bluuebunny/crossref_metadata_2025 huggingface dataset:
How Significant are Low-Level Flow Patterns in Tropical Cyclone Genesis over the Western North Pacific?
Authors: Yoshida Ryuji , Fudeyasu Hironori
Published: October 2019

The low-level flow pattern characteristics of the tropical cyclone genesis (TCG) environment over the western North Pacific (WNP) were investigated not only for the periods during which TCG occurred, but also for the periods during which no TCG occurred. The flow patterns investigated were the shear line (SL), confluence region (CR), and easterly wave (EW) patterns. Although these flow patterns are recognized as favorable environmental conditions for TCG, their general characteristics, such as the climatological horizontal distribution, have not been previously investigated and there has been no comparison of the significance of the TCG cases to the climatological mean. We examined flow patterns using flow pattern indices defined by the modified semiobjective analysis method. SL and CR were broadly distributed over the WNP east of the Philippines during the boreal summer season. There was a peak in the EW from summer to autumn and it was distributed in a band running in an east–west direction at a lower latitude. Flow pattern indices of all three flow patterns gradually intensified until the TCG date was reached. The SL and EW indices became more intense compared to the climatological mean one day before the TCG, while that of the CR did not exceed the climatological mean. TCG occurred at the eastern edge of the area with a high genesis potential index and relative humidity and a weak vertical shear over flow patterns. This determination of the general characteristics of favorable flow pattern conditions improves our understanding of the TCG process.
Understanding the Impact of Relationship Disruptions
Authors: Schmitz Christian , Friess Maximilian , Alavi Sascha , Habel Johannes
Published: October 2019

Personal relationships between salespeople and customers are essential for the success of business-to-business relationships, and research has shown that a change of the salesperson can severely harm financial performance. However, such interpersonal relationship disruptions may also have positive effects by encouraging vitalizing reexplorations of the relationship. Using multilevel loyalty theory and relationship life cycle theory, the authors offer a comprehensive conceptualization of potentially countervailing consequences of relationship disruptions. In particular, disruptions may have different effects on resale revenue (from previously sold products) versus new sale revenue (from newly sold products), contingent on both the history and expected future development of the relationship. Therefore, this study examines moderators on the firm-level relationship prior to disruption and salesperson relationship management afterward. Longitudinal data from 2,040 customers of an international business-to-business firm reveal that a disruption can increase overall performance by more than 29%, depending on the firm-level relationship before disruption and the new salesperson’s relationship management. Managers can use these findings proactively to evaluate and manage the risks and opportunities involved in relationship disruptions.
Developing Trade in Services
Authors: Lautenberg Alexis P.
Published: October 2019

Executive Summary

Services are simultaneously the most important sector of the UK economy and the sector facing the biggest challenge as a result of Brexit. The prospective departure from the European Single Market reduces the UK to the status of ‘3rd country’ in respect of services. Accessing the internal market will depend on both subjective and objective conditions that differ from sector to sector, requiring detailed and highly specific arrangements for such industries as aviation and financial services.

In practice, the EU can be expected to use these circumstances to discourage the UK from significantly diverging from European regulatory norms, as a matter of policy. In view of the weakness of, and uncertainty surrounding, international moves to oversee, let alone to further liberalise, trade in services, Brexit will thus leave the UK's services sector – and especially financial services – uniquely isolated and exposed. The government will hence need to consider carefully the costs of decisions to diverge from EU regulatory standards, and should be giving great priority to establishing clear objectives for close cooperation between the UK and the EU policy makers and regulators.
Reducing Inequalities
Authors: Jones Russell , Llewellyn John
Published: October 2019

Executive Summary

A backlash against numerous inequalities – and in particular against perceived unfairness in society – is a significant driver of the UK's current political malaise. Addressing inequalities between income groups, regions and generations will thus be key to re-establishing faith in government and avoiding further decline or even the threat of social unrest.

In income terms, the UK has become much more unequal than in the immediate post-war decades, and it should be a goal to reverse that trend – targeting the OECD average for income inequality and a halving of the number of those living below the poverty line. Measures to deal with perceived unfairnesses could include tighter scrutiny of competition in high-yielding sectors such as technology, and incentives for the appointment of worker representatives to company boards. But a government intent on tackling inequalities will inescapably need to raise public spending and direct taxation of income and capital from their current historically low levels. In particular spending on education and active labour market policies needs to increase, while gaps in the benefits system and regional imbalances are addressed.

Given the scale of technological change and the severe implications for the labour market, the risk is that policy will be insufficiently bold to deal with widespread disenchantment, which could ultimately pose a threat to democracy.
Spousal Relative Income and Male Psychological Distress
Authors: Syrda Joanna
Published: October 2019

Using Panel Study of Income Dynamics 2001-2015 dataset (6,035 households, 19,688 observations), this study takes a new approach to investigating the relationship between wife’s relative income and husband’s psychological distress, and finds it to be significantly U-shaped. Controlling for total household income, predicted male psychological distress reaches a minimum at a point where wives make 40% of total household income and proceeds to increase, to reach highest level when men are entirely economically dependent on their wives. These results reflect the stress associated with being the sole breadwinner, and more significantly, with gender norm deviance due to husbands being outearned by their wives. Interestingly, the relationship between wife’s relative income and husband’s psychological distress is not found among couples where wives outearned husbands at the beginning of their marriage pointing to importance of marital selection. Finally, patterns reported by wives are not as pronouncedly U-shaped as those reported by husbands.
(Not) in sync – digital time and forms of (dis-)connecting: ethnographic notes from Kinshasa (DR Congo)
Authors: Pype Katrien
Published: October 2019

Based on ethnographic research, this article explores the temporal politics of ‘electronic modernity’ in one locale in the Global South, in particular Kinshasa, capital city of the Democratic Republic of Congo. A major experience of digital connectivity in Kinshasa is one of unexpected and undesired disconnection, that is, the involuntary logging off of the Internet due to political interference, lack of battery time, or credit time (phone credit). This undesired mode of being disconnected is only one, albeit very familiar, way in which people participate (or not) in electronic modernity. This material allows me to revisit the notion of ‘global coevalness’ in electronic modernity, i.e., the idea that people can live in a shared world by participating in the same temporality due to the sheer fact that they are electronically and digitally connected. I thus want to think through how various materialities of digital media – in particular mobile phone batteries, optic fiber networks, and software – interact with the urban experience in the Global South, and how these entanglements produce not only temporal sameness, simultaneity, and synchronicity but also temporal difference and disjuncture. Ultimately, I argue that technological synchronicity does not always lead to social synchronicity.
Polluted Leisure and Blue Spaces: More-Than-Human Concerns in Fukushima
Authors: Evers Clifton
Published: October 2019

Following a magnitude 9 earthquake on March 11, 2011, a tsunami swept across the coast of Japan. The earthquake and tsunami disabled the Tokyo Electric Power Company’s (TEPCO) Fukushima Daiichi Nuclear Power Plant causing a nuclear accident. Subsequently, pollution in the form of radiation and concrete seawalls more powerfully influence how blue spaces (seas, oceans, rivers, lakes, and other waterways), health, sport, and leisure compose in Fukushima. In this article, I reflect on some fieldwork experiences while considering “polluted leisure” at this site. My argument is that pollution complicates any health-led blue spaces discourse that attributes positive transformations achieved during leisure-orientated sport in these spaces. Any accretion of health and well-being manifested in blue spaces is shown to simultaneously involve declension, within immediate and/or distant proximity.
Addressing multidrug resistant pathogens in pediatric palliative care patients—the nurses point of view: A qualitative study
Authors: Schmidt Pia , Hartenstein-Pinter Almut , Wager Julia , Hasan Carola , Zernikow Boris
Published: October 2019

Background:

Multidrug resistant pathogens are a large-scale healthcare issue. In particular, children with life-limiting conditions have a significantly increased risk of multidrug resistant pathogen colonization. Official hygiene requirements recommend children, who are colonized with multidrug resistant pathogens, to be isolated. In the context of pediatric palliative care, such isolation adversely affects the aim of social participation. To overcome this challenge of conflicting interests on a pediatric palliative care inpatient unit, a hygiene concept for patients colonized with multidrug resistant pathogens, called PALLINI, was implemented.

Aim:

The aim of this study was to identify the nurses’ attitudes and opinions toward PALLINI.

Methods:

Nurses ( N = 14) from the pediatric palliative care unit were queried in guideline-oriented interviews. Interviews were analyzed qualitatively by means of content analysis.

Results:

The following four categories were identified: (1) safety, (2) effort, (3) quality of care, and (4) participation. All categories demonstrated ambivalence by nursing staff regarding PALLINI. Ambivalence arose from guaranteeing infection control versus noncompliance by the families, additional workload for patients with multidrug resistant pathogens versus lack of resources, impaired relationship with the parents versus enabling better care for the child, as well as enabling some limited contact versus the larger goal of genuine social participation. Despite this, nurses reported the importance of arranging everyday-life for the patients so that they experience as much social participation as possible.

Conclusion:

The implementation of a new hygiene concept is challenging. Despite positive reception of PALLINI from the nurses, ambivalence remained. Addressing these ambivalences may be critical to best implement the new hygiene concept.
Market Development for African Endogenous Products
Authors: Babah Daouda Falylath , Barth Philip , Ingenbleek Paul T. M.
Published: October 2019

The macromarketing literature has devoted substantial attention to marketing systems including those in emerging and developing countries. However, the market development of ‘endogenous’ products, which are products that are rooted in Africa’s natural- and socio-cultural resources and systems, is still understudied. Drawing on the 4As-framework and an exploratory qualitative study that examines market growth constraints for a product in Benin, this paper develops a descriptive theoretical model of market development for African endogenous products. The findings show that markets can be developed through endogenous marketing systems, because traders are familiar with the products and, once markets in easy-to-reach areas become saturated, they advocate their use in new market areas. Through this process, markets potentially grow from urban to peri-urban and rural areas. Because endogenous products have an inherent competitive advantage over foreign products, they deserve support in development policies next to the large commodities that typically characterize Africa’s production portfolio.
Criminal Orders of Protection for Domestic Violence: Associated Revictimization, Mental Health, and Well-being Among Victims
Authors: Sullivan Tami P. , Weiss Nicole H. , Woerner Jacqueline , Wyatt Janan , Carey Camille
Published: October 2019

All states issue criminal protection orders (POs) with the intention of improving the lives of victims of domestic violence (DV); however, there is a dearth of research examining their impact. This study aims to examine the impact of criminal POs with different levels of restrictions on victims’ revictimization, mental health, and well-being. A cross-sectional design was used to collect data regarding two time points during one interview among a sample of 298 victims in a criminal DV case. Across the three levels of PO restrictions (limited, residential stay-away, and full no-contact), participants reported significantly reduced physical, sexual, and psychological DV; unwanted pursuit behavior; post-traumatic stress and depression symptom severity; and perceived stress and fear of revictimization. The amount of change varied between groups for revictimization variables. Full no-contact restrictions were associated with the greatest decreases in revictimization. However, findings must be interpreted with caution given the heterogeneity in victims’ experiences; some victims experienced an increase in revictimization and mental health problems and a decrease in well-being. Findings suggest that the court, through criminal POs, may be a system through which to reach victims who might not otherwise connect with services to promote safety and resilience.
Impact of Adverse Childhood Experiences on Oral Health Among Women in the United States: Findings From the Behavioral Risk Factor Surveillance System
Authors: Bosch Jeane , Weaver Terri L. , Arnold Lauren D.
Published: October 2019

It is well established that adverse childhood experiences (ACEs) negatively impact physical and mental health. There is a paucity of research examining the impact of ACEs on oral health. Therefore, the aim of this study was to better understand how ACEs may impact oral health utilizing a nationally representative sample of females. Data from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) were utilized. The sample comprised 36,249 females. Chi-square tests were used to examine associations between multiple forms of ACEs and oral health, mental health, smoking, and health-related quality of life. Logistic regression models were generated for the outcomes of interest: last dental cleaning, significant tooth loss, smoking, and health-related quality of life. Post-hoc analyses were conducted to examine whether smoking and dental cleaning moderated the relationship between ACEs and significant tooth loss. All ACE categories were significantly associated with poor health-related quality of life, being a current or former smoker, last dental cleaning >1 year, and significant tooth loss even after adjusting for demographic variables. Last dental cleaning and being a current or former smoker moderated the relationship between ACEs and significant tooth loss. This study affirms other findings that women with a history of ACEs were more likely to engage in health-risk behaviors, specifically cigarette smoking, which has been strongly associated with ACEs. These findings underscore the importance of including oral health in future studies given it has implications for disease development. Furthermore, dental visits may provide a window of opportunity for trauma-informed care.
Violence and Discrimination Against Men Who Have Sex With Men in Lebanon: The Role of International Displacement and Migration
Authors: Orr Lilla , Shebl Fatma M. , Heimer Robert , Khoshnood Kaveh , Barbour Russell , Khouri Danielle , Aaraj Elie , Mokhbat Jacques E. , Crawford Forrest W.
Published: October 2019

Homosexuality is illegal in Lebanon and men who have sex with men (MSM) may experience discrimination. Displaced Syrians, who currently comprise approximately 20% of Lebanon’s population, also face discrimination. Individuals who are members of both groups may experience heightened levels of discrimination and abuse. In partnership with local nongovernmental organizations serving the community, we recruited N = 292 MSM in Beirut, Lebanon. Participants were interviewed about experiences of violence and discrimination in the context of a larger health behavior survey, and all were offered anonymous HIV testing. Responses were analyzed using the framework of intersectionality, combining regression, geographical mapping of reported experiences, and network analysis of the participant recruitment pattern. MSM, born outside of Lebanon, who are primarily from Syria, face higher levels of discrimination and violence than native-born MSM (71% vs. 32% reporting at least one type of discrimination or violence). Socioeconomic status is also associated with discrimination and violence overall, and among native- and foreign-born MSM. Experiences vary by town and neighborhood, and are highly correlated between recruiting and recruited participants.These results highlight health risks faced by foreign-born MSM in Lebanon.
Comparative Effectiveness of Vancomycin Versus Linezolid for the Treatment of Acute Pulmonary Exacerbations of Cystic Fibrosis
Authors: Fusco Nicholas M. , Meaney Calvin J. , Frederick Carla A. , Prescott William A.
Published: October 2019

Background: Data are limited regarding the preferred antibiotics for treatment of acute pulmonary exacerbations (APEs) of cystic fibrosis (CF), when methicillin-resistant Staphylococcus aureus (MRSA) is suspected. Objective: To compare the rate of return to baseline lung function among individuals with APEs of CF treated with either vancomycin or linezolid. Methods: This retrospective study included individuals hospitalized for APEs of CF from May 1, 2015, to April 30, 2017 who were infected with MRSA and treated with vancomycin or linezolid. The primary outcome was the return to baseline lung function, as measured by forced expiratory volume in 1 s (FEV1). Descriptive and inferential statistics were used. All tests were 2-tailed with α set at 0.05. Results: A total of 122 encounters were included (vancomycin: n = 66; linezolid: n = 66). No difference existed in return to baseline FEV1 between vancomycin (53 [80.3%]) and linezolid (50 [75.8%]; P = 0.53); nor was there a difference in median percentage change in FEV1 from admission to follow-up between vancomycin (24.7%) and linezolid (20.7%; P = 0.61). Adverse drug events occurred more frequently in patient encounters treated with vancomycin (10 [15.2%]) compared with linezolid (2 [3%]; P = 0.002). Conclusion and Relevance: Our study observed no difference in the effectiveness of vancomycin compared with linezolid in terms of change in lung function for APEs of CF. The rate of adverse drug events was low. In individuals with CF infected with MRSA who are experiencing an APE, either vancomycin or linezolid appear to be viable treatment options.
School-Wide Positive Behavior Interventions and Supports: Fidelity of Tier 1 Implementation in 117 Dutch Schools
Authors: Nelen Monique J. M. , Blonk Anita , Scholte Ron H. J. , Denessen Eddie
Published: October 2019

School-wide positive behavior interventions and supports (SWPBIS) is a school-wide approach to create a safe and positive school climate. SWPBIS is a framework in which core features and procedures need to be adjusted to its specific school context, referred to as contextual fit. Implementing with fidelity is related to positive outcomes such as a decrease of behavioral problems. Therefore, when adapting SWPBIS to the context, fidelity of implementation needs to be assured. At the introduction of SWPBIS in the Netherlands in 2009, several procedures were adapted to the Dutch educational context, and different modalities of supporting schools in implementing SWPBIS emerged. In this study, the Tiered Fidelity Inventory (TFI) and School-Wide Evaluation Tool (SET) were used to assess fidelity of Tier 1 implementation in 117 Dutch schools. The average period of SWPBIS implementation was 2 years 5 months. Results showed that all core features and procedures were present. Mean total scores were 60% for the TFI and 70% for the SET. Most participating schools appeared to have leadership teams, expectations were taught, and acknowledgment provided. Teams had been trained, and discipline data collected. Compared with other features, annual evaluation, data-based decision making, and stakeholder involvement were less well implemented.
Regarding the shipwreck of others: for a critical visual topography of Mediterranean migration
Authors: Giubilaro Chiara
Published: October 2019

This article reflects on the relationship between photography and migration from a cultural geography perspective, with particular reference to the visual construction of the Mediterranean border regime. The contemporary aesthetics of Mediterranean migration is one of the domains in which visual and social norms are most closely intertwined. My main purpose is to unveil these processes of mutual (re)production by analysing how photographs forge our everyday perceptions of migration and affect our very ability to produce ethical and political responses to the events they portray. Drawing on a range of fields and approaches, including cultural geography, visual culture studies and postcolonial theories, I attempt here to develop a critical topography of looking, mapping out some of the performances and places involved in looking at Mediterranean migration. In the final part of the article, I seek to reinforce my theoretical statements by focusing on two photographic images of people being rescued along the Mediterranean route, in order to illustrate how photography can actually interfere with our ability to create spaces of cultural and political responsibility.
Discovery of crucial cytokines associated with abdominal aortic aneurysm formation by protein array analysis
Authors: Li Yuan , Yang Dan , Sun Bo , Zhang Xu , Li Fangda , Liu Zhili , Zheng Yuehong
Published: October 2019

As a common disease, abdominal aortic aneurysm (AAA) features permanently progressively dilated abdominal aorta. Various cytokines are implicated in AAA pathogenesis. Clarification of involved cytokines combined with functional analysis may provide new insights into AAA pathogenesis. Using a mouse model, this study analyzed the cytokine profiles in AAA. Cytokines were measured in AAA tissues of saline control or angiotensin II-treated ApoE−/− mice using an antibody array of 200 cytokines, cytokine receptors, and related proteins. Statistical analysis revealed that 21 of 200 proteins were differentially expressed in AAA. These differentially expressed proteins were subjected to function and pathway enrichment analysis, which revealed that leukocyte migration and positive regulation of cell adhesion were the most significant biological processes. Specific signaling pathways, including Janus kinase/signal transducers and activators of transcription and cytokine–cytokine receptor interaction, were prominent in Kyoto encyclopedia of genes and genomes pathway enrichment analysis. Importantly, our data identified cytokines which had not previously been illustrated in AAA pathogenic pathways. Bivariate correlation analysis between these cytokines and protease activity showed that granulocyte colony-stimulating factor (G-CSF), macrophage inflammatory protein 1 g, cardiotrophin 1, milk fat globule-EGF factor 8 protein, interleukin 33, and periostin were positively correlated with matrix metalloprotease 1 (MMP-1), MMP-9, cathepsin B, and cathepsin L. G-CSF was positively correlated with cathepsin L. In conclusion, these results demonstrate that cytokine profile is significantly altered in AAA, and that the newly identified crucial cytokines may function potentially in AAA pathogenesis.

Impact statement

Various cytokines are known contributors to abdominal aortic aneurysm (AAA) pathologic processes, but the mechanisms underlying the pathogenesis remains unclear. We illustrated the altered cytokine profiles in AAA by high throughput antibody array of 200 cytokines, cytokine receptors and related proteins, as well as bioinformatics analysis of differentially expressed proteins in lesion tissues from AAA mice infused with angiotensin II. Functional analyses of differentially expressed cytokines showed clustering on cell migration and adhesion processes. More importantly, crucial cytokines whose association with AAA formation had not been established were identified. Significant correlations were found between these cytokines and protease activity. This study identifies several crucial markers for further researches on the molecular basis of AAA.
Machine learning–based automated image processing for quality management in industrial Internet of Things
Authors: Rahmatov Nematullo , Paul Anand , Saeed Faisal , Hong Won-Hwa , Seo HyunCheol , Kim Jeonghong
Published: October 2019

The aim of this article is to automate quality control once a product, essentially a central processing unit system, is manufactured. Creating a model that helps in quality control, increases efficiency and speed of production by rejecting abnormal products automatically is vital. A widely used technology for this is to use industrial image processing that is based on the use of special cameras or imaging systems installed within the production line. In this article, we propose a highly efficient model to automate central processing unit system production lines in an industry such that images of the production lines are scanned and any abnormalities in their assembly are pointed out by the model and information about this is transferred to the system administrator via a cyber-physical cloud system network. A machine learning–based approach is used for proper classification. This model not only focuses on just the abnormalities but also helps in configuring the angles from which images of the production are taken, and our methods show 92% accuracy.
Strip-based deployment with cooperative communication to achieve connectivity and information coverage in wireless sensor networks
Authors: Cheng Wei , Lu Xiaolin , Li Yong , Wang Hui , Zhong Lei
Published: October 2019

Coverage and connectivity in wireless sensor network have been studied extensively in existing research works with physical and information coverage. The optimal deployment to achieve both information coverage and connectivity, on arbitrary values of the ratio of rc and rs, has been studied in previous work; meanwhile, the extended strip-based deployment based on information coverage is also studied. Either information coverage or cooperative communication could exploit collaboration of sensor nodes to improve the efficiency of deployment, while how good is strip-based deployment with both information coverage and cooperative communication is worth to be measured when the value of rc/ rs is varied. In this article, the relationship between the density of sensors needed to achieve physical or information coverage and connectivity and the variety of rc/ rs is derived in closed form for strip-based deployment of wireless sensor networks with cooperative communication. Then, a summary of different combinations of coverage and connectivity is provided, that physical or information coverage with or without cooperative communication could be employed to achieve full coverage and connectivity for strip-based deployment. Finally, some new strategy could be proposed based on the fusion of physical and information coverage to improve strip-based deployment. Some numerical results are provided to show the efficiency of all schemes to help researchers design more effective deployment schemes.
A stroke recovery trial development framework: Consensus-based core recommendations from the Second Stroke Recovery and Rehabilitation Roundtable
Authors: Bernhardt Julie , Hayward Kathryn S , Dancause Numa , Lannin Natasha A , Ward Nick S , Nudo Randolph J , Farrin Amanda , Churilov Leonid , Boyd Lara A , Jones Theresa A , Carmichael S Thomas , Corbett Dale , Cramer Steven C
Published: October 2019

A major goal of the Stroke Recovery and Rehabilitation Roundtable (SRRR) is to accelerate development of effective treatments to enhance stroke recovery beyond that expected to occur spontaneously or with current approaches. In this paper, we describe key issues for the next generation of stroke recovery treatment trials and present the Stroke Recovery and Rehabilitation Roundtable Trials Development Framework (SRRR-TDF). An exemplar (an upper limb recovery trial) is presented to demonstrate the utility of this framework to guide the GO, NO-GO decision-making process in trial development.
Recurrent pregnancy loss
Authors: Krishnaswamy Priyanka , Arora Rohit
Published: October 2019

Miscarriage is defined as the spontaneous loss of a pregnancy before the fetus reaches viability; it includes all pregnancy losses from the time of conception until 24 weeks of gestation. Early miscarriages are common, occurring in 10–20% of all pregnancies, with 2% of second-trimester pregnancies being miscarried before 24 weeks of gestation. Recurrent miscarriage, defined as the loss of three or more consecutive pregnancies, affects 1% of couples trying to conceive with the chance of having two consecutive miscarriages being 5%. Clinical studies show that 3 in 4 women will have a successful pregnancy with supportive care alone. Therefore, couples should be given reassurance about their chances of a successful pregnancy in the future. In this review we look at the epidemiological factors influencing rates of miscarriage, acquired and inherited thrombophilia, genetic, anatomical, endocrine, immune, infective and male factors for recurrent miscarriage. Despite these potential causes, the majority (around 50%) of recurrent pregnancy losses remain unexplained.
Medical Cannabis and School: Separating Fact From Fiction
Authors: Strawhacker MaryAnn Tapper
Published: October 2019

The majority of states have legalized medical marijuana (MM) despite its Federal Schedule 1 designation as an illegal substance. Public schools must comply with Drug Free Workplace laws or risk the loss of federal funding. To address the conflict between state and federal laws regulating MM, the National Association of School Nurses issued a position brief in January 2019. The accompanying article introduces the Cannabis/Marijuana Position Brief and provides guidance for school nurses who encounter a student treated with MM. Topics addressed include background implications of federal marijuana and hemp law, mechanism of action for MM, Epidiolex overview, current research regarding efficacy of MM for common qualifying conditions, and implications for school nursing practice.
Private Dental Care Benefits Non-Indigenous Children More Than Indigenous Children
Authors: Nair R. , Luzzi L. , Jamieson L. , Spencer A.J. , Hanna K.M.B. , Do L.G.
Published: October 2019

Introduction:

Various arrangements for funding health care facilities can have different levels of performance of care provision on different groups of people. Such differential performance of oral care is not previously known concerning Indigenous communities.

Objective:

This study aimed to assess the effect of visiting a public or private dental care facility on the performance of oral care experienced by Indigenous versus non-Indigenous children in Australia.

Methods:

Data from the National Child Oral Health Survey were used with a representative sample of children from all the states and territories of Australia. The performance of oral care was measured with the Child Oral Care Performance Assessment Scale (COPAS), which contains 37 items from 9 domains (Effective, Appropriate, Efficient, Responsive, Accessible, Safe, Continuous, Capable, and Sustainable) with a score ranging from 0 to 148. Mixed effects models that accounted for stratum and sampling weights were used for the stratified analyses (Indigenous vs. non-Indigenous) that assessed the effect of public versus private care on the COPAS. Relative excess risk due to interaction was calculated to assess effect modification.

Results:

Among the Indigenous children, private care was similar to public care (regression coefficient [RC] = −1.27, 95% CI = −9.5 to 6.97), whereas private care was higher than public care among non-Indigenous children (RC = 4.60, 95% CI = 3.67 to 6.18). This trend was similar among the 9 domains of the COPAS as well, except for Effectiveness, which was similar for private and public facilities among non-Indigenous children (RC = −0.03, 95% CI = −0.29 to 0.23). Based on the continuous COPAS score, effect modification was 4.46 (95% CI = 0.11 to 8.82) on the additive scale and 1.06 (1.01, 1.13) on the multiplicative scale. The relative excess risk due to interaction reported an excess chance of 1.17 (95% CI = 0.01 to 0.33), which was consistent with the stratified analyses and effect modification measured with the continuous score.

Conclusion:

Thus, this study found a higher performance of oral care in private care locations among non-Indigenous children versus Indigenous children.

Knowledge Transfer Statement:

The findings caution policy makers and other stakeholders that moving oral care from public to private care facilities can increase the inequity faced by Indigenous children in Australia.
Communication and Shared Decision Making in the Breast Cancer Treatment Consultation: A Comparative Analysis of English- and Spanish-Speaking Patients
Authors: Schapira Marilyn M. , Faghri Arshia , Jacobs Elizabeth A. , Fletcher Kathlyn E. , Ganschow Pamela S. , Gil Denise , Smallwood Alicia J. , Walker Cindy M. , Neuner Joan M.
Published: October 2019

Background. Communication in the breast cancer treatment consultation is complex. Language barriers may increase the challenge of achieving patient-centered communication and effective shared decision making. Design. We conducted a prospective cohort study among Spanish- and English-speaking women with stage 0 to 3 breast cancer in two urban medical centers in the Midwestern United States. Patient centeredness of care and decisional conflict were compared between Spanish- and English-speaking participants using the Interpersonal Processes of Care (IPC) and Decision Conflict Scale (DCS), respectively. Clinician behaviors of shared decision making were assessed from consultation audio-recordings using the 12-item Observing Patient Involvement in Decision Making (OPTION) scale. Multivariate regression analyses were conducted to control for differences in baseline characteristics and clinician specialty. Results. Fifteen Spanish-speaking and 35 English-speaking patients were enrolled in the study. IPC scores (median, interquartile range [IQR]) were higher (less patient centered) in Spanish- versus English-speaking participants in the domains of lack of clarity (2.5, 1-3 v. 1.5, 1-2), P = 0.028; perceived discrimination (1.1, 1-1 v. 1.0, 1-1), P = 0.047; and disrespectful office staff (1.25, 1-2 v. 1.0, 1-1), P < 0.0005 (Wilcoxon rank-sum test). OPTION scores (median, IQR) were lower in Spanish- versus English-speaking participants (21.9, 17.7-27.1 v. 31.3, 26.6-39.6), P = 0.001 (Wilcoxon rank-sum test). In multivariate analysis, statistically significant differences persisted in the IPC lack of clarity and disrespectful office staff between Spanish- and English-speaking groups. Conclusions. Our findings highlight challenges in cancer communication for Spanish-speaking patients, particularly with respect to perceived patient centeredness of communication. Further cross-cultural studies are needed to ensure effective communication and shared decision making in the cancer consultation.
Supraglottic airway versus endotracheal tube during interventional pulmonary procedures – a retrospective study
Authors: Behrens Kyle M. , Galgon Richard E.
Published: October 2019

Background

As the field of interventional pulmonology (IP) expands, anesthesia services are increasingly being utilized when complex procedures of longer duration are performed on sicker patients with high risk co-morbidities and lung pathology. Yet, evidence on the optimal anesthetic management for these patients remains lacking. Our aim was to characterize the airway management and, secondarily anesthetic maintenance patterns used for IP procedures at our institution.

Methods

From 2894 identified encounters, charts of 783 patients undergoing an IP procedure with general anesthesia over a 5-year period, employing an endotracheal tube (ETT) or a supraglottic airway (SGA) for airway maintenance, were identified and reviewed after exclusions. Patients posted for a concurrent thoracic surgical procedure and those already intubated at presentation were excluded. Baseline patient demographics, procedure, proceduralist type, anesthesia maintenance modality, neuromuscular blocking drug (NMBD) use, and airway management characteristics were extracted and analyzed.

Results

Inhaled general anesthesia with an ETT for airway maintenance was most commonly employed; however, SGAs were used in one-third of patients with a very low conversion rate (0.4%), and their use was associated with a significant reduction in NMBD use.

Conclusions

In this large series of patients receiving general anesthesia for IP procedures, inhaled anesthetic agents and ETTs were favored. However, in appropriately selected patients, SGA use was effective for airway maintenance and allowed for a reduction in NMBD use, which may have implications in this patient population who may have an increased risk for pulmonary complications and warrants further investigation.
Correction to: Rapid and reliable detection of α-globin copy number variations by quantitative real-time PCR
Authors: Grimholt Runa M. , Urdal Petter , Klingenberg Olav , Piehler Armin P.
Published: October 2019

The copy number of the HBA1 assay for the -(α)20.5 deletion in the HBA-CNV method described in the original article [1] was incorrectly reported.
Salivary creatinine as a diagnostic tool for evaluating patients with chronic kidney disease
Authors: Temilola Dada Oluwaseyi , Bezuidenhout Karla , Erasmus Rajiv Timothy , Stephen Lawrence , Davids Mogamat Razeen , Holmes Haly
Published: October 2019

Background

Preliminary studies have shown the potential use of salivary creatinine concentration in the diagnosis of chronic kidney disease (CKD). For saliva to replace serum as a diagnostic tool, studies must be done to determine its effectiveness in the diagnosis and staging of CKD. The aim of the present study was to evaluate the use of salivary creatinine as a safe and non-invasive alternative for identifying patients with CKD.

Methods

A cross-sectional study was conducted at Tygerberg Hospital in Cape Town, on 230 patients, across all stages of CKD. Ethical approval to conduct the study was obtained from the University of the Western Cape Biomedical Research Ethics Committee, and written informed consent was provided by each participant. Saliva and serum samples were collected for creatinine analysis and the correlation determined using Spearman’s correlation. Receiver operating characteristics (ROC) analysis was used to determine the diagnostic ability of salivary creatinine. A cut-off value for optimal sensitivity and specificity of salivary creatinine to diagnose CKD with glomerular filtration rate (GFR) < 60 mL/min/1.73 m2 was obtained.

Results

Serum creatinine values ranged from 46 μmol/L to 1581 μmol/L, with a median value of 134 μmol/L. Salivary creatinine values ranged from 3 μmol/L to 400 μmol/L, with a median of 11 μmol/L. There was a strong positive correlation (r = 0.82) between serum and salivary creatinine values. Linear regression analysis of serum and salivary creatinine for CKD patients was significant in all CKD stages, except for stage 1. Area under the curve for salivary creatinine was 0.839. A cut-off value of 8.5 μmol/L yielded a sensitivity of 78.3% and specificity of 74.0% for classifying patients as having CKD based on estimated GFR < 60 mL/min/1.73 m2.

Conclusions

The results support the potential of salivary creatinine as a non-invasive diagnostic tool for estimating GFR and identifying patients with CKD.
Amyloid PET, FDG-PET or MRI? - the power of different imaging biomarkers to detect progression of early Alzheimer’s disease
Authors: Ortner Marion , Drost René , Heddderich Dennis , Goldhardt Oliver , Müller-Sarnowski Felix , Diehl-Schmid Janine , Förstl Hans , Yakushev Igor , Grimmer Timo
Published: October 2019

Background

As investigations of disease modifying drugs aim to slow down progression of Alzheimer’ disease (AD) biomarkers to reliably track disease progression gain more importance. This is especially important as clinical symptoms, including psychometric measures, are only modestly associated with the underlying disease pathology, in particular at the pre-dementia stages. The decision which biomarkers to choose in clinical trials is crucial and depends on effect size. However, longitudinal studies of multiple biomarkers in parallel that allow direct comparison on effect size are scarce.

Methods

We calculated effect size and minimal sample size for three common imaging biomarkers of AD, namely amyloid deposition measured with PiB-PET, neuronal dysfunction measured with FDG-PET and cortical thickness measured with MRI in a prospective 24-month follow-up study in a monocentric cohort of early AD.

Results

Post hoc power calculation revealed large effect sizes of Cohen’s d for PiB-PET and cortical thickness and a small effect size for FDG-PET (1.315, 0.914, and 0.341, respectively). Accordingly, sample sizes for PiB-PET and cortical thickness required significantly smaller sample sizes than FDG-PET to reliably detect statistically significant changes after 24 months in early AD (n = 7, n = 12, and n = 70, respectively).

Conclusion

Amyloid imaging with PET and measuring cortical thickness with MRI are suitable biomarkers to detect disease progression in early AD within a small sample.
Understanding health-related behavior among adolescents living with HIV in Lima, Peru
Authors: Rodriguez Carly A. , Valle Emiliano , Galea Jerome , Wong Milagros , Kolevic Lenka , Muñoz Maribel , Lecca Leonid , Franke Molly F.
Published: October 2019

Background

The global HIV burden among adolescents ages 10–19 is growing. This population concurrently confronts the multifaceted challenges of adolescence and living with HIV. With the goal of informing future interventions tailored to this group, we assessed sexual activity, HIV diagnosis disclosure, combination antiretroviral therapy (cART) adherence, and drug use among adolescents living with HIV (ALHIV) in Lima, Peru.

Methods

Adolescents at risk or with a history of suboptimal cART adherence completed a self-administered, health behaviors survey and participated in support group sessions, which were audio recorded and used as a qualitative data source. Additionally, we conducted in-depth interviews with caregivers and care providers of ALHIV. Thematic content analysis was performed on the group transcripts and in-depth interviews and integrated with data from the survey to describe adolescents’ health related behaviors.

Results

We enrolled 34 ALHIV, of which 32 (14 male, 18 female, median age 14.5 years) completed the health behavior survey. Nine (28%) adolescents reported prior sexual intercourse, a minority of whom (44%) reported using a condom. cART adherence was highest in the 10–12 age group with 89% reporting ≤2 missed doses in the last month, compared to 36% in adolescents 13 years or older. Over 80% of adolescents had never disclosed their HIV status to a friend or romantic partner. Adolescents, caregivers, and health service providers described sexual health misinformation and difficulty having conversations about sexual health and HIV.

Conclusions

In this group of ALHIV, adherence to cART declined with age and condom use among sexually active adolescents was low. Multifactorial interventions addressing sexual health, gaps in HIV-related knowledge, and management of disclosure and romantic relationships are urgently needed for this population.
Interventions to prevent, delay or reverse frailty in older people: a journey towards clinical guidelines
Authors: Marcucci Maura , Damanti Sarah , Germini Federico , Apostolo Joao , Bobrowicz-Campos Elzbieta , Gwyther Holly , Holland Carol , Kurpas Donata , Bujnowska-Fedak Maria , Szwamel Katarzyna , Santana Silvina , Nobili Alessandro , D’Avanzo Barbara , Cano Antonio
Published: October 2019

Background

Age-related frailty is a multidimensional dynamic condition associated with adverse patient outcomes and high costs for health systems. Several interventions have been proposed to tackle frailty. This correspondence article describes the journey through the development of evidence- and consensus-based guidelines on interventions aimed at preventing, delaying or reversing frailty in the context of the FOCUS (Frailty Management Optimisation through EIP-AHA Commitments and Utilisation of Stakeholders Input) project (664367-FOCUS-HP-PJ-2014). The rationale, framework, processes and content of the guidelines are described.

Main text

The guidelines were framed into four questions – one general and three on specific groups of interventions – all including frailty as the primary outcome of interest. Quantitative and qualitative studies and reviews conducted in the context of the FOCUS project represented the evidence base. We followed the GRADE Evidence-to-Decision frameworks based on assessment of whether the problem is a priority, the magnitude of the desirable and undesirable effects, the certainty of the evidence, stakeholders’ values, the balance between desirable and undesirable effects, the resource use, and other factors like acceptability and feasibility. Experts in the FOCUS consortium acted as panellists in the consensus process. Overall, we eventually recommended interventions intended to affect frailty as well as its course and related outcomes. Specifically, we recommended (1) physical activity programmes or nutritional interventions or a combination of both; (2) interventions based on tailored care and/or geriatric evaluation and management; and (3) interventions based on cognitive training (alone or in combination with exercise and nutritional supplementation). The panel did not support interventions based on hormone treatments or problem-solving therapy. However, all our recommendations were weak (provisional) due to the limited available evidence and based on heterogeneous studies of limited quality. Furthermore, they are conditional to the consideration of participant-, organisational- and contextual/cultural-related facilitators or barriers. There is insufficient evidence in favour of or against other types of interventions.

Conclusions

We provided guidelines based on quantitative and qualitative evidence, adopting methodological standards, and integrating relevant stakeholders’ inputs and perspectives. We identified the need for further studies of a higher methodological quality to explore interventions with the potential to affect frailty.