bluuebunny/crossref_metadata_2025 huggingface dataset:
Access and Its Limits
Authors: Mickiewicz Paulina
Published: October 2015

Notions of access have become pervasive in how we currently speak about libraries and their democratic character, as well as in the ways in which we have come to speak about emerging media technologies and, in both cases, access has very clearly come to mean making things available. Although access as it relates to the library is a relatively recent phenomenon, libraries and access have nearly become synonymous. Yet the presumption of access often obscures lingering problems of inaccessibility to various services and spaces for particular classes of people. This article will examine and document the ways in which the normative priority of “access” has been architecturally materialized within the contemporary library. Through a close analysis of Montreal’s Grande Bibliothèque and the institution’s trajectory from conception to building, this article will explore how architecture has, in part, defined and delimited what sort of institutional public space the Grande Bibliothèque creates. Concepts employed within the preliminary conceptual design phase of the project, such as openness, access, freedom, and publicness, took on new, contradictory meanings when the library materialized, to reveal issues surrounding restriction, control, inaccessibility, and surveillance. I want to lay stress on the process of design and how its various agencies shaped a particular institutional incarnation of the library.
Ghosts, Devils, and the Undead City
Authors: Draus Paul , Roddy Juliette
Published: October 2015

As researchers working in Detroit, we have become sensitized to the rhetoric often deployed to describe the city, especially the vocabulary of monstrosity. While providing powerful images of Detroit’s problems, insidious monster narratives also obscure genuine understanding of the city. In this article, we first discuss the city of Detroit itself, describing its place in the American and global social imaginary as a product of its particular history. Second, we consider the concept of monstrosity, particularly as it applies to urban environments. Following this, we relate several prevalent or popular categories of monster to descriptions of Detroit, considering what each one reveals and implies about the state of the city, its landscape and its people. Finally, we discuss how narratives of monstrosity may be engaged and utilized to serve alternative ends.
Before the Wall Came Tumbling Down
Authors: VanDiver Rebecca
Published: October 2015

This article examines the well-known community mural, the Wall of Respect, begun on Chicago’s South Side in 1967, from the perspective of its ephemerality. A product of the Organization of Black American Culture’s (OBAC) Visual Arts Workshop, the Wall inspired similar murals across the United States. Completed at a moment when positive images of African Americans were scarce in the mainstream media, the Wall was filled with portraits of Black cultural and political leaders divided into eight sections (e.g., jazz, religion, politics, sports) accompanied by black and white photographic panels and text. The mural was conceived from the outset not as a static work, but as imagery which would change in response to community demands. Thus, the rise of the Black Power and Black Arts movements was registered in a series of alterations to the mural, outlined here, before its destruction in 1971.
Lymphocytosis as a response biomarker of natalizumab therapeutic efficacy in multiple sclerosis
Authors: Signoriello E , Lanzillo R , Brescia Morra V , Di Iorio G , Fratta M , Carotenuto A , Lus G
Published: October 2015

Background:

Natalizumab is an effective therapy in relapsing–remitting multiple sclerosis (RRMS), as it reduces lymphocyte transmigration through the blood–brain barrier (BBB) and induces lymphocytosis.

Objectives:

To analyse natalizumab-induced lymphocytosis (NIL) as a biomarker of drug efficacy.

Materials and methods:

We enrolled 50 relapsing–remitting (RR) and progressive–relapsing (PR) natalizumab-treated patients who had received at least 16 infusions and had been tested for lymphocyte count 24 hours before each administration. Clinical, MRI and hematological data were collected. Patients were divided into responders and sub-optimal responders according to the experience of at least one clinical and/or instrumental relapse during the treatment.

Results:

In 15 (30%) patients, an instrumental/clinical (14) or only instrumental (one) relapse occurred. We found a statistically significant difference in the mean percentage of the lymphocytes between the two groups over the first ten administrations ( p=0.04). The comparison between the time-to-relapse in the groups with high and low levels of lymphocytes showed that the group with a low NIL had a greater risk of relapse ( p=0.03).

Conclusions:

We suggest that NIL could be a biomarker of therapeutic efficacy in patients with RRMS treated with natalizumab, and that the risk of relapse may be higher in patients with a lower-than-expected NIL.
Individual differences in depression are associated with abnormal function of the limbic system in multiple sclerosis patients
Authors: Riccelli Roberta , Passamonti Luca , Cerasa Antonio , Nigro Salvatore , Cavalli Salvatore Maria , Chiriaco Carmelina , Valentino Paola , Nisticò Rita , Quattrone Aldo
Published: October 2015

Background:

Depression is common in patients with multiple sclerosis (MS), although the brain mechanisms of this psychiatric condition in MS are poorly understood. Specifically, it remains to be determined whether depression in MS is related to altered activity and functional connectivity patterns within limbic circuits.

Methods:

Seventy-seven MS patients with variable levels of depression (as assessed via the Beck Depression Inventory) underwent functional magnetic resonance imaging while performing an emotional processing task. To conduct the functional connectivity analyses, the bilateral amygdala and hippocampus, two areas critically involved in the pathophysiology of depression, were chosen as ‘seed’ regions. Multiple regression models were used to assess how depression in MS patients was correlated with the activity and functional connectivity patterns within the limbic system.

Results:

Depression scores in MS patients were negatively correlated: (1) with the activity in the subgenual cingulate cortex; (2) with the functional connectivity between the hippocampus and orbitofrontal cortex as well as the dorsolateral prefrontal cortex, and (3) with the functional connectivity between the amygdala and dorsolateral prefrontal cortex.

Conclusions:

Our study showed that individual differences in depression in MS patients were significantly associated with altered regional activity and functional connectivity patterns within the limbic system.
Ultra-small superparamagnetic iron oxide enhancement is associated with higher loss of brain tissue structure in clinically isolated syndrome
Authors: Maarouf Adil , Ferré Jean-Christophe , Zaaraoui Wafaa , Le Troter Arnaud , Bannier Elise , Berry Isabelle , Guye Maxime , Pierot Laurent , Barillot Christian , Pelletier Jean , Tourbah Ayman , Edan Gilles , Audoin Bertrand , Ranjeva Jean-Philippe
Published: October 2015

Background:

Macrophages are important components of inflammatory processes in multiple sclerosis, closely linked to axonal loss, and can now be observed in vivo using ultra-small superparamagnetic iron oxide (USPIO). In the present 1-year longitudinal study, we aimed to determine the prevalence and the impact on tissue injury of macrophage infiltration in patients after the first clinical event of multiple sclerosis.

Methods:

Thirty-five patients, 32 years mean age, were imaged in a mean of 66 days after their first event using conventional magnetic resonance imaging, gadolinium (Gd) to probe blood–brain barrier integrity, USPIO to study macrophage infiltration and magnetization transfer ratio (MTR) to assess tissue structure integrity. Statistics were performed using two-group repeated-measures ANOVA. Any patient received treatment at baseline.

Results:

At baseline, patients showed 17 USPIO-positive lesions reflecting infiltration of macrophages present from the onset. This infiltration was associated with local higher loss of tissue structure as emphasized by significant lower MTRnorm values ( p<0.03) in USPIO+/Gd+ lesions ( n=16; MTRnormUSPIO+/Gd+=0.78 at baseline, MTRnormUSPIO+/Gd+=0.81 at M12) relative to USPIO-/Gd+ lesions ( n=67; MTRnormUSPIO-/Gd+=0.82 at baseline, MTRnormUSPIO–/Gd+=0.85 at M12). No interaction in MTR values was observed during the 12 months follow-up (lesion type × time).

Conclusion:

Infiltration of activated macrophages evidenced by USPIO enhancement, is present at the onset of multiple sclerosis and is associated with higher and persistent local loss of tissue structure. Macrophage infiltration affects more tissue structure while tissue recovery during the following year has a similar pattern for USPIO and Gd-enhanced lesions, leading to relative higher persistent local loss of tissue structure in lesions showing USPIO enhancement at baseline.
What to make of cannabis and cognition in MS: In search of clarity amidst the haze
Authors: Feinstein Anthony , Banwell Emma , Pavisian Bennis
Published: October 2015

Given data showing that cannabis (herbal drug from the Cannabis sativa plant) can impair cognition in healthy subjects, the possibility that it may also do so in people with multiple sclerosis (MS) should be cause for concern. Approximately 20% of people with MS inhale or ingest cannabis for a variety of symptoms, or as a lifestyle choice. In addition, pharmaceutically manufactured cannabis (in capsules or spray) is prescribed most often for pain and spasticity; however, there is a dearth of literature on the cognitive effects of cannabis. Furthermore, methodological limitations introduce a cautionary note when interpreting the data. The evidence, which must therefore be considered preliminary, suggests that smoked cannabis may further compromise information processing speed and memory, with magnetic resonance imaging (fMRI) demonstrating more inefficient patterns of cerebral activation during task performance. The findings related to pharmaceutically manufactured cannabis are equivocal. There is a pressing need for further research to inform clinical opinion, which at present reflects a combination of uncertainty and dogma.
Prognostic indicators of secondary progression in a paediatric-onset multiple sclerosis cohort in Kuwait
Authors: Akhtar Saeed , Alroughani Raed , Ahmed Samar F , Al-Hashel Jasem Y
Published: October 2015

Background:

The frequency of paediatric-onset multiple sclerosis (POMS) and the precise risk of secondary progression of disease are largely unknown in the Middle East. This cross-sectional cohort study assessed the risk and examined prognostic factors for time to onset of secondary progressive multiple sclerosis (SPMS) in a cohort of POMS patients.

Methods:

The Kuwait National MS Registry database was used to identify a cohort of POMS cases (diagnosed at age <18 years) from 1994 to 2013. Data were abstracted from patients’ records. A Cox proportional hazards model was used to evaluate the prognostic significance of the variables considered.

Results:

Of 808 multiple sclerosis (MS) patients, 127 (15.7%) were POMS cases. The median age (years) at disease onset was 16.0 (range 6.5–17.9). Of 127 POMS cases, 20 (15.8%) developed SPMS. A multivariable Cox proportional hazards model showed that at MS onset, brainstem involvement (adjusted hazard ratio 5.71; 95% confidence interval 1.53–21.30; P=0.010), and POMS patient age at MS onset (adjusted hazard ratio 1.38; 95% confidence interval 1.01–1.88; P=0.042) were significantly associated with the increased risk of a secondary progressive disease course.

Conclusions:

This study showed that POMS patients with brainstem/cerebellar presentation and a relatively higher age at MS onset had disposition for SPMS and warrant an aggressive therapeutic approach.
Heterogeneity of acute multiple sclerosis lesions on sodium (23Na) MRI
Authors: Eisele Philipp , Konstandin Simon , Griebe Martin , Szabo Kristina , Wolf Marc E , Alonso Angelika , Ebert Anne , Serwane Julia , Rossmanith Christina , Hennerici Michael G , Schad Lothar R , Gass Achim
Published: October 2015

Background:

Advanced magnetic resonance imaging (MRI) techniques provide a window into pathological processes in multiple sclerosis (MS). Nevertheless, to date only few studies have performed sodium MRI in MS.

Objectives:

We analysed total sodium concentration (TSC) in hyperacute, acute and chronic lesions in MS with 23Na MRI.

Methods:

23Na MRI and 1H MRI were performed in 65 MS patients and 10 healthy controls (HC). Mean TSC was quantified in all MS lesions with a diameter of >5 mm and in the normal appearing white and grey matter (NAWM, NAGM).

Results:

TSC in the NAWM and the NAGM of MS patients was significantly higher compared to HC (WM: 37.51 ± 2.65 mM versus 35.17 ± 3.40 mM; GM: 43.64 ± 2.75 mM versus 40.09 ± 4.64 mM). Acute and chronic MS lesions showed elevated TSC levels of different extent (contrast-enhancing lesions (49.07 ± 6.99 mM), T1 hypointense lesions (45.06 ± 6.26 mM) and remaining T1 isointense lesions (39.88 ± 5.54 mM)). However, non-enhancing hyperacute lesions with a reduced apparent diffusion coefficient showed a TSC comparable to the NAWM (37.22 ± 4.62 mM).

Conclusions:

TSC is not only a sensitive marker of the severity of chronic tissue abnormalities in MS but is also highly sensitive to opening of the blood–brain barrier and vasogenic tissue oedema in contrast-enhancing lesions.
Increased prevalence of lymphoid tissue inducer cells in the cerebrospinal fluid of patients with early multiple sclerosis
Authors: Degn Matilda , Modvig Signe , Dyring-Andersen Beatrice , Bonefeld Charlotte M , Frederiksen Jette L , Geisler Carsten , von Essen Marina R
Published: October 2015

Background:

Inflammatory cytokines produced by cells of the immune system are believed to play a central role in the pathogenesis of multiple sclerosis (MS). Innate lymphoid cells (ILCs) have been shown to produce and secrete a wide range of the cytokines involved in MS pathogenesis; however, a possible implication of ILCs in MS development and disease progression has not been investigated.

Objective:

With this study, we aimed to clarify a potential role of ILCs in the early stages of MS.

Methods and Results:

Using flow cytometry, we analysed the prevalence and phenotype of ILCs in the cerebrospinal fluid (CSF) of patients experiencing their first or second demyelinating event. We found a substantial increase in both frequency and number of ILCs, in particular the LTi subset, as compared to healthy controls. We also found an association between CSF pleocytosis and an increased frequency of LTi cells in the CSF, suggesting a favoured recruitment of blood derived LTi cells.

Conclusion:

Our data suggests a role for ILCs, and in particular the LTi subset, in the early stages of MS. This finding represents an important contribution to the understanding of early inflammation in MS, and adds new knowledge beneficial for future MS therapies.
The resilience of ethnic minority parties in the face of strategic voting incentives
Authors: Allen Geoff
Published: October 2015

Recent research has indicated that social heterogeneity impacts party system size, even in restrictive settings. This research as yet has not established whether it is minority or majority voters who are behaving outside Duvergerian expectations. This study argues that it is ethnic voters that seem to defect from their parties at lower rates, which explains why small parties proliferate and persist in heterogeneous states. This hypothesis is tested on party-in-district level election returns in the German lander Schleswig-Holstein. The results show that small ethnic parties suffer notably less defection than small non-ethnic parties. The study proposes a number of potential causal mechanisms that could be driving ethnic voters, as a group, to defect at lower rates than non-ethnic voters.
Similar prompts may not be similar in the performance they elicit: Examining fluency, complexity, accuracy, and lexis in narratives from five picture prompts
Authors: de Jong Nel , Vercellotti Mary Lou
Published: October 2015

Only a few characteristics of picture-based narrative prompts have been studied to determine what features affect task performance. Thus, it is not easy to identify equivalent narrative prompts or identify features that are impactful. Tavakoli and Foster (2008) and Tavakoli (2009) examined the impact of prompt on the language produced by English learners during a picture-based narrative task in respect to narrative structure and storyline complexity. This study investigates if prompts within these known categories elicit similar performance. Considering the findings based on different prompts in Tavakoli and Foster, as well as in Robinson’s (2011) Triadic Componential Framework for pedagogical tasks, we added another feature, number of elements. All of the prompts in this study had a tight sequential structure (±causal reasoning), similar storyline complexity (±intentional reasoning), and similar main characters and props (±elements). Although the accuracy and complexity in the ESL narratives were similar across prompts, there were some unexpected differences in fluency and lexis. Potential explanations of the variation in these subareas of language performance are discussed. Overall, this study highlights the importance of piloting research and testing materials and of investigating features that constitute task complexity.
Investigating the nature of classroom willingness to communicate (WTC): A micro-perspective
Authors: Pawlak Mirosław , Mystkowska-Wiertelak Anna , Bielak Jakub
Published: October 2015

Recent years have witnessed a shift in empirical investigations of language learners’ willingness to communicate (WTC) from quantitative studies examining the ways in which WTC antecedents co-act and contribute to communication, treating the concept as a stable characteristic, to a mixed-methods approach that allows the examination of stable behavioral tendencies and dynamic changes brought about by contextual variables. The rationale behind this study comes from the assumption that more profound understanding of motives underlying learners’ readiness or reluctance to speak may help create classroom conditions that facilitate communication, thus contributing to linguistic attainment. More specifically, the study represents an attempt to tap factors that shape advanced learners’ WTC during conversation classes in four different groups of students. Each time, the data were collected by means of self-ratings (i.e. indications of the level of WTC on a scale from −10 to +10) and immediate reports (i.e. questionnaires including closed and open-ended items). A combination of quantitative and qualitative analysis revealed that the extent to which WTC fluctuated was impacted by a range of contextual and individual factors. It was enhanced in particular when students were given the opportunity to communicate with familiar receivers in small groups or pairs on topics related to personal experiences.
Profile and distribution characteristics of culturable airborne fungi in residential homes with children in Beijing, China
Authors: Fang Zhiguo , Tang Qingqing , Gong Chanjuan , Ouyang Zhiyun , Liu Peng , Sun Li , Wang Xiaoyong
Published: October 2015

A survey was conducted to evaluate the characteristics of airborne fungi in 31 residential homes in Beijing that housed children. Indoor fungal concentrations in the homes ranged from 62 to 3498 colony forming units (CFU)/m3 (mean 837 CFU/m3). A total of 225 fungal isolates belonging to 24 genera and 65 species were identified in the air. The most common fungi were Penicillium, Cladosporium, Aspergillus, and Alternaria based on concentration proportion and frequency. Approximately 40% of the total number of isolated fungal species belonged to Penicillium, which represented the maximum proportion of the total fungal concentration at ∼32%, followed by Cladosporium, Aspergillus, non-sporing fungi, Monilia, and Alternaria. The most frequently ocurring fungal species were Cladosporium cladosporioides (8.44%), Penicillium chrysogenum (5.33%) and Penicillium funiculosum (4.89%). Fungal concentrations in residential homes with a male child were significantly higher than those with a female child (** P < 0.01). The highest fungal concentration was detected in summer, followed by spring and autumn, and the lowest was in winter (** P < 0.01). These results provide a database of airborne fungi exposure in Beijing homes, and suggest that the gender of children in residences has a significant influence on both the concentration and composition of airborne fungi.
Is LinkedIn making you more successful? The informational benefits derived from public social media
Authors: Utz Sonja
Published: October 2015

This article uses a social capital framework to examine whether and how the use of three types of publicly accessible social media (LinkedIn, Twitter, Facebook) is related to professional informational benefits among a representative sample of Dutch online users. Professional informational benefits were conceptualized as the (timely) access to relevant information and being referred to career opportunities. The effect of content and structure of the respective online network on professional informational benefits was examined on the general (users vs. non-users of a platform) and more fine-grained level (within users of a specific platform). Overall, users of LinkedIn and Twitter reported higher informational benefits than non-users, whereas the Facebook users reported lower informational benefits. Posting about work and strategically selecting ties consistently predicted informational benefits. The network composition mattered most on LinkedIn; strong and weak ties predicted informational benefits. The results demonstrate the usefulness of the social capital framework.
#Gamergate and The Fappening: How Reddit’s algorithm, governance, and culture support toxic technocultures
Authors: Massanari Adrienne
Published: October 2015

This article considers how the social-news and community site Reddit.com has become a hub for anti-feminist activism. Examining two recent cases of what are defined as “toxic technocultures” (#Gamergate and The Fappening), this work describes how Reddit’s design, algorithm, and platform politics implicitly support these kinds of cultures. In particular, this piece focuses on the ways in which Reddit’s karma point system, aggregation of material across subreddits, ease of subreddit and user account creation, governance structure, and policies around offensive content serve to provide fertile ground for anti-feminist and misogynistic activism. The ways in which these events and communities reflect certain problematic aspects of geek masculinity are also considered. This research is informed by the results of a long-term participant-observation and ethnographic study into Reddit’s culture and community and is grounded in actor-network theory.
Internet memes as contested cultural capital: The case of 4chan’s /b/ board
Authors: Nissenbaum Asaf , Shifman Limor
Published: October 2015

This article explores the workings of memes as cultural capital in web-based communities. A grounded analysis of 4chan’s /b/ board reveals three main formulations of memes as capital, delineating them as subcultural knowledge, unstable equilibriums, and discursive weapons. While the first formulation follows well-documented notions about subcultural knowledge as a basis for boundary work, the latter two focus on the dualities intrinsic to Internet memes. The contradiction between following conventions and supplying innovative content leads to memes’ configuration as unstable equilibriums, triggering constant conflict about their “correct” use. Paradoxically, this struggle highlights collective identity, as it keeps shared culture at the center of discussion. Similarly, when memes are used as jabs at the most intense points of arguments, they function simultaneously as signifiers of superior authoritative status and as reminders of common affinity. Thus, the dualities underpinning memes’ structure lead to their performance as contested cultural capital.
Impact resistance of short bamboo fibre reinforced polyester concretes
Authors: Wong KJ , Low KO , Israr HA
Published: October 2015

Bamboo fibre is becoming more important as reinforcement in polymer composites owing to its environment sustainability and cost effectiveness. This study examines the performance of bamboo/polyester concretes under impact loading. Specimens at fibre volume fractions of 40 vol.%, 50 vol.% and 60 vol.% and 3 mm, 7 mm and 10 mm fibre lengths were fabricated. Results showed that the optimum impact resistance was attained at 50 vol.%/10 mm, with 16.6 times higher compared to neat polyester. Scanning electron micrographs revealed that the failure mechanisms include matrix cracking, fibre/matrix debonding, fibre pull-out, fibre end damage, fibre splitting and sand particles debonding. In addition, by relating the experimental results to a theoretical model, the damage zone size was found to increase with the fibre length except at 60 vol.%/10 mm, which could be due to fibre–fibre interaction. Results suggest that bamboo fibre is a good candidate to enhance the impact resistance of polyester concrete.
Perceived sociocultural impacts of tourism and community participation: A case study of Langkawi Island
Authors: Jaafar Mastura , Rasoolimanesh S Mostafa , Ismail Safura
Published: October 2015

Using partial least squares-structural equation modeling, we investigated the relationship between residents’ perceptions of the sociocultural impacts of tourism development and community participation in Pantai Cenang, Langkawi Island. We also investigated the moderating role of gender, age and education level on these relationships. The results revealed significant positive relationships between the positive and negative perceptions of residents and community participation; moreover, residents’ gender and age had a moderating effect on these relationships. These findings have implications for tourism development planners and government authorities seeking to expand the involvement of local residents in tourism developments.
Cultural conservation and residents’ attitudes about ethnic minority tourism
Authors: Yun Hee Jeong , Zhang Xuan
Published: October 2015

Tourism to areas traditionally inhabited by ethnic minorities has become an important topic in China during recent years, but the attendant issue of ethnic cultural conservation has become an increasing problem. This study investigates residents’ attitudes toward cultural conservation and their perception of the impact of tourism. The study site is the ancient city of Fenghuang in Hunan province, China. The study’s results show that residents in Fenghuang agree with the cultural conservation, and that their positive perceptions of the impact of tourism are influenced by their attitudes toward cultural conservation. This result means that there is the positive relationships between tourism development and cultural conservation in ethnic minority area. All results reflect the importance of residents’ attitudes toward cultural conservation in the development of tourism, so the study may be useful for both tourism developers and cultural managers.
The impact of book reading in the early years on parent–child language interaction
Authors: Gilkerson Jill , Richards Jeffrey A , Topping Keith J
Published: October 2015

Early language development predicts later reading competence, but does reading to young children enhance the language interaction between them and their parents? Automatic assessment of language interaction now yields adult word counts, conversational turn counts and child vocalization counts. This study had 98 families return reading activity logs for a day coinciding with automatic language analysis, and of these, 36 reported reading with their children aged 26–61 months on that day. Reading periods yielded much higher adult word counts and conversational turns than non-reading periods, indicating a greater degree of parent–child language engagement and interaction during reading periods. Such differences were not evident in child vocalization. Adult word counts and conversational turns were high during reading for both high and low education level mothers. Gender effects during reading were evident for adult word counts (but not conversational turns or child vocalization), indicating greater adult word counts with male children. These results have important implications for practical action by parents.
Towards a service-dominant approach to social marketing
Authors: Luca Nadina R. , Hibbert Sally , McDonald Ruth
Published: October 2015

Over the last decade, social marketing has moved away from traditional marketing management approaches towards service-oriented theory, integrating concepts from other disciplines, to account for the distinctive nature of social change and develop an ecological perspective. This article extends prior literature by interrogating the applicability of service-dominant logic (SDL) to social marketing, with a particular emphasis on how a systems perspective can offer new ways to address challenges of social change. In so doing, it examines how the social marketing benchmarks can be extended through applying (and adapting) the principles, concepts and theories of SDL. The article provides critical reflection on the challenges of transferring service-dominant theory to social change contexts highlighting implications for practice and a future research agenda.
Four Ways We Can Improve Policy Diffusion Research
Authors: Gilardi Fabrizio
Published: October 2015

This article puts forward four strategies to improve policy diffusion research in political science: (1) use existing concepts consistently and improve their measurement, (2) clarify whether the goal is to improve the understanding of diffusion itself or to use diffusion research to explain another phenomenon, (3) pay more attention to the quality of the research design, and (4) discuss explicitly the practical implications of diffusion. Taken together, these recommendations trace a distinctive way forward for policy diffusion research.
Building an Integrative Outpatient Care Program for Breast Cancer Patients in Taiwan
Authors: Lin Yi-Hsien , Shiu Jing-Huei , Chen Fang-Pey , Chiu Jen-Hwey
Published: October 2015

Background. Breast cancer patients may experience various symptoms that affect the quality of life significantly and they seek complementary and alternative medicine (CAM). To meet the needs of patients, we developed an integrative outpatient care program. Methods. This program provided CAM consultation and acupuncture for breast cancer patients at Taipei Veterans General Hospital. The outcome measures included Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12) and patient satisfaction questionnaires on the first visit (baseline) and at 6 months. Results. Forty-five breast cancer patients were enrolled. All patients completed the study. The median age was 53.3 (±8.3). The symptoms most often experienced during previous cancer treatments were fatigue (35.6%), arthralgia (20%), nausea (6.7%), and insomnia (6.7%). The symptoms most wished to be diminished by the patients were arthralgia (22.2%), insomnia (17.8%), and fatigue (15.6%). Thirty-four patients (75.6%) had sought CAM therapy to reduce these symptoms. Fifteen patients (33.3%) received CAM consultation only and 30 (66.7%) received acupuncture in addition. Sixteen patients completed at least 6 sessions of acupuncture. No serious adverse effect was reported. In the SF-12 Questionnaire on all the patients, physical component summary (PCS) was 49.6 (±5.6) at baseline and 44.9 (±7.6) at 6 months ( P = .001); the mental component summary (MCS) was 44.7 (±6.1) at baseline and 52.3 (±9.3) at 6 months ( P < .001). For patients who had completed acupuncture, PCS was 49.2 (±4.9) at baseline and 41.4 (±7.6) at 6 months ( P = .148); the MCS was 45.6 (±6.2) at baseline and 49.7 (±11) at 6 months ( P = .07). Thirty-eight (84.4%) patients were satisfied with this program. Conclusions. Our results demonstrated that an integrative outpatient care program of conventional and Chinese medicine is feasible. Most patients were satisfied with this program and the quality of life was improved. It is important to conduct more research to build a model that integrates CAM with conventional medicine in Taiwan.
WoWing Alone
Authors: Braithwaite Andrea
Published: October 2015

World of Warcraft ( WoW) is one of the most successful and longest running multiplayer online games in gaming. Over time, Blizzard Entertainment’s approach to multiplayer activities in WoW has changed. During the past decade, in-game world events, group matchmaking systems, and phasing technologies have been used to increasingly emphasize individual achievement rather than collaborative effort. The game is shifting away from sociable activities in favor of ones that situate players as powerful, atomized characters. WoW’s governmentality now encourages players to see each other as obstacles to success and to see themselves as entrepreneurial subjects. These neoliberal strategies have the potential to impact our ability to collectively imagine and create alternative forms of social interaction and organization.
A scoping review of research on the prescribing practice of Canadian pharmacists
Authors: Faruquee Chowdhury Farhana , Guirguis Lisa M.
Published: October 2015

Background:

Pharmacists in Canada have been prescribing since 2007. This review aims to explore the volume, array and nature of research activity on Canadian pharmacist prescribing and to identify gaps in the existing literature.

Methods:

We conducted a scoping review to examine the literature on prescribing by pharmacists in Canada according to methodological trends, research areas and key findings. We searched for peer-reviewed research articles and abstracts in the Ovid MEDLINE, Ovid EMBASE and International Pharmaceutical Abstracts databases without any date limitations. A standardized form was used to extract information.

Results:

We identified 156 articles; of these, 26 articles and 12 abstracts met inclusion criteria. One-half of the research studies (20) used quantitative methods, including surveys, trials and experimental designs; 11 studies used qualitative methods and 7 used other methods. Research on pharmacist prescribing demonstrated an improvement in patient outcomes (13 studies), varied stakeholder perceptions (10 studies) and factors that influence this practice change (11 studies). Pharmacist prescribing was adopted when pharmacists practised patient-centred care. Stakeholders held contrasting perceptions of pharmacist prescribing.

Discussion:

Canadian research has demonstrated the benefit of pharmacist prescribing on patient outcomes, which is not present in the international literature. Future research may consider a meta-analysis addressing the impact on patient health. Gaps in research include comparisons between provinces, effects on physicians’ services, overall patient safety and access to health care systems and economic implications for society.

Conclusion:

A growing body of research on pharmacist prescribing has captured the early impact of prescribing on patient outcomes, perceptions of practice and practice change. Opportunities exist for pan-Canadian research that examines the system impact.
Traditional midwifery or ‘wise women’ models of leadership: Learning from Indigenous cultures
Authors: Chamberlain Catherine , Fergie Doseena , Sinclair Amanda , Asmar Christine
Published: October 2015

This article originated in a leadership program for Indigenous 1 Australian researchers, where a participant who had worked with traditional midwives in South Sudan reflected on her experiences. While there is increasing interest in how leadership studies can learn from Indigenous leadership experiences, much of this work has focused on men’s experiences or has not paid particular attention to women’s leadership. In this article, we suggest that women’s experience as traditional midwives or ‘wise women’ has been a crucial domain of leadership over millennia. We begin by describing the features of traditional women’s leadership through midwifery before reviewing Indigenous and non-Indigenous leadership theories. Drawing on published and unpublished sources, four principles of midwifery leadership are identified: being a leader who empowers and frees others with ‘no one person wiser than the other’; embodying wisdom and ethical practice which nurtures social, cultural and spiritual needs of women and mentors the next generation by ‘walking together’; being competent and skilled as well as emotionally attuned (‘feeling the job’) to engender trust and calm which is crucial to birth, ‘depending on each other but looking to her to be in charge’ and paying attention and being responsive to emergent change and unfolding present reality rather than being prescriptive, ‘using her knowledge to adjust the situation’. While these emphases are recognisable as part of several ancient wisdom traditions, we suggest that they connect to, and have relevance for, emerging leadership thinking and practice beyond the midwifery or medical context, for men as well as women and for non-Indigenous and Indigenous leadership alike.
A new surgical technique for the treatment of scaphotrapezial arthritis associated with trapeziometacarpal arthritis: the narrow pseudoarthrosis
Authors: Rubino M. , Cavagnaro L. , Sansone V.
Published: October 2015

We describe a technique for treating Eaton stage IV osteoarthritis of the first ray, which is a development of our previously published technique for treating trapeziometacarpal arthritis. This simple technique is based on a limited resection arthroplasty of the first trapeziometacarpal and the scaphotrapezial joints, with the aim of inducing the formation of a narrow pseudoarthrosis at both sites. A total of 26 consecutive patients were treated for Eaton stage IV arthritis at a mean follow-up of 4.7 years (range 3.2–6.6). There were statistically significant improvements in all clinical parameters: mean appositional and oppositional pinch strength, mean DASH score (65 points pre-operatively to 8.7 points at final follow-up), and in mean visual analogue scale score (8.6 to 0.2 points). Although a larger cohort and a longer follow-up will be necessary to evaluate this new technique fully, these results encourage us to believe that the limited excision arthroplasty of the trapeziometacarpal and scaphotrapezial joints is a viable alternative to the existing surgical treatments for stage IV thumb arthritis.

Level of evidence: 4
Potential infection control risks associated with roaming healthcare industry representatives
Authors: Schiffers H , Zaatreh S , Mittelmeier W , Bader R
Published: October 2015

Background:

Healthcare industry representatives (HCIR) visit multiple hospitals every day. Most enter hygiene sensitive areas and work in close proximity to caregivers and patients.

Objective:

The objective of the present study was to evaluate the HCIRs’ current status in hygiene training and vaccination.

Methods:

An anonymous walking intercept study was used based on questionnaires to evaluate industry representatives in comparison to physicians and nurses (n = 311 participants, participation rate 30.2%) after their visit to the MEDICA Congress. The valid participants consisted of HCIR (n = 208), hospital nurses (n = 49) and physicians (n = 41). A total of 82.2% (n = 171) HCIR worked in varying hospitals.

Results:

They frequently request access to hygiene and data-privacy sensitive areas: Among them 51.9% (n = 108) accessed the outpatient clinic, 41.8% (n = 87) the operating room (OR), 33.7% (n = 70) the central supply and sterilisation department (CSSD), and 32.7% (n = 68) the intensive care unit. HCIR requesting access to hygiene sensitive areas showed the lowest scores in hygiene training and a significantly lower Hepatitis B vaccination status, i.e. 37.5% compared to 70.7% for physicians and 53.1% for nurses.

Discussion:

Status of HCIR hygiene training was inadequate – as was vaccination and contamination control. Therefore, HCIR are exposed to increased infection risk and may unknowingly act as infection vector between different hospitals.
The antimicrobial stewardship program in Gulf Cooperation Council (GCC) states: insights from a regional survey
Authors: Enani Mushira A
Published: October 2015

Objectives:

The purpose of the current study is to describe the prevalence and characteristics of antimicrobial stewardship programs (ASP) in Gulf Cooperation Council (GCC) states to explore opportunities and overcome barriers to effective ASP implementation.

Methods:

A cross-sectional questionnaire survey was used to evaluate the current status of ASP: major stewardship components, barriers of implementation and program impact in acute care hospitals of GCC states.

Results:

Forty-seven healthcare professionals responded from four GCC states, the majority from Saudi Arabia (81%). Twenty-nine (62%) participating hospitals had ASP in place. Of these established programs, 35 (75%) reported lack of funding and personnel as major barriers to program implementation. The top three objectives cited for the hospital ASP were to reduce resistance (72.3%), improve clinical outcomes (70.2%) and reduce costs (44.7%). The reported impact of existing ASP was reduction of inappropriate prescribing (68%), reduction of broad spectrum antibiotic use (63.8%), reduction of healthcare-associated infections (61.7%), reduction of length of stay or mortality metrics (59.6%), reduction in direct antibiotic cost (57.4%) and reduction of reported antibiotic resistance (55.3%).

Conclusion:

Survey participants from GCC states who have implemented ASP report significant impacts in the reduction of broad spectrum antibiotic use, hospital-acquired infection, inappropriate prescribing and antimicrobial resistance. These findings suggest a promising opportunity to enhance existing ASP through sharing of best practices and support the development of regional guidelines across GCC states.
Assessing System Accuracy of Blood Glucose Monitoring Systems Using Rectangle Target Plots
Authors: Müller Peter , Hattemer Andrew , Stephan Peter
Published: October 2015

Background:

Results from accuracy assessments of systems for self-monitoring of blood glucose (SMBG) are often visualized in difference or regression plots. These approaches become more difficult to read as the number of data points displayed increases, thus limiting their use. In the recently presented rectangle target plot (RTP) approach, data from each reagent system lot or product are displayed graphically as a single rectangle, thus allowing the plot to remain comprehensible even when displaying system accuracy data from multiple reagent system lots or products.

Methods:

The RTP illustrates the accuracy of SMBG systems. Each rectangle shows the mean bias and the variability of a system. By use of statistical tolerance intervals, each rectangle most closely approximates the total error for lower (<100 mg/dL) and upper (≥100 mg/dL) glucose concentrations. RTPs were created for data from 8 different manufacturers of systems for SMBG. In total, the accuracy data of 87 different reagent system lots of 50 different SMBG systems were displayed in RTPs.

Results:

The RTP approach was suitable for 81 of the 87 reagent system lots analyzed. In the remaining cases, outliers caused excessive skewness of the distribution of measurements. The reagent system lots analyzed were grouped according to manufacturer in RTPs. Data from 3 to 15 different reagent system lots were displayed in each RTP.

Conclusion:

Applying the RTP approach to a large number of reagent system lots showed that it was suitable in more than 93% of cases analyzed. The display of system accuracy data in RTPs enables lot-to-lot variability within specific products and product reliability of specific manufacturers to be visualized in a comprehensible manner.
Early detection of cervical spondylotic myelopathy using diffusion tensor imaging: Experiences in 1.5-tesla magnetic resonance imaging
Authors: Ahmadli Uzeyir , Ulrich Nils H , Yuqiang Yao , Nanz Daniel , Sarnthein Johannes , Kollias Spyros S
Published: October 2015

*These authors contributed equally to this work. The purpose of this study was to investigate the usefulness of diffusion tensor imaging (DTI) for early detection of pathological alterations in the myelon in patients with cervical spondylotic myelopathy (CSM) without T2-weighted imaging (T2W) signal abnormalities but with a narrowed spinal canal with corresponding clinical correlation. Axial DTI at 1.5T together with routine magnetic resonance imaging was performed on 18 patients fulfilling above mentioned criteria. Quantitative fractional anisotropy (FA) and apparent diffusion coefficient (ADC) maps were generated. Values at the narrowest cervical levels were compared to pre- and poststenotic levels and the interindividual means were tested for statistically significant differences by means of paired t-tests. The correlation between the grade and width of canal stenosis in the axial plane was measured. FA was significantly reduced at the stenotic level, compared to prestenotic level, whereas no significant differences were found when compared to poststenotic level. No significant differences between ADC values at stenotic level versus both adjacent non-stenotic levels were found, suggesting very early stage of degeneration. ADC values correlated significantly with the width of the spinal canal at the prestenotic level, but not at the poststenotic level. Findings indicate sufficient robustness of routine implementation of DTI at 1.5T to detect abnormalities in the spinal cord of CSM patients, before apparent T2W signal abnormalities and marked clinical deterioration. Therefore, larger and long-term studies should be conducted to establish the DTI scalar metrics that would indicate early intervention for a better clinical outcome in patients with clinical signs of CSM.