demonstrated that NPs saw patients across all age groups for one to more than five problems per encounter and that NPs handled both acute and episodic care and chronic disease management issues. Patients with chronic conditions had more encounters with physicians than with NPs. In addition, compared to physicians, NPs saw more female than male patients. Our findings provide a snapshot of NP practice in FHTs and may be useful in informing other practice models in Ontario, elsewhere in Canada, and internationally. More evidence is needed, however, to clarify the responsibilities of the NPs in collaborative relationships with physicians and to embed policies that will ensure that NPs work to their full potential. In addition, applying service coding to all health care providers in FHTs could enhance data on interprofessional teams and the individual clinicians that comprise them.
Transdiagnostic Cognitive Behavioral Therapy for the Treatment of Emotional Disorders: A Group Case Study
Authors: Harris Kelly R. , Norton Peter J.
Published: August 2018

A recent shift in the conceptualization of both depressive and anxiety disorders supports the notion that these disorders may best fall under a single classification of “emotional disorders.” This understanding has resulted in the development of various transdiagnostic cognitive behavioral therapy (tCBT) protocols to address underlying core pathology shared by emotional disorders. While there is evidence to suggest tCBT is effective in reducing co-occurring depression, research into the efficacy of face-to-face tCBT has generally focused on the delivery of tCBT to individuals with predominantly anxiety diagnoses. The current case study aims to expand the research by examining the impact of group tCBT for individuals with a principal depressive diagnosis. A session-by-session explanation of a 12-week group tCBT protocol designed to treat a heterogeneous group of individuals diagnosed with an emotional disorder is provided in detail and accompanied by a quantitative case study of a recently delivered treatment group. The case study demonstrates the feasibility and pragmatic application of the group tCBT treatment approach. Data presented support the continued research of transdiagnostic interventions for the treatment of emotional disorders and justify future randomized controlled trials to further evaluate the presented intervention.
Therapeutic Intervention of Aloe Gel Containing Nano-Sized and Micron-Sized Silver Sulfadiazine Gel on Second-Degree Burn: A Comparative Study
Authors: Barkat Md Abul , Harshita  , Pottoo Faheem Hyder , Singh Satya Prakash , Ahmad Farhan J.
Published: August 2018

The current work focuses on the formulation development, optimization, and in vivo assessment of nano-sized silver sulfadiazine ( nSSD) and micron-sized silver sulfadiazine ( mSSD) topical gel composed of Aloe vera gel ( Aloe gel) and Carbopol 940 for the management of second-degree burn wound. The optimized concentration of gel-forming agent (Carbopol 940) was chosen based on best possible consistency and spreadability of the gel. The second-degree burn infliction was developed in the posterior region of rats followed by anesthesia. Afterward, the created wounds were further treated individually by both the gel formulation (1 application daily) for 14 days and observations were recorded. The nSSD gel showed better wound healing and a higher degree of tissue hyperplasia as compared with mSSD gel in rats. In vitro drug release study showed better drug release from nSSD gel (74.25 ± 3.331%) as compared with mSSD gel formulation (61.32 ± 2.112%) after 24 hours. The nSSD and mSSD topical gel-treated rats showed 95.63% and 78.75% wound healing after 14 days, while in the case of control group rats, 48.65% wound contraction was seen after 14 days. Furthermore, the histopathological study revealed that the nSSD gel was more efficient in controlling the wound infection and showed better wound healing as compared with mSSD gel formulation.