bluuebunny/crossref_metadata_2025 huggingface dataset:
Optic nerve double inversion recovery hypersignal in patients with clinically isolated syndrome is associated with asymptomatic gadolinium-enhanced lesion
Authors: London Frédéric , Zéphir Hélène , Hadhoum Nawal , Lannoy Julien , Vermersch Patrick , Pruvo Jean-Pierre , Hodel Jérôme , Leclerc Xavier , Outteryck Olivier
Published: December 2018

Background:

Optic nerve involvement is not considered in dissemination in space (DIS) or time (DIT) of multiple sclerosis (MS) lesions.

Objectives:

To evaluate frequency of optic nerve involvement using three-dimensional (3D)-double inversion recovery (DIR) sequence in clinically isolated syndrome (CIS) and to measure its relationship with DIS and DIT (2010 and 2017 McDonald criteria).

Methods:

From November 2013 to August 2016, 57 CIS patients underwent 3T-magnetic resonance imaging (3T-MRI) including 3D-DIR sequence and optical coherence tomography (OCT) at 3 months after CIS. We assessed signal abnormalities of the optic nerves on DIR sequence and collected data for DIS and DIT criteria according to 2010 and 2017 McDonald criteria.

Results:

Among the 57 recruited patients, the presence of ⩾1 DIR hypersignal in optic nerve was observed in 36 (63%; 48 optic nerves) including asymptomatic hypersignal in 22 (38.5%; 25 optic nerves). Optic nerve involvement was significantly associated with DIT ( p = 0.006) and MS according to 2010 criteria ( p = 0.01) but was not significantly associated with presence of DIS criteria according to 2010 and 2017 McDonald criteria. We identified a significant ( p < 0.001) temporal peripapillary retinal nerve fiber layer thinning on eyes with optic nerve involvement versus healthy controls.

Conclusions:

Optic nerve involvement is very frequent at the earliest clinical stage of MS. It is associated with the presence of asymptomatic gadolinium-enhancement and retinal axonal loss and may reflect the inflammatory disease activity level.
Implications of generational change: European river cruises and the emerging Gen X market
Authors: Cooper Donald , Holmes Kirsten , Pforr Christof , Shanka Tekle
Published: December 2018

This article focuses on the Generation X (Gen X) cohort that will replace the baby boomers as the main target market for tourism experiences tailored specifically to the senior/mature market in the coming years. Its context is a successful segment of the cruising industry: the European river cruising sector. The study explores the potential impacts of this generational change on river cruising. Little is currently known about Gen X’s tourism motivations, expectations and behaviour. Generational theory is employed in this study as the framework to identify distinct features of the Gen X cohort. Using a phenomenological research design, 39 in-depth interviews were conducted with participants in two important European river cruise source market countries, Australia and the United States. Findings of this study indicate that Gen Xers have distinct tourism motivations, needs and interests that have evolved from their formative experiences. A range of political, financial and social issues have been identified that may affect Gen Xers’ predisposition towards products aimed for the mature market such as European river cruises in their currently offered format. The study contributes to tourism theory, offering an understanding of Gen Xers’ desire and ability to participate in such tourism activities in the future.
Media Framing and the Threat of Global Pandemics: The Ebola Crisis in UK Media and Policy Response
Authors: Pieri Elisa
Published: December 2018

Pandemics pose new and difficult challenges. Risks associated with the spread of pandemics generate intense speculation in Western media. Taking the 2014–2015 Ebola outbreak as a case study, the article critically analyses how the risk of contagion in the US, Europe, and the UK has been constructed in UK media and policy discourse. Drawing on the importance of media framing in shaping a given problem definition, causal interpretation and treatment recommendation, the article critically assesses the impacts of the British newspaper framing of Ebola, questioning the rationale of a UK domestic political response based on containment and border screenings. The article also takes a comparative angle, engaging with constructions of previous pandemics. Underscoring the importance of a sociological analysis of these framings, the article critically reflects on the role of media communication in reproducing certain topoi, which reduce the scope for open public debate around best responses to a pandemic emergency.
Through the mother’s voice: Exposure and intimacy in Lesley McIntyre’s photo project The Time of Her Life and Elisabeth Zahnd Legnazzi’s Chiara A Journey Into Light
Authors: Sile Agnese
Published: December 2018

When it comes to depicting ill or disabled children, the ethics of representation becomes increasingly complex. The perception of photographs as voyeuristic and objectifying is of particular concern here and resonates with widespread fear about the eroticisation, mistreatment and exploitation of children. Although these fears are reasonable, this view does not take into account the voice and agenda of the photographic subject, disregards the possibility of recognition and the participatory nature of photography. In this article, I focus on photography as a collaborative practice. I analyse two photographic projects by photographers/mothers that document their ill and dying daughters – Lesley McIntyre’s photographic essay The Time of Her Life (2004) and Elisabeth Zahnd Legnazzi’s Chiara A Journey Into Light (2009). Illness in these projects is not experienced in isolation. Instead, the photographs and accompanying texts provide a space to engage in a dialogue which is built on the interdependency of all the participants of the photographic act – the photographer, the subject of the photograph and the viewer. My aim is to question how these projects construct experiences and articulate private expressions of illness and how the photographs enhance and/or challenge the mother–daughter bond. Alan Radley’s critical analysis of representations of illness, Emmanuel Lévinas’s and Maurice Blanchot’s perspectives on ethical philosophy and visual social semiotics approach developed by Kress and Van Leeuwen provide a guiding framework for this study.
Political comedy engagement: Identity and community construction
Authors: Doona Joanna
Published: December 2018

This article uses the concept of cultural citizenship to understand engagement in political comedy. The concept stresses popular culture’s value for identity and community construction, as well as the importance of learning about and respecting others. Using empirical work on Swedish young adult political comedy audiences in the form of data from in-depth interviews and focus groups, the article argues for analysis of engagement in various discursive forms, in studies of media and citizenship. More specifically, the article answers the question: which citizenship values are defended by political comedy engagement? In order to identify such values, the study focuses on the ways in which audience members construct identity and community, in relation to their political comedy engagement. Four themes of community construction are found: lacking social contexts, ideology and strong emotions, knowledge and education, and irony as a discursive mode and disposition. From these, the values of playful and emotional modes of engagement are conceptualized. The final parts of the article argue for those modes’ legitimacy and significance – both in relation to engagement in, and through, political comedy.
Limitations of the flutter derivative model
Authors: Zhang Xin , Zhao Lin
Published: December 2018

Flutter derivatives identified from transient (free-decay) vibrations might not be suitable for the analysis of bridge flutter. The application of transient flutter derivatives in the flutter analysis relies on two assumptions: (1) transient flutter derivatives and steady-state flutter derivatives are equivalent and (2) aeroelastic effects are superposable. Both assumptions are challenged in this article. It is shown through transient vibration tests that (1) the aeroelastic-coupling between heaving and rotational motions may switch from one pattern to another as the wind speed varies and (2) some of the transient flutter derivatives may be time-varying. The former implies that the predicted flutter type based on transient flutter derivatives may not be unconditionally consistent with the experimentally observed flutter type; the latter implies the transient flutter derivatives may be physically different from the steady-state flutter derivatives. These two issues undermine the basic assumptions of the flutter analysis of bridges. A possible corollary to this study is that if free vibration is used to predict bridge flutter, we should resort to the steady-state (flutter state) vibration instead of the transient vibration of the sectional model. A revision to the aeroelastic force model is proposed to facilitate the discussion.
An evaluation of behaviour change techniques in health and lifestyle mobile applications
Authors: Antezana Gaston , Venning Anthony , Blake Victoria , Smith David , Winsall Megan , Orlowski Simone , Bidargaddi Niranjan
Published: December 2018

Despite the current popularity and potential use of mobile applications (apps) in the area of behaviour change, health promotion, and well-being for young people, it is unclear whether their design is underpinned by theory-based behaviour change techniques. Understanding the design of these apps may improve the way they can be used to support young people’s well-being.The objectives of this study were to investigate what behaviour change techniques are included in the content of health and lifestyle apps, and determine which of these are prominent in app design. Thirty of the top-listed health and lifestyle apps across three categories (physical activity, diet, and sleep) were freely downloaded from the two most popular app stores (GooglePlay™ and AppStore™). Selected apps were used by trained researchers and the features identified coded against the Behaviour Change Techniques Taxonomy 1, a systematic classification of techniques used in behaviour change interventions. It was found that 9 of the 93 behaviour change techniques listed in the Behaviour Change Techniques Taxonomy 1 were common across the chosen health and lifestyle apps. The app found to include the most behaviour change techniques had 20 (21%), while the app found to include the least had 1 behaviour change technique (1%). The most frequently used behaviour change techniques were related to goal setting and feedback. Entire categories in the Behaviour Change Techniques Taxonomy 1 were absent in the design of the selected apps.
The political ambivalences of participatory planning initiatives
Authors: Van Wymeersch Elisabet , Oosterlynck Stijn , Vanoutrive Thomas
Published: December 2018

This article explores the relevance of combining multiple understandings of democratic politics to analyse the ambivalent and contentious dynamics of citizen participation in spatial planning. Building forth on the ongoing efforts in critical planning theory to overcome the deadlock between collaborative and agonistic oriented planning approaches, we argue for the refraining from ‘over-ontologising’ the question of democratic politics in planning processes, and start from the assumption that participatory planning processes as an empirical reality can accommodate radically different, even incompatible views on democracy. In addition, it is argued that while current planning scholars predominantly focus on the applicability of the collaborative and (ant)agonistic approach to democratic politics, a third approach – based on Jacques Rancière’s notion of political subjectification grounded in equality – may be discerned. By mobilising an empirical study of a contentious participatory planning initiative in Ghent (Belgium), that is, the Living Street experiment, we illustrate that while different approaches to democratic politics do not necessarily align with each other, they are often simultaneously at work in concrete participatory planning processes and indeed explain their contentious nature.
From ‘traditional professions’ to ‘new professionalism’: A multi-level perspective for analysing professionalisation in adult and continuing education
Authors: Egetenmeyer Regina , Breitschwerdt Lisa , Lechner Reinhard
Published: December 2018

Within the discourse about the professionalisation of adult and continuing education, an extensive discussion about how adult and continuing education can become a profession has taken place. Based on ‘classic professionalisation theories’, which are guided by the concept of ‘traditional professionals’, this discussion was about the fulfilment of specific attributes, and profession was considered in terms of its role in society. In the last two decades, this perspective has changed, and theoretical and empirical approaches now focus on the ‘professionalism’ of adult educators. This development is linked to extensive transformations in the modern working world, in which professionalism is considered a sign of quality. These changes and their influence on professionalisation were already discussed in terms of a sociology of professions and the ‘new professionalism’ approach – but researchers in adult and continuing education have so far made little use of this perspective. This paper is analysing the discourse around ‘new professionalism’ for its adaptability in adult and continuing education. Based on this analysis, it proposes a multi-level perspective for analysing professionalisation in adult and continuing education.
Human Resource Development and Expanding STEM Career Learning Opportunities: Exploration, Internships, and Externships
Authors: Ainslie Paul J. , Huffman Shelley L.
Published: December 2018

The Problem

American businesses are facing unprecedented opportunities in the global marketplace but are struggling to hire skilled workers in STEM (science, technology, engineering, and mathematics)-related jobs to address these opportunities. The past decade has resulted in an increase of STEM jobs; human resource development (HRD) practitioners have an important responsibility in the recruitment and retention of STEM employees.

The Solution

This article focuses on STEM careers and education pathways. HRD practitioners can play an important role in fostering career exploration and development for those aspiring to or currently in a STEM field by leading unique coalition initiatives to engage schools and others in talent solutions. In particular, programs in Indiana are highlighted for both their novel engagement methods and providing workplace learning experiences that HRD practitioners can replicate.

The Stakeholders

Human resource leaders, HRD practitioners, leaders in the education-business ecosystem.
Advancing Women of Color in STEM: An Imperative for U.S. Global Competitiveness
Authors: Alfred Mary V. , Ray Sarah M. , Johnson Michele A.
Published: December 2018

The Problem

The underrepresentation of people of color in science, technology, engineering, and mathematics (STEM) has become a crisis of significant proportion. The crisis is more pronounced when we examine participation by race and gender and explore how these two primary identity dimensions serve to marginalize women of color in STEM fields. These differential representations start during the early years and continue within institutions of higher education and the workplace.

The Solution

To address the absence of women of color in STEM, it is important to understand the forces that hinder and support their career development, beginning with early childhood experiences and throughout education and work environments. Interventions promoting diversity, equity, and inclusion must start in early and secondary education and continue through academia and the workplace.

Stakeholders

Addressing this crisis is the responsibility of leaders of public and higher education and those of business and industry.
Future Directions: Challenges and Solutions Facing Career Readiness and Development in STEM Fields
Authors: McDonald Kimberly S. , Waite Alina M.
Published: December 2018

The Problem

This issue has highlighted some of the challenges in recruiting, preparing, and retaining individuals in science, technology, engineering, and mathematics (STEM) careers. Specifically, there is an increasing need to attract and prepare more STEM workers, address the underrepresentation of women in these careers, and provide ways to develop STEM students’ and employees’ social skills.

The Solution

These challenges require a systems approach involving educational institutions, community programs, and businesses and industry. Human resource development (HRD) initiatives and expertise are needed in all types of organizations to support the preparation and retention of a vibrant STEM workforce.

The Stakeholders

Teachers and faculty working with STEM students, managers and HRD practitioners, and HRD scholars interested in STEM careers.
Vasculitis—What Do We Have to Know? A Review of Literature
Authors: Shavit Eran , Alavi Afsaneh , Sibbald R. Gary
Published: December 2018

Cutaneous and other vasculitides are specific inflammations of the blood vessel wall that can take place in any organ system of the body including the skin. Vasculitis has been traditionally divided according to the size of the vessel involved (small, medium, and large). Vasculitis is more of a reaction pattern rather than a specific disease entity. Therefore, the clinical presentation of vasculitis (most commonly palpable purpura on the lower extremities) dictates a thorough history, review of systems, and a meticulous physical examination. The diagnosis of vasculitis relies also on the histopathological and immunofluorescence studies. Wound care specialist may face with vasculitis-associated ulcers along with a spectrum of other cutaneous presentations associated with vasculitis. The focus of this article is to update the types, etiology, pathogenesis, and management options for cutaneous vasculitis.
Current Practice and Emerging Molecular Imaging Technologies in Oral Cancer Screening
Authors: Strome Arianna , Kossatz Susanne , Zanoni Daniella Karassawa , Rajadhyaksha Milind , Patel Snehal , Reiner Thomas
Published: December 2018

Oral cancer is one of the most common cancers globally. Survival rates for patients are directly correlated with stage of diagnosis; despite this knowledge, 60% of individuals are presenting with late-stage disease. Currently, the initial evaluation of a questionable lesion is performed by a conventional visual examination with white light. If a lesion is deemed suspicious, a biopsy is taken for diagnosis. However, not all lesions present suspicious under visual white light examination, and there is limited specificity in differentiating between benign and malignant transformations. Several vital dyes, light-based detection systems, and cytology evaluation methods have been formulated to aid in the visualization process, but their lack of specific biomarkers resulted in high false-positive rates and thus limits their reliability as screening and guidance tools. In this review, we will analyze the current methodologies and demonstrate the need for specific intraoral imaging agents to aid in screening and diagnosis to identify patients earlier. Several novel molecular imaging agents will be presented as, by result of their molecular targeting, they aim to have high specificity for tumor pathways and can support in identifying dysplastic/cancerous lesions and guiding visualization of biopsy sites. Imaging agents that are easy to use, inexpensive, noninvasive, and specific can be utilized to increase the number of patients who are screened and monitored in a variety of different environments, with the ultimate goal of increasing early detection.
Increasing reward prospect promotes cognitive flexibility: Direct evidence from voluntary task switching with double registration
Authors: Fröber Kerstin , Pfister Roland , Dreisbach Gesine
Published: December 2018

Recent research has suggested that sequential changes in the prospect of performance-contingent rewards may influence the balance between cognitive flexibility and stability: whereas constant high reward prospect seems to promote cognitive stability, increasing reward prospect has been shown to promote flexible behaviour in voluntary task-switching paradigms. Previous studies, however, confounded cognitive flexibility regarding voluntary task choices with control processes during task execution. We present five experiments to dissociate these two processes by means of a double registration procedure, in which task choice is registered prior to task execution. The data yielded clear evidence for reward-driven modulation of the flexibility-stability balance already at the level of task choices, with higher voluntary switch rates when reward prospect increased compared with situations in which reward prospect remained high. This effect was further modulated by the specific type of registration procedure, suggesting that only deliberate task choices are affected by the reward sequence. These results thus confirm that the prospect of performance-contingent reward can indeed promote either cognitive stability or flexibility depending on the immediate reward history.
Metabolic syndrome identifies normal weight insulin-resistant stroke patients at risk for recurrent vascular disease
Authors: Dearborn Jennifer L , Viscoli Catherine M , Inzucchi Silvio E , Young Lawrence H , Kernan Walter N
Published: December 2018

Background

The obesity paradox refers to the finding in observational studies that patients with obesity have a better prognosis after stroke than normal weight patients.

Aim

To test the hypothesis that there might be important heterogeneity within the obese stroke population, such that those with metabolic syndrome would be at higher risk for stroke or myocardial infarction and all-cause mortality compared to patients without metabolic syndrome.

Methods

The Insulin Resistance Intervention after Stroke trial enrolled non-diabetic patients with a recent ischemic stroke or transient ischemic attack and insulin resistance. We examined the association between metabolic syndrome and outcome risk in patients with normal weight at entry (body mass index (BMI) = 18.5–24.9 kg/m2), overweight (BMI = 25–29.9 kg/m2), or obesity (BMI ≥ 30 kg/m2). Analyses were adjusted for demographic features, treatment assignment, smoking, and major comorbid conditions.

Results

Metabolic syndrome was not associated with greater risk for stroke or myocardial infarction among 1536 patients who were overweight (adjusted hazard ratio (HR), 0.95; 95% confidence interval (CI): 0.69–1.31) or 1626 obese patients (adjusted HR, 1.00; 95% CI: 0.70–1.41). However, among 567 patients with a normal BMI, metabolic syndrome was associated with increased risk for stroke or myocardial infarction (adjusted HR, 2.05; 95% CI: 1.25–3.37), and all-cause mortality (adjusted HR, 1.70; 95% CI: 1.03–2.81) compared to patients without metabolic syndrome.

Conclusions

The presence of metabolic syndrome identified normal weight patients with insulin resistance but no diabetes who have a higher risk of adverse cardiovascular outcomes, compared with patients without metabolic syndrome.
How do neurologists diagnose transient ischemic attack: A systematic review
Authors: Fitzpatrick Tess , Gocan Sophia , Wang Chu Q , Hamel Candyce , Bourgoin Aline , Dowlatshahi Dar , Stotts Grant , Shamy Michel
Published: December 2018

Background

Identifying and treating patients with transient ischemic attack is an effective means of preventing stroke. However, making this diagnosis can be challenging, and over a third of patients referred to stroke prevention clinic are ultimately found to have alternate diagnoses.

Aims

We performed a systematic review to determine how neurologists diagnose transient ischemic attack.

Summary of review

A systematic literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using MEDLINE, Embase, and the Cochrane Library databases. Publications eligible for inclusion were those that included information on the demographic or clinical features neurologists use to diagnose transient ischemic attacks or transient ischemic attack–mimics. Of 1666 citations, 210 abstracts were selected for full-text screening and 80 publications were ultimately deemed eligible for inclusion. Neurologists were more likely to diagnose transient ischemic attack based on clinical features including negative symptoms or speech deficits. Patients with positive symptoms, altered level of consciousness, or the presence of nonfocal symptoms such as confusion or amnesia were more likely to be diagnosed with transient ischemic attack–mimic. Neurologists commonly include mode of onset (i.e. sudden versus gradual), recurrence of attacks, and localizability of symptoms to a distinct vascular territory in the diagnostic decision-making process. Transient ischemic attack diagnosis was more commonly associated with advanced age, preexisting hypertension, atrial fibrillation, and other vascular risk factors.

Conclusions

Neurologists rely on certain clinical and demographic features to distinguish transient ischemic attacks from mimics, which are not currently reflected in widely used risk scores. Clarifying how neurologists diagnose transient ischemic attack may help frontline clinicians to better select patients for referral to stroke prevention clinics.
Redundancy allocation problem in a bridge system with dependent subsystems
Authors: Sabri-Laghaie Kamyar , Eshkevari Milad , Fathi Mahdi , Zio Enrico
Published: December 2018

The redundancy allocation problem is an important problem in system reliability design. Many researchers have investigated the redundancy allocation problem under different assumptions and for various system configurations. However, most of the studies have disregarded the dependence among components and subsystems. In real-world applications, the performance of components and subsystems can affect each others. For instance, the heat radiated by a subsystem can accelerate degradation of adjacent components or subsystems. In this article, a procedure is proposed for solving the redundancy allocation problem of a bridge structure with dependent subsystems. Copula theory is utilized for modeling dependence among subsystems, and artificial neural network and particle swarm optimization are applied for finding the best redundancy allocation. A numerical example is included to elaborate the proposed procedure and show its applicability.
Healthcare Signage Design: A Review on Recommendations for Effective Signing Systems
Authors: Rodrigues Rita , Coelho Rita , Tavares João Manuel R. S.
Published: December 2018

This article provides a set of recommendations, selected from the systematic literature review carried out, regarding signage systems for healthcare institutions that can be used for designing or redesigning more competent signage systems. The signage systems in healthcare settings are usually poorly designed due to the expansion of the original facilities, a lack of awareness of existing guidelines by the developers, and a lack of agreement between the existing recommendations. There are several guidelines and recommendations available in the literature; however, each work was developed for specific cultural contexts, so there is a lack of uniformity among them. Hence, there is a need to uniformize the guidelines for signage design in healthcare, in order to provide supportive information for developers to build and implement effective and efficient signage systems. This study examined the available literature on the subject and established a set of guidelines organized in categories to help the design process. A literature review was conducted, and 34 selected publications were analyzed from which recommendations were created. A best practices manual was also studied and used as the analytical framework to establish the design categories of the developed recommendations. This review resulted in guidelines divided into nine design categories that should be considered in the design and implementation process of signage systems in healthcare facilities.
Clinical and hemodynamic factors in predicting response to fluid challenge during right heart catheterization
Authors: Moghaddam Nima , Swiston John R. , Levy Robert D. , Lee Lisa , Huckell Victor F. , Brunner Nathan W.
Published: December 2018

Fluid challenge during right heart catheterization has been used for unmasking pulmonary hypertension (PH) related to left‐sided heart disease. We evaluated the clinical and hemodynamic factors affecting the response to fluid challenge and investigated the role of fluid challenge in the classification and management of PH patients. We reviewed the charts of 67 patients who underwent fluid challenge with a baseline pulmonary arterial wedge pressure (PAWP) of≤ 18 mmHg. A positive fluid challenge (PFC) was defined as an increase in PAWP to > 18 mmHg after 500 mL saline infusion. Clinical characteristics and echocardiographic and hemodynamic parameters were compared between PFC and negative fluid challenge (NFC). PFC was associated with female sex, increased BMI, and hypertension. A greater rise in PAWP was observed in PFC (6.8 ± 2.3 vs. 3.8 ± 2.7 mmHg, P = 0.001). A larger increase in PAWP correlated with a lower transpulmonary gradient (r = –0.42, P < 0.001), diastolic pulmonary gradient (r = –0.42, P < 0.001), and pulmonary vascular resistance (r = –0.38, P < 0.001). We found 100% of the patients with PFC were classified as WHO group 2 PH compared to 49% of the NFC patients (P < 0.001). Fewer patients with PFC were started on advanced PH therapies and more were discharged from PH clinic. A PFC and the magnitude of PAWP increase after saline loading are associated with parameters related to left heart disease. In our population, fluid challenge appeared to influence the classification of PH and whether patients are started on therapy or discharged from clinic.
Associations between endothelial nitric oxide synthase gene polymorphisms and the risk of coronary artery disease: A systematic review and meta-analysis of 132 case-control studies
Authors: Li Xiaoqing , Lin Yong , Zhang Ruizhi
Published: December 2018

The roles of endothelial nitric oxide synthase gene polymorphisms in coronary artery disease have been intensively analyzed, with inconsistent results. Therefore, we performed this study to better assess the relationship between endothelial nitric oxide synthase genetic variations and the risk of coronary artery disease. Eligible studies were searched in PubMed, Medline, Embase, and Web of Science. Odds ratios with 95% confidence intervals were used to evaluate associations between endothelial nitric oxide synthase polymorphisms and coronary artery disease. A total of 132 genetic association studies were finally included. Significant associations with the risk of coronary artery disease were detected for the rs891512, rs1799983, rs2070744, rs11771443 and rs869109213 polymorphisms. Further subgroup analyses according to ethnicity of participants revealed that the rs1799983 and rs2070744 polymorphisms were significantly associated with the risk of coronary artery disease in both Caucasians and Asians, whereas the rs869109213 polymorphism was only associated with the risk of coronary artery disease in Caucasians. When we stratified data based on type of disease, we found that the rs1799983, rs2070744 and rs869109213 polymorphisms were all significantly correlated with the risk of myocardial infarction or acute coronary syndrome in certain genetic models. In conclusion, our findings indicate that the rs891512, rs1799983, rs2070744, rs11771443 and rs869109213 polymorphisms may serve as genetic biomarkers of coronary artery disease.
Better lung function with increased handgrip strength, as well as maximum oxygen uptake, in congenital heart disease across the lifespan
Authors: Smith Maia P , Müller Jan , Neidenbach Rhoia , Ewert Peter , Hager Alfred
Published: December 2018

Background

The respiratory benefits of muscle strength are well-known in heart-healthy populations, but recommendations and research often focus instead on aerobic fitness (peak oxygen uptake) or total activity. Independent benefits of strength thus may be underestimated, especially in congenital heart disease where perceived dangers of certain types of exercise may outweigh perceived benefits. To assess whether it is plausible that pulmonary benefits of strength in heart-healthy populations also apply in congenital heart disease, we simultaneously correlated these patients’ lung function with fitness, strength, and cardiac diagnosis.

Methods

Lung function (forced expiratory volume in one second percentage predicted (FEV1%pred)) was modeled as function of handgrip strength, congenital heart disease diagnosis, peak oxygen uptake and the interactions of handgrip with sex and diagnosis in 538 Germans (58% male, ages 6–82 years) in linear models corrected for age, sex, height and weight. Congenital heart disease diagnoses were: complex cyanotic; Fallot/Truncus arteriosus communis (common arterial trunk) (TAC); shunts; transposition of the great arteries (TGA); left heart; and other/none.

Results

Each kg of handgrip was associated with 0.74% higher FEV1%pred ( p < 0.001) and handgrip explained almost 10% of variance in FEV1%pred. While some groups had higher FEV1%pred than others ( p for global null <0.0001), all experienced similar associations with strength ( p for interaction with handgrip >0.10 for both sex and diagnosis.) Correction for peak oxygen uptake eliminated the association with congenital heart disease, but not handgrip.

Conclusion

Strength was associated with better lung function in all ages even after correction for peak oxygen uptake, regardless of sex and congenital heart disease. This suggests that strength may be at least as important for lung function as aerobic fitness. Heart-safe strength training may improve pulmonary function in congenital heart disease.
Apocrine gland anal sac adenocarcinoma with perineural metastasis in a cat
Authors: Raleigh Joseph S , Lanza Matthew R , Perry James A
Published: December 2018

Case summary

A 15-year-old female spayed domestic shorthair cat was presented for hyporexia and acute development of L4–Cd myelopathy (urinary incontinence, pelvic limb paresis with hyporeflexia and absent tail tone). Humane euthanasia was elected owing to the rapid neurological deterioration and necropsy was performed. Post-mortem examination identified a right-sided anal sac mass and medial iliac lymphadenopathy. No gross lesions were evident in the cauda equina or peripheral nerves. Histopathology and immunohistochemistry utilizing wide-spectrum cytokeratin confirmed apocrine gland carcinoma of the anal sac with lymph node, peripheral nerve and cauda equina metastasis.

Relevance and novel information

This is the first report of feline anal sac adenocarcinoma metastasizing to perineural tissue. In addition, it provides a novel differential diagnosis for L4–Cd myelopathy and urinary incontinence in a cat.
Successful utilization of the EMR in a multiple sclerosis clinic to support quality improvement and research initiatives at the point of care
Authors: Claire Simon Kelly , Hentati Afif , Rubin Susan , Franada Tiffani , Maurer Darryck , Hillman Laura , Tideman Samuel , Szela Monika , Meyers Steven , Frigerio Roberta , Maraganore Demetrius M
Published: December 2018

Background

Many physicians enter data into the electronic medical record (EMR) as unstructured free text and not as discrete data, making it challenging to use for quality improvement or research initiatives.

Objectives

The objective of this research paper was to develop and implement a structured clinical documentation support (SCDS) toolkit within the EMR to facilitate quality initiatives and practice-based research in a multiple sclerosis (MS) practice.

Methods

We built customized EMR toolkits to capture standardized data at office visits. Content was determined through physician consensus on necessary elements to support best practices in treating patients with demyelinating disorders. We also developed CDS tools and best practice advisories within the toolkits to alert physicians when a quality improvement opportunity exists, including enrollment into our DNA biobanking study at the point of care.

Results

We have used the toolkit to evaluate 541 MS patients in our clinic and begun collecting longitudinal data on patients who return for annual visits. We provide a description and example screenshots of our toolkits, and a brief description of our cohort to date.

Conclusions

The EMR can be effectively structured to standardize MS clinic office visits, capture data, and support quality improvement and practice-based research initiatives at the point of care.
Feminization of Agriculture in the Eastern Hills of Nepal: A study of Women in Cardamom and Ginger Farming
Authors: Upreti Bishnu Raj , Ghale Yamuna , Shivakoti Sharmila , Acharya Sushant
Published: December 2018

There have been very few studies in the process of feminization of agriculture in Nepal. The overall purpose of this study was to analyze the changing role of women in high-value agriculture in the postconflict context of Nepal. In this study, we applied qualitative research tools: focus group discussion, key informant interview, on-site observation, and descriptive and interpretative analysis. The study found that after the peace agreement of 2006, the engagement of women in high-value agriculture such as large cardamom and ginger increased rapidly and contributed to the empowerment of women. The study reveals that rural women’s engagement in “women cooperatives” provided them social, economic, and political recognition and decision-making space. However, they are facing additional challenges and risks related to marketing, crop protection, and export to international markets. Though recent policy changes are favorable to address risks and challenges, their effective implementation is yet to be fully realized. This article concludes that the changing political context in Nepal has provided space for women to engage in high-value agriculture. However, women’s engagement is limited to production and primary processing, while further along the value chain, where more profits are made with less risk, women tend to acquire less benefits. The government needs special policy and regulatory provisions and institutional arrangements to address (a) the problem of international export market and (b) the problem of crop protection measures.
Living and Working at Oasis Hospital: Recollections of Missionary Nurses
Authors: Zielinski Ruth , Lagerwey Mary
Published: December 2018

Mission hospitals in postcolonial developing countries were often staffed by female nurses who cared for women during labor and birth. This article is a thematic analysis of narratives from nurses who served at Oasis Hospital, United Arab Emirates, during the years 1960 to 1980. Despite the challenges and sacrifices (both during their service and upon returning to their homelands), these nurses spoke fondly of community, friendships, and a sense of accomplishment.
The definition of syntactic types: The generation, analysis, and sorting of universes of superblock designs
Authors: Feng Chen , Peponis John
Published: December 2018

Syntactic types are defined as sets of designs with particular properties. We are specifically interested in the definition of deformed grids, a particular type of street network internal to superblocks. The superblocks under study are surrounded by arterial streets and have traversing local main streets and internal street infills. The argument takes advantage of three kinds of rules or algorithms: generative rules that produce a universe of designs, analytical algorithms that can be applied to the description of properties of interest for each member of the universe, and query or sorting rules that allow us to identify those members of the universe that have particular ranges and combinations of properties of interest. The iterative application of analytical and sorting algorithms assists the transition from an intuitive to formalized definitions of type.
Subscapularis-On Approach in Reverse Shoulder Arthroplasty
Authors: Lädermann Alexandre , Tay Eileen , Scheibel Markus
Published: December 2018

Using a subscapularis- and deltoid-preserving anterior approach is an option for patients undergoing reverse shoulder arthroplasty. Outcomes are better at short term than compared with the standard deltopectoral approach. Maintaining the integrity of the subscapularis tendon and preserving the deltoid muscle minimizes the need for postoperative immobilization and rehabilitation, allowing the patient to achieve active shoulder range of motion more rapidly, without increasing the incidence of shoulder dislocation. Overall length of hospital stay and duration of postoperative physical therapy are minimized, leading to significant economic gain. Future studies with longer follow-up are required to document the potential long-term benefits of this surgical technique.

Level of Evidence of the study: Review, Level IV
Surgery in nontuberculous mycobacteria pulmonary disease
Authors: Lu Mimi , Fitzgerald Dominic , Karpelowsky Jonathan , Selvadurai Hiran , Pandit Chetan , Robinson Paul , Marais Ben J.
Published: December 2018

Medical treatment of pulmonary nontuberculous mycobacteria (NTM) disease has highly variable outcomes. Despite the use of multiple antibiotics, sputum clearance is often difficult to achieve, especially in cases with macrolide resistant NTM infection. Immunocompromised patients and those with structural lung disease are at increased risk, although occurrence in immunocompetent patients without structural lung disease is well recognised. Most pulmonary NTM disease involvesMycobacterium aviumcomplex (MAC), but with enhanced identification multiple species have now been recognised as opportunistic pathogens. The observed increase in NTM disease, especially infection with multidrug-resistantMycobacterium abscessuscomplex, is probably multifactorial. Surgery has been used as adjuvant treatment in patients with 1) focal disease that can be removed or 2) bothersome symptoms despite medical treatment that can be ameliorated. Early post-surgical mortality is low, but long-term morbidity and mortality are highly dependent on the degree of lung involvement and the residual lung function, the potency of medical treatment and the type of surgical intervention. In conjunction with antibiotic therapy, reported post-surgical sputum clearance was excellent, although publication bias should be considered. Bronchopleural fistulae were problematic, especially in pneumonectomy cases. Study results support the use of minimal resection surgery, in a carefully selected subgroup of patients with focal disease or persistent symptoms.

Educational aims

To critically review the literature describing the use of surgery in the treatment of pulmonary disease caused by nontuberculous mycobacteria (NTM).

To assess the outcomes and complications observed with different surgical approaches used in the treatment of pulmonary NTM disease.
Nasal microbiota and symptom persistence in acute respiratory tract infections in infants
Authors: Neumann Roland P. , Hilty Markus , Xu Binbin , Usemann Jakob , Korten Insa , Mika Moana , Müller Loretta , Latzin Philipp , Frey Urs
Published: December 2018

Acute respiratory tract infections (ARI) in infancy have been implicated in the development of chronic respiratory disease, but the complex interplay between viruses, bacteria and host is not completely understood. We aimed to prospectively determine whether nasal microbiota changes occur between the onset of the first symptomatic ARI in the first year of life and 3 weeks later, and to explore possible associations with the duration of respiratory symptoms, as well as with host, environmental and viral factors.

Nasal microbiota of 167 infants were determined at both time-points by 16S ribosomal RNA-encoding gene PCR amplification and subsequent pyrosequencing. Infants were clustered based on their nasal microbiota using hierarchical clustering methods at both time-points.

We identified five dominant infant clusters with distinct microbiota at the onset of ARI but only three clusters after 3 weeks. In these three clusters, symptom persistence was overrepresented in the Streptococcaceae-dominated cluster and underrepresented in the cluster dominated by “Others” (p<0.001). Duration of symptoms was not associated with the type of respiratory virus.

Infants with prolonged respiratory symptoms after their first ARI tend to exhibit distinct microbial compositions, indicating close microbiota–host interactions that seem to be of importance for symptom persistence and recovery.
In the Shadow of Litigation: Arbitration and Medical Malpractice Reform
Authors: Staszak Sarah
Published: December 2018

Alongside the dramatic growth in the use of mandatory, binding arbitration in the United States, proposals to use arbitration in lieu of medical malpractice litigation have proliferated as a mechanism for providing a more efficient and less costly way to resolve disputes. However, these proposals have largely been divorced from an understanding of the history, politics, and law of arbitration, which comes with a significant cost. Although liberals developed arbitration with the goal of ensuring access to justice for those who struggled to find it in traditional courts, conservatives (both in Congress and in the private sector) began to promote it in the latter part of the 20th century as a way to keep what they considered “lesser” cases out of court and to better protect corporate and other powerful institutional defendants from litigation. This article examines this transition toward the use of private, mandatory, and binding arbitration through three periods of institutional change: partisan conversion, judicialization, and privatization. It argues that it is essential to situate malpractice reform proposals in the history, politics, and law of arbitration in practice, where partisan efforts have privatized arbitration with significant effects for equality under the law.
Beneath the Surface of Unnecessary Surgery: A Case Study on the Limits of Existing Protections
Authors: Smith David Barton
Published: December 2018

Unnecessary surgery has been a focus of health policy concern for decades. Such events are supposed to be prevented by the (a) self-policing of hospital medical staffs, (b) oversight of state medical boards, (c) third-party restrictions on payment, and (d) threat of malpractice lawsuits. While critics may point to failures of will on the part of those responsible for such policing, this case study points to more fundamental problems. The case involved an extension of the diagnosis of Chiari malformation to justify surgery to help relieve symptoms of individuals previously identified as suffering from chronic pain or fatigue syndrome. It illustrates how strenuous efforts to reduce what other members of the medical profession perceived as unnecessary surgery were overcome by (a) uncertainty concerning appropriate diagnosis and treatment, (b) patient desperation-driven self-referrals unrestricted by professional oversight or geographic boundaries, (c) the ambition of a surgeon determined to practice as he or she desired, (d) a business-focused national hospital chain insulated from direct clinical accountability, and (e) the highly profitable nature of the surgery itself.