bluuebunny/crossref_metadata_2025 huggingface dataset:
Revalidation of the RACE scale after its regional implementation in Catalonia: a triage tool for large vessel occlusion
Authors: Carrera David , Gorchs Montse , Querol Marisol , Abilleira Sònia , Ribó Marc , Millán Mònica , Ramos Anna , Cardona Pedro , Urra Xabier , Rodríguez-Campello Ana , Prats-Sánchez Luis , Purroy Francisco , Serena Joaquín , Cánovas David , Zaragoza-Brunet Josep , Krupinski Jerzy A , Ustrell Xavier , Saura Júlia , García Sonia , Mora Maria Àngela , Jiménez Xavier , Dávalos Antoni , Pérez de la Ossa Natalia
Published: December 2018

Background and purpose

Our aim was to revalidate the RACE scale, a prehospital tool that aims to identify patients with large vessel occlusion (LVO), after its region-wide implementation in Catalonia, and to analyze geographical differences in access to endovascular treatment (EVT).

Methods

We used data from the prospective CICAT registry (Stroke Code Catalan registry) that includes all stroke code activations. The RACE score evaluated by emergency medical services, time metrics, final diagnosis, presence of LVO, and type of revascularization treatment were registered. Sensitivity, specificity, and area under the curve (AUC) for the RACE cut-off value ≥5 for identification of both LVO and eligibility for EVT were calculated. We compared the rate of EVT and time to EVT of patients transferred from referral centers compared with those directly presenting to comprehensive stroke centers (CSC).

Results

The RACE scale was evaluated in the field in 1822 patients, showing a strong correlation with the subsequent in-hospital evaluation of the National Institute of Health Stroke Scale evaluated at hospital (r=0.74, P<0.001). A RACE score ≥5 detected LVO with a sensitivity 0.84 and specificity 0.60 (AUC 0.77). Patients with RACE ≥5 harbored a LVO and received EVT more frequently than RACE <5 patients (LVO 35% vs 6%; EVT 20% vs 6%; all P<0.001). Direct admission at a CSC was independently associated with higher odds of receiving EVT compared with admission at a referral center (OR 2.40; 95% CI 1.66 to 3.46), and symtoms onset to groin puncture was 133 min shorter.

Conclusions

This large validation study confirms RACE accuracy to identify stroke patients eligible for EVT, and provides evidence of geographical imbalances in the access to EVT to the detriment of patients located in remote areas.
Study of Testing Method for Dynamic Initiation Toughness of Sandstone under Blasting Loading
Authors: Xiao Dingjun , Zhu Zheming , Hu Rong , Lang Lin
Published: December 2018

In this paper, an internal central single‐cracked disk (ICSCD) specimen was proposed for the study of dynamic fracture initiation toughness of sandstone under blasting loading. The ICSCD specimen had a diameter of 400 mm sandstone disc with a 60 mm long crack. Blasting tests were conducted by using the ICSCD specimens. The blasting strain‐time curve was obtained from the radial strain gauges placed around the blast hole. The fracture initiation time was determined by circumferential strain gauges placed around the crack tip. The stress history on the blast hole of the sandstone specimen was then derived from measured strain curve through the Laplace transform. The numerical solutions were further obtained by the numerical inversion method. A numerical model was established using the finite element software ANSYS. The type I dynamic stress intensity factor curves of sandstone under blasting loading were derived by the mutual interaction integration method. The results showed that (1) the ICSCD specimen can be used to measure dynamic initiation fracture toughness of rocks; (2) the stress on the blast hole wall can be obtained by the Laplace numerical inversion method; (3) the dynamic initiation fracture toughness of the ICSCD sandstone specimen can be calculated by the experimental‐numerical method with a maximum error of only 7%.
Short-Term Photovoltaic Power Generation Combination Forecasting Method Based on Similar Day and Cross Entropy Theory
Authors: Wang Qi , Ji Shunxiang , Hu Minqiang , Li Wei , Liu Fusuo , Zhu Ling
Published: December 2018

The forecast for photovoltaic (PV) power generation is of great significance for the operation and control of power system. In this paper, a short-term combination forecasting model for PV power based on similar day and cross entropy theory is proposed. The main influencing factors of PV power are analyzed. From the perspective of entropy theory, considering distance entropy and grey relation entropy, a comprehensive index is proposed to select similar days. Then, the least square support vector machine (LSSVM), autoregressive and moving average (ARMA), and back propagation (BP) neural network are used to forecast PV power, respectively. The weights of three single forecasting methods are dynamically set by the cross entropy algorithm and the short-term combination forecasting model for PV power is established. The results show that this method can effectively improve the prediction accuracy of PV power and is of great significance to real-time economical dispatch.
The Optimal Design of an Arch Girder of Variable Curvature and Stiffness by Means of Control Theory
Authors: Jasińska Dorota , Kropiowska Dorota
Published: December 2018

The problem of optimal design of the statically indeterminate arch girder which constitutes the primary structural system of the arch bridge is presented. The task is to determine the optimal shape of the axis of the arch girder, as well as the optimal distribution of the cross section height, ensuring the minimum arch volume as well as fulfillment of the standard requirements. This optimisation task, with numerous control functions and constraints, is formulated as a control theory problem with maintaining the formal structure of the minimum principle and then transformed to the multipoint boundary value problem and solved by means of numerical methods. The numerical results are obtained with optimal control methods, using the Dircol software. Since the changes in the shape and cross-section of the arch affect the distribution of the dead and moving loads transferred on the girder from the bridge deck, the optimisation procedure is combined with the finite element method analysis, which together with the complexity of the multidecision arch optimisation problem accounts for the novelty of the proposed approach. The numerical analysis reveals that the optimal girder shape is the frame-arched structure, with considerable lengths of straight sections and only short arch elements, in the areas of the application of concentrated forces and moments. The presented method can be successfully extended to optimisation of structures with different static schemes and load categories taken into account.
Direct Targeting of MYCN Gene Amplification by Site-Specific DNA Alkylation in Neuroblastoma
Authors: Yoda Hiroyuki , Inoue Takahiro , Shinozaki Yoshinao , Lin Jason , Watanabe Takayoshi , Koshikawa Nobuko , Takatori Atsushi , Nagase Hiroki
Published: December 2018

Amplification of MYCN plays a pivotal role in multiple types of tumors and correlates with poor prognosis in high-risk neuroblastoma. Despite recent advances in the treatment of neuroblastoma, no approaches directly target the master oncogene MYCN. Difficulties in targeting the MYCN protein inspired us to develop a new gene-level–inhibitory strategy using a sequence-specific gene regulator. Here, we generated a MYCN-targeting pyrrole-imidazole (PI) polyamide, MYCN-A3, which directly binds to and alkylates DNA at homing motifs within the MYCN transcript. Pharmacologic suppression of MYCN inhibited the proliferation of cancer cells harboring MYCN amplification compared with MYCN nonamplified cancer cells. In neuroblastoma xenograft mouse models, MYCN-A3 specifically downregulated MYCN expression and suppressed tumor progression with no detectable adverse effects and resulted in prolonged overall survival. Moreover, treatment with MYCN-A3, but not MYCN nontargeting PI polyamide, precipitated a copy number reduction of MYCN in neuroblastoma cells with MYCN amplification. These findings suggest that directly targeting MYCN with MYCN-A3 is a novel therapeutic approach to reduce copy number of the MYCN gene for MYCN-amplified neuroblastoma.

Significance:

This study presents a novel approach to drugging an amplified oncogene by showing that targeting gene amplification of MYCN suppresses MYCN expression and neuroblastoma growth.
Time Trends in Atrial Fibrillation-Associated Stroke and Premorbid Anticoagulation
Authors: Yiin Gabriel S.C. , Li Linxin , Bejot Yannick , Rothwell Peter M.
Published: December 2018

Background and Purpose—

Prevalence of atrial fibrillation (AF) is increasing, but the impact on overall burden of stroke is uncertain, as is the proportion that could be attributed to under anticoagulation. We did a population-based study of AF-associated stroke and a systematic review of time trends in other stroke incidence studies and of rates of premorbid anticoagulation.

Methods—

The proportion of incident strokes with associated AF was determined in the OXVASC (Oxford Vascular Study; 2002–2017) and in other prospective, population-based stroke incidence studies published before December 2017. Proportions were pooled by Mantel Haenszel methods, and the pooled percentage of cases with premorbid anticoagulation was determined. Analyses were stratified by the age of study population, mid-study year, country, and ethnicity.

Results—

Of 1928 patients with incident ischemic stroke in OXVASC, 629 (32.6%; 95% CI, 30.5–34.7) were AF associated, consistent with the pooled estimate from 4 smaller studies over the same study period (608/1948; 31.2%, 30.0–32.4;
P
het
=0.80). The pooled estimate from all studies reporting premorbid AF over 25 million person-years of observation (1960 onwards; 33 reports) was lower (18.6%, 16.8–20.3) and more heterogeneous (
P
het
<0.0001), but 62% of heterogeneity was explained by the age of study population, study period, country, and ethnicity. The proportion of incident strokes on premorbid anticoagulation increased over time, both for ischemic stroke in OXVASC (2002–2007: 15.1%, 2008–2012: 19.6%, and 2013–2017: 35.9%;
P
trend
<0.0001), and across all studies (
P
=0.002), but the pooled estimates suggested substantial undertreatment even in the most recent periods (2001–2015: 25.7%, 21.1–30.3 and ≥2010: 31.6%, 18.2–44.9).

Conclusions—

About 1 in 3 incident ischemic strokes are still AF associated, due partly to low rates of anticoagulation for known prior AF, which therefore represents a major public health opportunity to reduce the burden of stroke.
Nationwide Analysis of Cost Variation for Treatment of Aneurysmal Subarachnoid Hemorrhage
Authors: Yoon Seungwon , Yoon Jennifer C. , Winkler Ethan , Liu Caterina , Lawton Michael T.
Published: December 2018

Background and Purpose—

Aneurysmal subarachnoid hemorrhage (aSAH) has a high healthcare cost burden.

Methods—

We performed a cross-sectional analysis of the costs of clipping and coiling of aSAH using the National Inpatient Sample and Vizient databases. We conducted multiple regression analyses to estimate national costs and study associations between patient demographic, clinical, and hospital factors and treatment costs.

Results—

We identified 23 324 ruptured aneurysm patients in the National Inpatient Sample (2002–2013) and found mean inflation-adjusted costs for clipping increased 41.0% ($66 358±1354–$93 597±2339), whereas costs for coiling increased 38.9% ($62 972±2657–$87 441±2382). Multivariate analysis showed that age, length of stay, insurance, comorbidities, risk of mortality, and urban teaching hospital status were associated with higher hospital costs for clipping and coiling (all
P
<0.05). In the Vizient database (2013–2015), costs for clipping and coiling increased 11% and 5%, respectively. Both databases demonstrated that the western United States had the highest health expenditures for aSAH (
P
<0.05).

Conclusions—

Findings show substantial cost increases and regional cost disparities for aSAH treatments. Patient and hospital factors copredict higher costs for aSAH procedures. Interhospital and regional cost variations open the door for cost-containment strategic development.
Gadolinium Leakage in Ocular Structures Is Common in Lacunar Infarction
Authors: Förster Alex , Al-Zghloul Mansour , Wenz Holger , Böhme Johannes , Groden Christoph , Alonso Angelika
Published: December 2018

Background and Purpose—

We investigated the frequency and pattern of blood-brain barrier, as well as blood-retina barrier, impairment in acute lacunar infarction as demonstrated by hyperintense acute reperfusion marker and gadolinium leakage in ocular structures (GLOS), respectively, on fluid-attenuated inversion recovery images.

Methods—

Acute lacunar infarction patients who underwent repeated magnetic resonance imaging after intravenous contrast agent administration were identified and the presence of GLOS in the anterior chamber and vitreous body and hyperintense acute reperfusion marker noted on fluid-attenuated inversion recovery.

Results—

Overall, 24 acute lacunar infarction patients (median age 64.5 years; interquartile range, 54–78 years) were included. On contrast-enhanced fluid-attenuated inversion recovery, GLOS was observed in 11 (45.8%) patients: in 4 (16.7%) in the anterior chamber only and in 7 (29.2%) in the anterior chamber and vitreous body. In all patients, GLOS was bilateral and symmetrical. In patients with GLOS in the anterior chamber only, the time between initial and follow-up magnetic resonance imaging was significantly shorter (7.5 [interquartile range, 4.25–11.5] hours) compared with patients with GLOS in the anterior chamber and vitreous body (28 [interquartile range, 10–43] hours;
P
=0.047). Hyperintense acute reperfusion marker could not be demonstrated in any of the patients.

Conclusions—

In acute lacunar infarction patients, unlike hyperintense acute reperfusion marker, GLOS is a frequent finding and shows a similar temporal evolution like in larger ischemic stroke.
Stakeholder Identification and Salience After 20 Years: Progress, Problems, and Prospects
Authors: Wood Donna J. , Mitchell Ronald K. , Agle Bradley R. , Bryan Logan M.
Published: December 2018

To contribute to the continuing challenge of explaining how managers identify stakeholders and assess their salience, in this article, we chronicle the history, assess the impact, and evaluate the possibilities opened by Mitchell, Agle, and Wood (MAW-1997). We do so through two types of qualitative analysis, and also through utilizing a quantitative network analysis tool. The first qualitative analysis categorizes the major contributions of the most influential papers succeeding MAW-1997; the second identifies and compares the relevant issues with MAW-1997 at the time of initial publication and today. We apply main path analysis, a quantitative tool, to map how this scholarly domain has evolved. These three analyses robustly depict the impact of MAW-1997 and the ensuing scholarly conversation, and they enable us to illustrate the current state and trajectory of stakeholder identification and salience scholarship. We close by discussing pressing topics related to the broader body of stakeholder theory literature.
The role of gut microbiota in intestinal and liver diseases
Authors: Hrncir Tomas , Hrncirova Lucia , Kverka Miloslav , Tlaskalova-Hogenova Helena
Published: December 2018

The world-wide incidence of many immune-mediated and metabolic diseases, including those of the intestines and liver, is steadily increasing. Gut microbiota plays a central role in the pathogenesis of these diseases as it mediates environmental changes to the intestinal immune system. Various environmental factors including diet, food additives and medication also trigger the compositional and functional alterations of microbiota, that is, dysbiosis, and this dysbiosis is closely associated with many chronic inflammatory diseases. However, the causal relationship remains unclear for the majority of these diseases. In this review, we discuss essential epidemiological data, known pathogenetic factors including those of genetic and environmental nature, while mainly focusing on the role of gut microbiota in the development of selected intestinal and liver diseases. Using specific examples, we also briefly describe some of the most widely-used animal models including gnotobiotic models and their contribution to the research of pathogenetic mechanisms of the host–microbiota relationship.
Reasons for Living Inventory for Adolescents: Psychometric Properties Among Portuguese Adolescents
Authors: Ventosa Brás Marta Sofia , Guerreiro Carmo Cláudia Isabel , de Jesus Saul Neves
Published: December 2018

Reasons for living are protective factors against suicidal behavior in adolescents. One of the most useful measures to assess them is the Reasons for Living Inventory for Adolescents (RFL-A) developed by Osman et al. The goal of this study was to examine the psychometric properties of its Portuguese version of the RFL-A. To this end, we recruited 512 high school adolescents (mean age = 16.7 years), who completed the RFL-A, a Suicidal Ideation Questionnaire, and a hopelessness scale. Exploratory factor analysis replicated the original five-factor model and confirmatory factor analysis obtained satisfactory adjustment values. The RFL-A shows good reliability (internal consistency and temporal stability) as well as good convergent, discriminant, and concurrent validities. These results indicate that the RFL-A is a valid and reliable measure to study protective factors against suicidal behaviors in Portuguese adolescents.
Building a Local Preservation Ethic in the Era of Urban Renewal: How Did Neighborhood Associations Shape Historic Preservation Practice in Lexington, Kentucky?
Authors: Poole Lauren A. R. , Appler Douglas R.
Published: December 2018

The federal urban renewal program had wide-ranging consequences for American cities of all sizes and locations. Among the most consequential was its catalyzing effect on the historic preservation movement nationwide. While preservation practice at the dawn of the urban renewal era emphasized historic monuments, by its end in the mid-1970s, preservationists were much more concerned with neighborhoods, districts, and larger swaths of urban fabric, thus, becoming relevant to all manner of future city shaping and revitalizing efforts. While this expansion took place nationwide, the paths taken by individual cities varied considerably. Because of its large number of historic downtown residential neighborhoods, and its long involvement with historic preservation, Lexington, Kentucky, provides an ideal case study to explore this transformation, highlighting the ways in which neighborhood associations and local preservation organizations collaborated to set the stage for widespread adoption of local historic districts in the 1970s.
Profiles of Psychological Flexibility: A Latent Class Analysis of the Acceptance and Commitment Therapy Model
Authors: Tyndall Ian , Waldeck Daniel , Pancani Luca , Whelan Robert , Roche Bryan , Pereira Antonina
Published: December 2018

There exists uncertainty for clinicians over how the separate subcomponent processes of psychological flexibility, a core construct of the Acceptance and Commitment Therapy model, interact and influence distress experienced. The present study ( N = 567) employed latent class analysis to (a) identify potential classes (i.e., subgroups) of psychological flexibility based on responses on measures of key subcomponent process and (b) examine whether such classes could reliably differentiate levels of self-reported psychological distress and positive and negative emotionality. We found three distinct classes: (a) High Psychological Flexibility, (b) Moderate Psychological Flexibility, and (c) Low Psychological Flexibility. Those in the Low Psychology Flexibility class reported highest levels of psychological distress, whereas those in the High Psychological Flexibility class reported lowest levels of psychological distress. This study provides a clearer view to clinicians of the profile of the broader spectrum of the psychological flexibility model to facilitate change in clients.
Extracorporeal cardiopulmonary resuscitation after pulmonary artery rupture
Authors: Soynov Ilya , Kornilov Igor , Zubritskiy Alexey , Nichay Nataliya , Kulyabin Yuriy , Gorbatykh Artem , Omelchenko Alexander , Bogachev-Prokophiev Alexander
Published: December 2018

Pulmonary artery rupture during pulmonary balloon valvuloplasty is a rare and life-threatening complication. Here, we present a pulmonary artery rupture in a 10-month-old infant. The patient had a tamponade, ineffective cardiac massage for 40 minutes and extreme hemodilution due to blood loss. Extracorporeal life support was used for three days. The patient was discharged without any neurological sequelae.
Hemodynamic energy during pulsatile extracorporeal circulation using flexible and rigid arterial tubing: a reassessment
Authors: Dürr Anke , Kunert Andreas , Albrecht Günter , Liebold Andreas , Hoenicka Markus
Published: December 2018

Introduction:

Pulsatile extracorporeal circulation may improve organ perfusion during cardiac surgery. Some minimally invasive extracorporeal circulation (MiECC) systems allow pulsatile perfusion. The present study investigated the influence of arterial tubing compliance on hemodynamic energy transfer into the patient.

Methods:

Aortic models with adult human geometry were perfused in a mock circulation. A MiECC system was connected using either high-compliance silicone tubing or standard kit tubing. Energy equivalent pressure (EEP) and surplus hemodynamic energy (SHE) were computed from flow and pressure data. Aortic models with physiological and sub-physiological compliance were tested to assess the influence of the pseudo-patient.

Results:

Non-pulsatile flow did not generate SHE. SHE during pulsatile flow in the compliant aortic model was significantly higher with kit tubing compared to silicone tubing. Maximum SHE was achieved at 1.6 L/min with kit tubing (7.7% of mean arterial pressure) and with silicone tubing (4.9%). Using the low-compliance aortic model, SHE with kit tubing reached a higher maximum of 14.2% at 1.8 L/min compared to silicone tubing (11.8% at 1.5 L/min).

Conclusions:

Flexible arterial tubing did not preserve more hemodynamic energy from a pulsatile pump compared to standard kit tubing in a model of adult extracorporeal circulation. The pseudo-patient’s compliance significantly affected the properties of the mock circulation.
Comparison of Two School-Based Oral Health Education Programs in 9-Year-Old Children
Authors: Eden Ece , Akyildiz Melis , Sönmez Işıl
Published: December 2018

This study evaluated the effectiveness of two school-based oral health education (OHE) programs on the oral health knowledge and behavior and oral hygiene of 9-year-old children in Turkey. The study included 1,053 school children aged 9 years in Aydin, Turkey. This study was a prospective, two-arm, and parallel-group clinical trial between two different OHE programs. The dentist group received one lecture on OHE given by dentists in the classroom. The teacher group had a similar lecture given by school teachers, including supporting materials which were available throughout the academic year. Oral health knowledge and behavior were evaluated with a questionnaire at baseline, and then at 1 and 6 months. In total, 110 students were randomly selected to undergo a plaque accumulation assessment according to the Silness–Löe Index at baseline and 1 month later to determine the effects of the education programs on oral hygiene. At baseline, tooth-brushing frequency was similar in the study groups. Compared with baseline, the frequency of brushing increased significantly after 1 and 6 months in both groups ( p < .001). Teacher education was more effective for teaching correct brushing techniques ( p < .001). A significant decrease in plaque accumulation has been evaluated in both study groups at the 1-month examination after the education session ( p < .05). Both OHE programs were found to generate improvements in knowledge and behavior of children on oral health and plaque control in the short term.
Converging Cultures: Partnering in Affirmative and Inclusive Health Care for Members of the Lesbian, Gay, Bisexual, and Transgender Community
Authors: Schweiger-Whalen Lindsey , Noe Shelly , Lynch Stephanie , Summers Linda , Adams Eve
Published: December 2018

BACKGROUND: Members of the lesbian, gay, bisexual, and transgender (LGBT) community suffer from disproportionate rates of physical and mental illness. This population experiences enhanced vulnerability to illness as a result of societal marginalization, known as minority stress, which is compounded by insufficient LGBT education for health care professionals and stigmatizing experiences within medical institutions. AIMS: The aims of this study were to review the literature on LGBT cultural competence interventions; evaluate the effect of a 4-hour pilot workshop, “Converging Cultures,” on the development of cultural competence; and make recommendations for best practices in developing LGBT cultural competence among health care providers. METHOD: The study used a repeated-measures pre-/posttest design among a sample of 130 hospital employees and undergraduate nursing students. The GAP (Gay Affirmative Practice scale) scale, a measure of LGBT-affirmative practice beliefs, and an objective Knowledge Quiz were administered before and directly following the training. The posttest included three open-ended questions to elicit self-reflection and capture the development of cultural competence according to Campinha-Bacote’s theory, the process of cultural competence in the delivery of healthcare services. RESULTS: Paired sample t tests revealed significant improvement on the GAP and Knowledge Quiz. Open-ended responses reflected the five constructs of Campinha-Bacote’s theory. CONCLUSIONS: Self-reflection is an essential component of LGBT cultural competence education to uncover personal biases that affect clinical behavior. Future educational efforts for sexual and gender minorities should strive to avoid inadvertent marginalization of LGBT people through integration of concepts with existing curricula and workplace training.
The Impact of Eco-Innovation on Performance Through the Measurement of Financial Resources and Green Patents
Authors: Marín-Vinuesa Luz María , Scarpellini Sabina , Portillo-Tarragona Pilar , Moneva José M.
Published: December 2018

The main objective of this article is to contribute empirically to the understanding of the impact that eco-innovation has on firms’ financial performance within the framework of the resources-based view. Specifically, eco-innovation is measured by using eco-innovative activities and financial resources applied to eco-innovation to argue that the identification and measurement of certain resources of firms allow companies that are particularly active in investing in eco-innovation to be more competitive. Furthermore, the analysis attempts to ascertain whether firms that own green patents and other characteristics exhibit different level of financial performance than firms without registered green patents. The empirical partial least squares structural equation modeling results indicate a positive relationship between the investment of resources and the financial performance of eco-innovative firms. The effects of involving managers in eco-innovative processes as an environmental capability of firms are also tested.
The Faith, Activity, and Nutrition (FAN) Dissemination and Implementation Study, Phase 1: Implementation Monitoring Methods and Results
Authors: Saunders Ruth P. , Wilcox Sara , Jake-Schoffman Danielle E. , Kinnard Deborah , Hutto Brent , Forthofer Melinda , Kaczynski Andrew T.
Published: December 2018

Faith-based settings offer opportunities for reaching populations at risk for chronic conditions and are optimal settings for dissemination and implementation (D&I) research. Faith, Activity, and Nutrition (FAN) is an evidence-based program designed to promote physical activity (PA) and healthy eating (HE) through church policy, systems, and environmental change. We report implementation fidelity for Phase 1 of the FAN D&I project, a countywide effort. The group randomized study included pre- and postintervention assessments of core PA and HE components. We compared implementation in early intervention ( n = 35) versus delayed intervention (control, n = 19) churches; assessed individual church implementation; and examined the effects of level of implementation on church member outcomes. Implementation assessments were conducted with the FAN coordinator via telephone survey. Study outcomes were assessed with church members 8 to 12 months following baseline assessment via self-administered surveys. We found significantly higher levels of implementation for PA opportunities, PA and HE guidelines, PA and HE messages, and PA and HE pastor support in intervention versus control churches and showed church-level variation in PA and HE implementation. PA self-efficacy varied by level of implementation; high and low implementers did not differ in proportion of church members physically inactive, although low implementers had fewer members inactive than controls. The high level of implementation in intervention churches shows promise for broader dissemination of FAN.
A 10-Month-Old Infant Presenting With Signs of Precocious Puberty Secondary to a Sclerosing Stromal Tumor of the Ovary in the Absence of Hormonal Elevation
Authors: Squillaro Anthony I , Zhou Shengmei , Thomas Stefanie M , Kim Eugene S
Published: December 2018

Precocious puberty in an infant is an alarming and infrequent finding, making the differential diagnosis difficult for practitioners. Precocious puberty secondary to a sclerosing stromal tumor (SST) of the ovary is rare. We present a case of a child that began precocious puberty at 3 months of age including development of breast buds, pubic hair, growth spurt, and menarche 5 days prior to presenting to pediatric endocrinology at 10 months. She underwent right salpingo-oophorectomy which demonstrated a soft tissue mass occupying almost the entire ovary with a tan-pink fleshy cut surface. Histological examination confirmed a variant of SST. This case represents an extremely young onset of precocious puberty secondary to a variant of SST without hormonal elevation.
Influence of local turbulent flow on the performance of a mixed-lubrication bearing
Authors: Lv Fangrui , Zou Donglin , Ta Na , Rao Zhushi
Published: December 2018

For some large heavy load bearings, asperity contact may occur in the area near the minimum film thickness. However, in the remaining area, the liquid film may be much thicker, and thus turbulence develops locally. To investigate the influence of local turbulent flow on the performance of a mixed-lubrication bearing, in this paper, the bearing is divided into a mixed-lubrication region and a pure hydrodynamic lubrication region according to the film thickness ratio. The liquid in the mixed-lubrication region is calculated using the average Reynolds equation, and the generalized Reynolds equation considering turbulence is used to describe the pure hydrodynamic lubrication region. The calculation procedure is established and a journal bearing is simulated. The results show that local turbulence influences the bearing performance, and it remarkably influences the friction coefficient.
Subjective health in relation to hedonic and eudaimonic wellbeing: Evidence from the Gallup World Poll
Authors: Joshanloo Mohsen , Jovanović Veljko
Published: December 2018

This study investigated the relationships between subjective health, hedonic wellbeing (i.e. positive affect, negative affect, and life satisfaction), and eudaimonic wellbeing (i.e. psycho-social functioning). The sample was drawn from the Gallup World Poll and included a total of 1,567,295 individuals in 165 countries. We found that both hedonic and eudaimonic wellbeing were uniquely associated with subjective health. However, the relative contributions of each dimension to subjective health varied, with negative affect demonstrating the strongest relationship with subjective health and life satisfaction demonstrating the weakest association. The moderating effects of some national-level variables were also explored.
Autism and the transition to university from the student perspective
Authors: Lambe Sinead , Russell Ailsa , Butler Catherine , Fletcher Sangeet , Ashwin Chris , Brosnan Mark
Published: December 2018

University provides individuals with the opportunity to develop greater independence in living skills and social networks, while also gaining valuable qualifications. Despite a high proportion of autistic individuals aspiring to attend university, many either do not seek or gain entry or drop out prematurely. Although some steps have been taken to develop effective support, a recent review highlighted the scarcity of research into programmes designed to support autistic students transitioning to university. In addition, few studies have examined the views of autistic students themselves. This study investigated the perspectives of autistic students transitioning to university. Three focus groups were conducted with 25 autistic students preparing to start university. Participants were asked about their hopes for starting university, as well as their worries and concerns. Data were analysed using thematic analysis, from which five main themes were identified: The Social World, Academic Demands, Practicalities of University Living, Leaving the Scaffolding of Home and Transition to Adulthood. The results provide an important account of the challenges autistic students face when transitioning to university, as well as their aspirations. These findings have a number of practical implications.
Liminal Knowledge: Positioning Intersectionality in Academia
Authors: Cordova Amanda Jo , Knecht Lisa Mendoza
Published: December 2018

This qualitative inquiry explores what Chicana/o doctoral students in an Educational Leadership program perceive about the positioning of the intersection of their gender, race, and ethnicity in relationship to their academic advancement and leadership development. Chicana feminist epistemology (CFE) grounds this study to invigorate the interrogation of dualities imposed by binary social constructs of male/female, Chicana/Chicano, and Chicana/o/White. Testimonio accounts of three Chicana/o doctoral students reveal a liminal space of knowledge where the daily experiences of choques or cultural collisions are revealed as the norm of academic life. We assert, that by tapping this vital source of liminal knowledge, we can re-position the intersections of our identity as aspiring educational leaders to re-articulate, re-imagine, and claim spaces of leadership informed by a mestiza consciousness1 that is inclusive of the many layers of our intersectionality.
Modulated Electrohyperthermia in Integrative Cancer Treatment for Relapsed Malignant Glioblastoma and Astrocytoma: Retrospective Multicenter Controlled Study
Authors: Fiorentini Giammaria , Sarti Donatella , Milandri Carlo , Dentico Patrizia , Mambrini Andrea , Fiorentini Caterina , Mattioli Gianmaria , Casadei Virginia , Guadagni Stefano
Published: December 2018

Background: There are interesting studies on glioma therapy with modulated electrohyperthermia (mEHT), which combines heat therapy with an electric field. Clinical researchers not only found the mEHT method feasible for palliation but also reported evidence of therapeutic response. Purpose: To study the efficacy and safety of mEHT for the treatment of relapsed malignant glioma and astrocytoma versus best supportive care (BSC). Methods: We collected data retrospectively on 149 patients affected by malignant glioma and astrocytoma. Inclusion criteria were informed consent signed; >18 years old; histological diagnosis of malignant glioma or astrocytoma; relapsed after surgery, adjuvant temozolomide-based chemotherapy, and radiotherapy; and indication for treatment with mEHT in palliative setting. mEHT was performed with capacitive coupling technique keeping the skin surface at 26°C and the tumor temperature at 40°C to 42.5°C for > 90% of treatment duration (20-60 minutes). The applied power was 40 to 150 W using a step-up heating protocol. Results from patients treated with mEHT were compared with those treated with BSC. Results: A total of 149 consecutive patients were enrolled in the study, 111 (74%) had glioblastoma multiforme (GBM), and 38 (26%) had astrocytoma (AST). mEHT was performed for 28 (25%) of GBM and 24 (63%) of AST patients. Tumor response at the 3-month follow-up was observed in 29% and 48% of GBM and AST patients after mEHT, and in 4% and 10% of GBM and AST patients after BSC, respectively. The survival rate at first and second year in the mEHT group was 77.3% and 40.9% for AST, and 61% and 29% for GBM, respectively. The 5-year overall survival of AST was 83% after mEHT versus 25% after BSC and 3.5% after mEHT versus 1.2% after BSC for GBM. The median overall survival of mEHT was 14 months (range 2-108 months) for GBM and 16.5 months (range 3-156 months) for the AST group. We observed 4 long-term survivors in the AST and 2 in the GBM group. Two of the long survivors in AST and 1 in GBM group were treated by mEHT. Conclusions: mEHT in integrative therapy may have a promising role in the treatment and palliation of relapsed GBM and AST.
Do GPs use motivational interviewing skills in routine consultations with patients living with mental-physical multimorbidity? An observational study of primary care in Scotland
Authors: McKenzie Kylie J , Pierce David , Mercer Stewart W , Gunn Jane M
Published: December 2018

Objectives

To examine whether motivational interviewing is used by GPs in consultations with patients living with mental-physical multimorbidity.

Methods

Secondary analysis of selected videos from an existing database of routine general practice consultations with adult patients in Glasgow, Scotland. Consultations involving patients with mental-physical multimorbidity were selected and coded using the Motivational Interviewing Treatment Integrity (MITI) coding system.

Results

Sixty consultations were coded involving 32 GPs across 16 practices. Mean consultation length was 9.9 min. On average GPs asked 1.7 questions per minute and offered 1.2 pieces of information per minute. Using the MITI, five GPs met beginner proficiency for the relational global qualities of partnership and empathy; however, none of the GPs met beginner proficiency for the technical global rating of efforts made to encourage patients to discuss behaviour change. Simple reflections were observed in 67% of consultations and complex reflections in 28% of consultations. Confrontation, a technique inconsistent with motivational interviewing, was observed in 18% of consultations.

Discussion

MI was not evident in these consultations with patients living with mental-physical multimorbidity. This study provides information about the baseline motivational interviewing-consistent skills of GPs working with multimorbid patients and may be helpful in informing motivational interviewing training efforts and future research.
Favorable Opportunity Structures for Populist Communication: Comparing Different Types of Politicians and Issues in Social Media, Television and the Press
Authors: Ernst Nicole , Esser Frank , Blassnig Sina , Engesser Sven
Published: December 2018

The aim of this study is to explore favorable opportunity structures for populist communication of politicians in Western democracies. We analyze the content and style of 2,517 statements from 103 politicians from six countries (France, Italy, Germany, Switzerland, United Kingdom, and United States) who differ in their party affiliation (populist versus nonpopulist) and hierarchical position (backbencher vs. frontbencher). To learn more about their media strategies and chances of success, we investigate four communication channels (Facebook, Twitter, talk shows, and news media) that systematically differ in their degree of journalistic intervention and examine fourteen often-raised topics that differ in their suitability for populist mobilization. Our content analysis shows the highest probability of populist communication comes from (1) members of populist parties and (2) backbenchers who address (3) mobilizable issues in (4) social media or newspaper articles. We conclude by explaining why populists have become so successful in getting their messages into newspapers.
NC State’s Principal Leadership Academies: Context, Challenges, and Promising Practices
Authors: Fusarelli Bonnie C. , Fusarelli Lance D. , Drake Timothy A.
Published: December 2018

Developing effective educational leaders is fundamentally and irrevocably an interpersonal, relational process—one that requires face-to-face contact, deep thought, deliberation, reflection, engagement, and interaction. It requires cultivation of the habits of heart, mind, and soul. For nearly a decade, the faculty at North Carolina State University (NCSU) have focused on dramatically improving principal preparation. This article explores the initial design of the program, its key features and how they have evolved, processes established for continuous improvement, major challenges faced and approaches to addressing these challenges, and recent program initiatives.
Information and Knowledge Processes in Health Care Value Co-Creation and Co-Destruction
Authors: Kaartemo Valtteri , Känsäkoski Helena
Published: December 2018

The purpose of this article is to explore how information and knowledge processes (IKPs) influence co-creation and co-destruction of value in a health service system. A qualitative, single embedded case-approach is taken to develop theory through a systematic combining of theoretical framework, empirical fieldwork, and case analysis. Six theoretical propositions are set to describe the linkage between IKPs and value co-creation (and co-destruction). The article contributes to health marketing and transformative service research by linking organizational activities to the motivation and empowerment of patients and their families, by highlighting the importance of the role of knowledge integration in value co-creation, by introducing a shift toward systems thinking, by conceptualizing value as manifested as health behavior change, and by underlining that health care processes may have a negative (value co-destructing) influence on the well-being of actors.
Prevalence and Risk Factors of Work-Related Musculoskeletal Disorders Among Intensive Care Unit Nurses in China
Authors: Yang Shuai , Lu Jingmei , Zeng Jiaqi , Wang Liqian , Li Yinglan
Published: December 2018

This cross-sectional study investigated the prevalence and risk factors of work-related musculoskeletal disorders among intensive care nurses in the Hunan Province of China. Nurses working in mixed intensive care units of 20 tertiary hospitals in this province participated in an online survey regarding work-related musculoskeletal injuries. The seven-part questionnaire included basic demographics; job and workplace characteristics; risk perception; physical, psychosocial, and workplace organizational factors; and musculoskeletal symptoms. The response rate was 70.7% (702 of 993 nurses). Approximately 97% of the respondents reported experiencing at least one work-related musculoskeletal disorder within the previous year. Low back pain was the most commonly reported musculoskeletal disorder (80.1%), followed by neck (78.6%) and shoulder pain (70.4%). The multivariate logistic regression analysis indicated that work-related musculoskeletal disorders were significantly associated with female gender (odds ratio [OR] = 0.115), unmarried status (OR = 0.136), a greater perception of risk (OR = 2.352), and lack of a safe work environment (OR = 1.056). These findings underscore the need for nurses and managers to reinforce risk awareness, improve physical and psychosocial working conditions, and promote a safer work environment.
Enemies, Allies, and the Struggle for Self-definition in “Muslim Punk” Rock
Authors: McDowell Amy D.
Published: December 2018

Research shows that both entertainment and news media coverage of Islam and Muslims generate anti-Muslim attitudes in the wider U.S. public. In this article, I explore how this media trend shaped Taqwacore punks’ struggle to define what it means to be American, Muslim, and punk rock on their own terms. Upon their first U.S. tour, Taqwacore started getting the attention of both independent and mainstream media outlets. Taqwacores initially welcomed this because it helped them expand their audience to other (potential) Taqwacores as well as to a larger non-Muslim public. Their perspective changed, however, as they started to realize that most mainstream media stories were turning their punk protest into sensationalist stories about Americanized “Muslim punks” who oppose Islamic conventions. It was around this time that Taqwacores began imagining their audience as either with them or against them, enemies or allies. This study shows how this understanding of their audience shaped an internal dispute among Taqwacores about whether or not to identify as “Muslim punk.” Findings reveal that their internal debate over the Muslim punk label is structured by a racist media frame that defines Muslims as either good or bad, with or against the United States.
Self-contamination during doffing of personal protective equipment by healthcare workers to prevent Ebola transmission
Authors: Suen Lorna K. P. , Guo Yue Ping , Tong Danny W. K. , Leung Polly H. M. , Lung David , Ng Mandy S. P. , Lai Timothy K. H. , Lo Kiki Y. K. , Au-Yeung Cypher H. , Yu Winnie
Published: December 2018

Background

Healthcare workers (HCWs) use personal protective equipment (PPE) in Ebola virus disease (EVD) situations. However, preventing the contamination of HCWs and the environment during PPE removal crucially requires improved strategies. This study aimed to compare the efficacy of three PPE ensembles, namely, Hospital Authority (HA) Standard Ebola PPE set (PPE1), Dupont Tyvek Model, style 1422A (PPE2), and HA isolation gown for routine patient care and performing aerosol-generating procedures (PPE3) to prevent EVD transmission by measuring the degree of contamination of HCWs and the environment.

Methods

A total of 59 participants randomly performed PPE donning and doffing. The trial consisted of PPE donning, applying fluorescent solution on the PPE surface, PPE doffing of participants, and estimation of the degree of contamination as indicated by the number of fluorescent stains on the working clothes and environment. Protocol deviations during PPE donning and doffing were monitored.

Results

PPE2 and PPE3 presented higher contamination risks than PPE1. Environmental contaminations such as those originating from rubbish bin covers, chairs, faucets, and sinks were detected. Procedure deviations were observed during PPE donning and doffing, with PPE1 presenting the lowest overall deviation rate (%) among the three PPE ensembles (p < 0.05).

Conclusion

Contamination of the subjects’ working clothes and surrounding environment occurred frequently during PPE doffing. Procedure deviations were observed during PPE donning and doffing. Although PPE1 presented a lower contamination risk than PPE2 and PPE3 during doffing and protocol deviations, the design of PPE1 can still be further improved. Future directions should focus on designing a high-coverage-area PPE with simple ergonomic features and on evaluating the doffing procedure to minimise the risk of recontamination. Regular training for users should be emphasised to minimise protocol deviations, and in turn, guarantee the best protection to HCWs.