bluuebunny/crossref_metadata_2025 huggingface dataset:
Pediatric Stroke Rates Over 17 Years: Report From a Population-Based Study
Authors: Lehman Laura L. , Khoury Jane C. , Taylor J. Michael , Yeramaneni Samrat , Sucharew Heidi , Alwell Kathleen , Moomaw Charles J. , Peariso Katrina , Flaherty Matthew , Khatri Pooja , Broderick Joseph P. , Kissela Brett M. , Kleindorfer Dawn O.
Published: April 2018

We previously published rates of pediatric stroke using our population-based Greater Cincinnati Northern Kentucky Stroke Study (GCNK) for periods July 1993–June 1994 and 1999. We report population-based rates from 2 additional study periods: 2005 and 2010. We identified all pediatric strokes for residents of the GCNK region that occurred in July 1, 1993–June 30, 1994, and calendar years 1999, 2005, and 2010. Stroke cases were ascertained by screening discharge ICD-9 codes, and verified by a physician. Pediatric stroke was defined as stroke in those <20 years of age. Stroke rates by study period, overall, by age and by race, were calculated. Eleven children died within 30 days, yielding an all-cause case fatality rate of 15.7% (95% confidence interval 1.1%, 26.4%) with 3 (27.3%) ischemic, 6 (54.5%) hemorrhagic, and 2 (18.2%) unknown stroke type. The pediatric stroke rate of 4.4 per 100 000 in the GCNK study region has not changed over 17 years.
Depressive Symptoms Moderate Dating Violence Prevention Outcomes Among Adolescent Girls
Authors: Collibee Charlene , Rizzo Christie J. , Kemp Kathleen , Hood Erik , Doucette Hannah , Gittins Stone Daniel I. , DeJesus Brett
Published: April 2018

Purpose: Few dating violence prevention programs assess how variations in initial violence risk affects responsiveness. This study examines the efficacy of Date SMART, a dating violence and sexual risk prevention program designed to target high-risk adolescent girls, in preventing dating violence in the context of varying initial levels of depressive symptoms. Method: A diverse sample of N = 109 female adolescents with a history of physical dating violence participated in a randomized controlled trial of the Date SMART program and a knowledge only (KO) comparison. Results: Using baseline depression level as a primary risk factor, a series of multilevel models revealed significant main effects of baseline depression such that higher baseline depression was associated with greater physical dating violence perpetration and victimization. Results also showed a three-way interaction for assessment point, depressive symptoms, and condition for physical dating violence perpetration. Specifically, those with higher baseline depression in Date SMART showed significantly less physical dating violence perpetration at follow-ups compared with those with higher baseline depression in the KO group. This difference in violence reduction between conditions was not observed for those with lower baseline depression. Discussion: Date SMART appears to effectively reduce physical dating violence perpetration in those with higher levels of initial risk. Current findings support that adolescents with different risk profiles respond differently to violence prevention programs.
Violence Against Women and Its Consequences on Women’s Reproductive Health and Depression: A Jordanian Sample
Authors: Damra Jalal K. , Abujilban Sanaa
Published: April 2018

The aims of this study were to investigate the women’s current reproductive health (RH) status, depression levels, and to clarify the relationships between the violence against women and depression and the RH components. Three hundred women participated in the study. Data were collected from the Women Health Center (WHC) in Prince Faisal hospital in Rusaifa, Jordan. The findings revealed that around 25.9%, 13.1%, 83.2%, and 65.1% of the participant women had been exposed to physical, sexual, control, and psychological violence, respectively. Around 77.7% of women were using contraceptives; oral contraceptives and intrauterine devices (IUDs) were the most common family planning methods used. In addition, the results revealed that 50% of women were suffering from significant levels of depression. A positive relationship between exposure to all violence types and women’s depression levels was found but not for all RH components.
Systemic Thrombolytic Therapy for Massive and Submassive Pulmonary Embolism
Authors: Igneri Lauren A. , Hammer John M.
Published: April 2018

Objective:

To critically evaluate the published literature assessing the safety and efficacy of thrombolytic therapy for massive and submassive pulmonary embolism (PE).

Methods:

A search of human trials in the English-language (September 2017) was conducted through the MEDLINE database using the following terms: PE, tissue plasminogen activator, tenecteplase, and alteplase. 67 unique articles were identified, of which 24 clinical trials discussing clinical outcomes related to administration of either intravenous tenecteplase or alteplase were included.

Results:

Thrombolytic therapy with anticoagulation significantly reduced mortality compared to anticoagulation alone in massive PE. In submassive PE, thrombolytics reduced the rate of right ventricular dysfunction and hemodynamic collapse; however, there is an increased risk of major and minor bleeding with no benefit on long-term functional outcomes.

Conclusions:

Patients with massive PE should receive thrombolytics when no major contraindications to therapy exist. Patients with submassive PE at highest risk for progression to hemodynamic instability should receive anticoagulation and be monitored for clinical deterioration. If an imminent risk of hemodynamic instability or cardiac arrest occurs, thrombolytics should be administered if no contraindications exist. Net mortality benefit and risk of bleeding must be considered when deciding to administer thrombolytic therapy in massive or submassive PE.
Prophylactic Use of Steroids and Antibiotics in Acute Hydrocarbon Poisoning in Children
Authors: Das Saibal , Behera Sapan Kumar , Xavier Alphienes Stanley , Selvarajan Sandhiya
Published: April 2018

Ingestion of hydrocarbons is a common cause of childhood poisoning in low and middle-income countries. Although mild ingestions are usually devoid of complications, the morbidity and mortality associated with such poisoning are primarily related to pulmonary aspiration. Subsequent complications, most importantly, secondary bacterial infections can worsen the clinical condition. Standard treatment protocol for acute accidental hydrocarbon poisoning does not advocate routine use of steroids or antibiotics. However, some studies have demonstrated beneficial effects of prophylactic steroid and antibiotic to prevent chemical pneumonitis. In this article, we have summarized the findings of the clinical studies from literature, which have evaluated the advantages of early administration of steroids and antibiotics to prevent chemical pneumonitis in acute hydrocarbon poisoning in children. From these studies, we have found that there is no convincing evidence for initiating steroid and antibiotic to improve outcome in these children.
Local public libraries as human rights intermediaries
Authors: Glušac Luka
Published: April 2018

Traditionally, the literature has recognised the role of public libraries in the promotion of human rights, through their efforts in making information accessible to anyone, irrespective of their personal circumstances. At the same time, scholars have largely overlooked their potential in the protection of human rights. This article shows that libraries can make an important contribution to the protection function, by using the example of cooperation between the National Ombudsman of Serbia and 15 local public libraries in smaller municipalities. The research is framed within the Orchestration theory, recently developed by Abbott and others. We demonstrate that the relationship between the Ombudsman and local libraries can successfully be analysed with O-I-T framework, where the Ombudsman (Orchestrator) enlists local libraries (Intermediary) to become more accessible to citizens (Target), providing them with an easier way to communicate their human rights concerns and lodge a complaint with this key human rights remedy mechanism, by using the video communication software installed in local libraries. The results of this research could serve to inspire similar studies exploring the application of the Orchestration theory on the complex multi-actor human rights dynamics from a global perspective to national and local environments. While this research was inspired by the Serbian experience, its key policy implication is that innovative cooperation between a national human rights institution (NHRI) and local libraries is perfectly applicable to other states as well. The design of the project implemented in Serbia can be copied successfully worldwide, as it is not based on complicated infrastructural or institutional changes, but on creative and cost-effective idea.
Disgust, stigma, and the politics of abortion
Authors: Kumar Anuradha
Published: April 2018

Despite the growing body of research on the emotion of disgust – including its relationship to political ideology, moral judgment, matters of sex and sexuality, and death – the global reproductive rights movement has paid relatively little attention to the role disgust plays in the debate over abortion. By focusing on the right of a woman to make her own decision about an unwanted pregnancy, the pro-choice community has allowed anti-choice groups to define and frame the abortion procedure, abortion providers, and women who have abortions in terms associated with disgust. This commentary encourages further examination of what triggers disgust, its measurement, and ways of mitigating it, which could be useful for reducing abortion stigma, in future legal cases and in abortion research, advocacy, and communications.
Professional self-concept and professional values of senior students of the nursing department
Authors: Çöplü Mehtap , Tekinsoy Kartın Pınar
Published: April 2018

Aim:

This study was carried out in order to determine professional self-concept and professional values in the students, who were studying in the final year of the nursing department in schools providing undergraduate education in the Inner Anatolia Region.

Method:

This cross-sectional study was conducted on a total of 619 senior students of nursing departments in the Inner Anatolia Region. Data were collected using a Student Information Form, Professional Self-Concept Scale for the Student Nurses, and The Nurses’ Professional Values Scale. Descriptive statistics, the Shapiro–Wilk test, the t-test, analysis of variance, and the Bonferroni tests were used for data analysis.

Ethical Considerations:

A written consent was obtained from Ethics Board of Erciyes University Faculty of Medicine and from nursing schools participating in the study. Prior to data collection, students were informed about the purpose of the study and gave written and verbal consents. Participation in the study was on voluntary basis.

Findings:

In the study, students’ total and sub-dimension scores from the Professional Self-Concept Scale for the Student Nurses and total scores from the Nurses’ Professional Values Scale were moderately high. It was detected that women received higher scores than men from the sub-dimension of professional attributes; the students who had positive perception of the nursing image and voluntarily selected their department received high scores from professional satisfaction, professional competence, and professional attributes sub-dimensions of the Professional Self-Concept Scale for the Student Nurses ( p < 0.001).

Implication:

In order to improve students’ perceptions of professional self-concept and professional values, it is thought that students’ awareness should be increased on these topics.
Care Planning: What Works, for Whom, and in What Circumstances? A Rapid Realist Review
Authors: Brown Sarah , Lhussier Monique , Dalkin Sonia M. , Eaton Simon
Published: April 2018

Care planning has been described as a “better conversation” that helps people with long-term conditions to be in control of planning their care. Each person with long-term conditions faces individual challenges and each health care setting is fundamentally different, so there is a need for empirical testing of the specific mechanisms through which care planning may lead to health improvements. A rapid realist review was conducted to unearth underpinning mechanisms leading to outcomes in particular contexts. These are expressed in the form of realist theories, which are developed and refined through the review process. Fifty-one full text studies were included in the review. Seven program theories were iteratively tested and refined. A detailed description of what care planning is and what it should look like in practice has been achieved in the form of realist theories.
Does Remorse Count? ICTY Convicts’ Reflections on Their Crimes in Early Release Decisions
Authors: Hola Barbora , van Wijk Joris , Constantini Francesca , Korhonnen Armi
Published: April 2018

Based on all publicly available International Criminal Tribunal for the Former Yugoslavia (ICTY) early release decisions as of May 31, 2017, this explorative article empirically analyzes, systematizes, and evaluates how ICTY convicts reflected on their past crimes during early release proceedings and how this affected decision-making of the ICTY President regarding their level of rehabilitation and early release. For this purpose, we developed an analytical framework distinguishing between acknowledgement of responsibility and remorse, as two forms of reflection on the past crimes, and their general and personal dimensions. Our analysis demonstrates that of all 53 individuals early released at the ICTY, 36% were considered sufficiently rehabilitated and a part of their sentence pardoned without any information regarding their outlook on the crimes they had been convicted of. Only 19% of the early released prisoners acknowledged their personal responsibility and expressed remorse for the crimes they committed. Others denied, only partially accepted responsibility and/or showed remorse on a general level, which, however, did not bar their early release. The article argues that this haphazard practice brings into question the ICTY legacy with respect to its goal of offender rehabilitation and its potential effects on reconciliation in the Former Yugoslavia.
Attitudes Toward the Police in Communities Using Different Consolidation Models
Authors: Chermak Steven , Wilson Jeremy M.
Published: April 2018

Faced with continuing fiscal constraints, a growing number of communities have sought to provide police services in nontraditional ways. While a considerable amount of previous research explores community opinion about the police, no previous work, to our knowledge, focuses on what residents think of these nontraditional models. We surveyed residents in four communities with alternative models of policing: a merged department, two agencies that contracts for services, and a regional agency. We asked residents about their confidence in the police. We found that the type of police model was an important predictor of police confidence, controlling for other traditional measures of attitudes toward the police. We conclude with suggestions for research both on opinion regarding the police generally and among these types of communities specifically.
Teaching Data Journalism in New Zealand
Authors: Hannis Grant
Published: April 2018

This case study details how a postgraduate journalism programme in New Zealand uses a short, focused module to introduce students to the basic concepts and practices of data journalism. The students consider and reflect upon the examples of published data journalism and work through an example of data visualization. While some areas for improvement are suggested, a survey of the students reveals they are generally satisfied with the module.
The dynamic thermal process of indoor environment and building envelope during intermittent heating
Authors: Li Yanru , Wang Mengwei , Zhang Yin , Long Enshen
Published: April 2018

During intermittent heating, the heat storage in the building envelope and its release could have a coupling influence on the variation in the indoor environment. In this project, a simplified second-order lumped capacity system was developed to study the dynamic thermal process of indoor environment and in the building envelope during intermittent heating processes. An experimental model simulation was presented, and an onsite measurement in a residential building was carried out for the model validation. Based on the modelling simulation, the effects of the heating load and building envelope’s thermal capacity on the dynamic responses of the indoor thermal environment and heat storage of the building envelope were analysed. The results show that the heating energy consumption was reduced, while the indoor thermal comfort was not affected by the rational choice of the building envelope and heating load. This paper presents an optimization of the intermittent heating operation mode and the building envelope to maintain the indoor thermal environment for occupant comfort while saving energy by efficiency in the operation of the heat storage system. Our findings should provide guidance for practical building thermal design for energy efficiency of buildings.
Numerical prediction of the performance of marine propellers using computational fluid dynamics simulation with transition-sensitive turbulence model
Authors: Helal Mohamed M , Ahmed Tamer M , Banawan Adel A , Kotb Mohamed A
Published: April 2018

Determining and understanding the performance characteristics of marine propellers by experiments is quite a complex and costly task. Numerical predictions using computational fluid dynamics simulations could be a valuable alternative provided that the laminar-to-turbulent transition flow effects are fundamentally understood with the suitable numerical models developed. Experience suggests that the use of classical turbulent flow models may lead to high discrepancies especially at low rotational speeds where the effects of fluid flow transition from the laminar to the turbulent state may influence the predicted propeller’s performance. This article proposes a complete and detailed procedure for the computational fluid dynamics simulation of non-cavitating flow over marine propellers using the “ k–kl–ω” transition-sensitive turbulence model. Results are evaluated by “ANSYS FLUENT 16” for the “INSEAN E779A” propeller. Comparisons against the fully turbulent standard “ k–ε” model and against experiments show improved agreement in way of flow transition zones at lower rotational speeds, that is, at low Reynolds numbers.
The dynamics of eccentric block in a fully mechanical vertical drilling tool under the effect of torsional vibration
Authors: Li Lixin , Xue Qilong , Liu Baolin , Wang Jin , Li Xinyu
Published: April 2018

In present, the drilling industry have to face the reality of low oil and gas prices, fully mechanical vertical drilling tool is likely to become the best choice for vertical drilling in the future. Without electric measurement and control system, the mechanical vertical drilling tool has a mechanically stable platform with gravity sensitivity. The stable platform included an eccentric block which is not only sensitive to gravity but also severely affected by torsional vibration. In this article, we reveal the dynamics of eccentric block under the effect of torsional vibration, which is the key element of the well deviation control accuracy in mechanical vertical drilling tool. The dynamic model of eccentric block is established using Lagrangian equation and Coulomb friction, and the law of dynamic characteristics under the effect of different amplitudes and period of torsional vibration is found. The results show that, with the deviation angle and eccentric torsion moment of eccentric block is increased, the resistance to torsional vibration increases. While the frequency of torsional vibration decreases, a subordinate period gradually appears after the rotation speed value of ω is less than 1 rad/s, the torsional vibration with large amplitude and high frequency is detrimental to the stability of the eccentric block. In addition, the largest Lyapunov exponent is estimated using the time series of simulation, the dynamics of eccentric block under the effect of torsional vibration can be switched four types, and the maximum and minimum values of largest Lyapunov exponent are 3.99 × 10−2 and −2.98 × 10−2, which means with the state of torsional vibration changes and the response of eccentric block would be transformed to chaos.
Availability and maintenance modeling for a two-component system with dependent failures over a finite time horizon
Authors: Qiu Qingan , Cui Lirong , Kong Dejing
Published: April 2018

This article studies the availability and optimal maintenance policy for a two-component system with failure interaction over a finite time horizon. Failure of component 1 is soft and can only be detected by inspections. Failure of component 2 is hard and self-announcing. Each hard failure acts as a shock to the first component and increases its hazard rate. Periodic and opportunistic inspections (offered by failures of component 2) are used to reveal the failure of component 1 and followed by replacement decisions. Furthermore, age-based preventive replacement is performed for component 1. Under this maintenance policy, a recursive method is developed to obtain the availability measure of component 1. Furthermore, the total maintenance cost of component 1 over a finite time horizon is analyzed. The objective is to find the optimal maintenance policy for component 1 such that the expected total cost is minimized. A case study on electrical distribution system is provided to validate the effectiveness of the adopted approach.
Inhibition of autophagy with 3-methyladenine is protective in a lethal model of murine endotoxemia and polymicrobial sepsis
Authors: Li Qirui , Li Lingyun , Fei Xiaoyuan , Zhang Yuanyue , Qi Chang , Hua Shuyao , Gong Feili , Fang Min
Published: April 2018

Here, the regulatory role of autophagy is examined in both an LPS-induced lethal endotoxic shock mouse model and cecal ligation and puncture (CLP) mouse model. Autophagy-inhibitor 3-methyladenine (3-MA) and autophagy-enhancer rapamycin were administrated to mice challenged with LPS or CLP. Animals challenged with LPS or CLP combined with 3-MA displayed increased survival after endotoxemia, but LPS combined with rapamycin worsened the endotoxic shock of the mice. Among the different organs studied, the lungs and intestines exhibited significant differences among LPS alone, LPS combined with 3-MA and LPS combined with rapamycin. LPS combined with 3-MA attenuated the inflammatory damages of these organs as compared with LPS alone. In contrast, LPS combined with rapamycin increased damage in these organs. Consistently, serum inflammatory mediators TNF-α and IL-6 were decreased by the treatment of LPS combined with 3-MA as compared with LPS alone, while administration of LPS combined with rapamycin increased the serum TNF-α and IL-6 levels. Similar results were found in mouse bone marrow-derived macrophages exposed to LPS. Moreover, the regulatory effect of autophagy to endotoxic shock is dependent on the TLR4 signaling pathway. Our results demonstrate the central role of autophagy in the regulation of endotoxic shock and its potential modulation for endotoxic shock treatment.
TLR agonist combinations that stimulate Th type I polarizing responses from human neonates
Authors: Surendran Naveen , Simmons Andrea , Pichichero Michael E
Published: April 2018

Each year millions of neonates die due to vaccine preventable infectious diseases. Our study seeks to develop novel neonatal vaccines and improve immunogenicity of early childhood vaccines by incorporating TLR agonist-adjuvant combinations that overcome the inherent neonatal Th2 bias and stimulate Th1 polarizing response from neonatal APCs. We systematically stimulated cord blood mononuclear cells with single and multiple combinations of TLR agonists and measured levels of IL-12p70, IFN-γ, IFN-α, IL-10, IL-13, TNF-α, IL-6 and IL-1β from cell culture supernatants. APC-specific surface expression levels of costimulatory markers CD40, CD83 and PD-L1 were assessed by flow cytometry. Whole blood assays were included to account for the effect of plasma inhibitory factors and APC intracellular TNF-α and IL-12p40 secretions were measured. We found robust Th1 polarizing IL-12p70, IFN-γ and IFN-α responses when cord blood APCs were stimulated with TLR agonist combinations that contained Poly I:C, Monophosphoryl Lipid A (MPLA) or R848. Addition of class A CpG oligonucleotide (ODN) to Th1 polarizing TLR agonist combinations significantly reduced cord blood IL-12p70 and IFN-γ levels and addition of a TLR2 agonist induced significantly high Th2 polarizing IL-13. Multi-TLR agonist combinations that included R848 induced lower inhibitory PD-L1 expression on cord blood classical dendritic cells than CpG ODN-containing combinations. Incorporation of combination adjuvants containing TLR3, TLR4 and TLR7/8 agonists to neonatal vaccines may be an effective strategy to overcome neonatal Th2 bias.
The choice of sliding surface for robust roll control: Better suppression of high angle of attack/sideslip perturbations
Authors: Seyedtabaii S , Delavari M
Published: April 2018

The nominal aerodynamic parameters of aircraft are often approximate and aircraft may experience high value of angle of attack/sideslip perturbations during their manoeuvres. Preventing instability and air crash requires a robust controller capable of containing the dynamic uncertainty and the perturbations. In this respect, the problems of roll control in such a situation are studied and a better choice of sliding surface is proposed. Sliding mode control manages the uncertainty and adaptive fuzzy is employed to shape the transient response. As a result, a setup is formed which outperforms the basic controller both in terms of transient speed, response robustness and control effort. The strength of the method is more appreciated in case of high angle of attack/sideslip perturbed manoeuvres. This is proved theoretically and illustrated by simulations.
Thirty Minutes of Running Exercise Decreases T2 Signal Intensity but Not Thickness of the Knee Joint Cartilage: A 3.0-T Magnetic Resonance Imaging Study
Authors: Karanfil Yiğitcan , Babayeva Naila , Dönmez Gürhan , Diren H. Barış , Eryılmaz Muzaffer , Doral Mahmut Nedim , Korkusuz Feza
Published: April 2018

Objective

Recent studies showed a potential of magnetic resonance imaging (MRI), which can be used as an additional tool for diagnosing cartilage degeneration in the early stage. We designed a cross-sectional study in order to evaluate knee joint cartilage adaptation to running, using 3.0-T MRI equipped with the 3-dimensional turbo spin echo (VISTA = Volume ISotropic Turbo spin echo Acquisition) software. By this thickness (mm) and signal intensity (mean pixel value) can be quantified, which could be closely related to the fluid content of the knee joint cartilage, before and after running.

Methods

A total of 22 males, aged 18 to 35 years, dominant (right) and nondominant (left) knees were assessed before and after 30 minutes of running. Cartilage thickness and signal intensity of surfaces of the patella, medial and lateral femoral and tibial condyles were measured.

Results

Cartilage thickness of the lateral condyle decreased at the dominant knee, while it increased at the medial tibial plateau. Signal intensity decreased at all locations, except the lateral patella in both knees. The most obvious decrease in signal intensity (10.6%) was at the medial tibial plateau from 949.8 to 849.0 of the dominant knee.

Conclusion

There was an increase in thickness measurements and decrease in signal intensity in medial tibial plateau of the dominant knee after 30 minutes of running. This outcome could be related to fluid outflow from the tissue. Greater reductions in the medial tibial plateau cartilage indicate greater load sharing by these areas of the joint during a 30-minute running.
Global Citizenship Education and Human Rights in Scottish education: An analysis of education policy
Authors: Daniels Stephen J
Published: April 2018

Recently, doubt has been cast on the ability of Scottish education to meet relevant Human Rights requirements relating to education. This article will outline both a means of clarification for international requirements for Human Rights Education, and an analysis of documentation outlining Scottish educational policy for compatibility with these requirements. In doing so, this article will outline the development, and application, of a tool for document analysis focused on international requirements for Human Rights Education. The findings of this analysis suggest a number of key limitations in the current approach favoured by the Scottish Government. This approach posits Global Citizenship Education as a cross-curricular theme capable of fulfilling obligations in relation to rights in Curriculum for Excellence. I suggest that there is a distinct lack of support for the Human Rights Education requirements relating to the inclusion of taught content about human rights and that problems of apoliticality and the misguided focus on responsibilities all stand as significant barriers to Global Citizenship Education meeting the aims of Human Rights Education. I argue, on this basis, that the strategy currently adopted in Scotland appears to fall short of meeting basic international requirements for Human Rights Education.
The Hand of Professional School Counseling Meets the Glove of Restorative Practices
Authors: Smith Lance C. , Garnett Bernice R. , Herbert Alyxandra , Grudev Nicholas , Vogel Jamilah , Keefner Whitney , Barnett Ally , Baker Taylor
Published: April 2018

To introduce restorative practices (RP) to the school counseling literature, the authors explicate the hand in glove fit between the RP model for schools and school counselor identity and scope of practice. Drawing from the American School Counselor Association’s (ASCA) National Model, ASCA’s Ethical Standards for School Counselors, multitiered systems of support (MTSS), and the school counseling literature, the authors make the case for the profession of school counseling to take up RP and integrate the model into school counseling research, theory, and practice.
Smoking Trajectory Classes and Impact of Social Smoking Identity in Two Cohorts of U.S. Young Adults
Authors: Johnson Amanda L. , Villanti Andrea C. , Williams Valerie , Rath Jessica M. , Vallone Donna M. , Abrams David B. , Hedeker Donald , Mermelstein Robin J.
Published: April 2018

This study describes cigarette smoking trajectories, the influence of social smoker self-identification (SSID), and correlates of these trajectories in two cohorts of U.S. young adults: a sample from the Chicago metropolitan area (Social Emotional Contexts of Adolescent and Young Adult Smoking Patterns [SECAP], n = 893) and a national sample (Truth Initiative Young Adult Cohort Study [YA Cohort], n = 1,491). Using latent class growth analyses and growth mixture models, five smoking trajectories were identified in each sample: in SECAP: nonsmoking ( n = 658, 73.7%), declining smoking ( n = 20, 2.2%), moderate/stable smoking ( n = 114, 12.8%), high/stable smoking ( n = 79, 8.9%), and escalating smoking ( n = 22, 2.5%); and in YA Cohort: nonsmoking ( n = 1,215, 81.5%), slowly declining smoking ( n = 52, 3.5%), rapidly declining smoking ( n = 50, 3.4%), stable smoking ( n = 139, 9%), and escalating smoking ( n = 35, 2.4%). SSID was most prevalent in moderate/stable smoking (35.5% SECAP), rapidly declining smoking (25.2% YA Cohort), and nonsmoking. Understanding nuances of how smoking identity is formed and used to limit or facilitate smoking behavior in young adults will allow for more effective interventions to reduce tobacco use.
Metastasis Affecting Craniocervical Junction: Current Concepts and an Update on Surgical Management
Authors: O’Sullivan Michael Denis , Lyons Frank , Morris Seamus , Synnott Keith , Munigangaiah Sudarshan , Devitt Aidan
Published: April 2018

Study Design:

Literature review.

Objectives:

Metastatic disease affecting the craniovertebral junction (CVJ) only accounts for 0.5% of all spine metastases. The management of these disease processes is complex, which involves multimodality radiological studies and various surgical approaches. We aimed to review the available evidence and summarize the findings in this review.

Methods:

The authors conducted search of PubMed and Google Scholar with the following search terms: metastasis, craniovertebral junction (CVJ), occipitocervical, approaches, stability, and radiotherapy. Articles were reviewed by the authors and determined for inclusion based on relevance and level of evidence.

Results:

The majority of relevant research reviewed composed of literature reviews of particular aspects regarding metastatic disease affecting the craniovertebral junction, including diagnosis, surgical approach, and radiotherapy.

Conclusions:

Prompt evaluation of rotational neck pain with or without occipital neuralgia may reveal early metastatic disease within a stable CVJ. Magnetic resonance imaging appears to be the gold standard imaging modality in detecting this pathology, with nuclear bone scan playing a role in distinguishing benign and malignant processes. Unfortunately, no level 1 evidence exists for use of either radiotherapy or surgery in these cases; however, from the available literature, spinal instability and evidence of progressive neurology are relative indications for operative intervention.
“Saving Face”: An Online Study of the Injecting Use of DIY Botox and Dermal Filler Kits
Authors: Brennan Rebekah , Wells John S. G. , Van Hout Marieclaire
Published: April 2018

This study reports on an empirically underdocumented practice in contemporary aesthetic enhancement culture, the self-injection of unregulated DIY Botox and dermal filler kits purchased online. Data were collected from 4 online discussion forums containing disclosures in relation to use of DIY kits and analyzed using ethnographic content analysis. Motivation to source DIY Botox and dermal fillers online was grounded in desire to avoid financial cost of professional services and a lack of confidence in practitioners. Future intentions to order online raw materials and “formulas” to prepare dermal fillers at home were expressed. Individuals taught themselves to inject through watching YouTube tutorials and downloading Botox injection maps from the Internet. Although individuals demonstrated awareness of the health risks involved with self-injection of unregulated products, this was not a deterrent. Future research is warranted to document the injecting practices and health outcomes of individuals who inject DIY Botox and dermal filler kits to inform targeted harm reduction interventions by health-care practitioners.
Depression and Anxiety Among Patients on Chronic Opioid Therapy
Authors: Elrashidi Muhamad Y. , Philpot Lindsey M. , Ramar Priya , Leasure William B. , Ebbert Jon O.
Published: April 2018

Background:

Chronic noncancer pain (CNCP) and chronic opioid therapy (COT) commonly coexist with comorbid depression and anxiety. We investigated the prevalence of depression and anxiety and their correlates at the time of controlled substance agreement (CSA) enrollment among patients with CNCP and a history of depression or anxiety on COT.

Methods:

Retrospective analysis of 1066 patients in a Midwest primary care practice enrolled in CSAs for COT between May 9, 2013, and August 15, 2016. Patients with self-reported symptoms or a clinical history of depression or anxiety were screened at CSA enrollment using the Patient Health Questionnaire–9 item scale and the Generalized Anxiety Disorder–7 item scale.

Results:

The percentage of patients screening positive for depression and anxiety at CSA enrollment was 15.4% and 14.4%, respectively. Patients screening positive for depression or anxiety were more likely to be younger, unmarried, unemployed, and live alone compared to patients not screening positive. Patients screening positive for depression or anxiety were more likely to smoke cigarettes and report concern from friends or relatives regarding alcohol consumption. Compared to patients screening negative, patients screening positive for depression had higher odds of receiving opioid doses of ≥50 morphine milligram equivalents per day (adjusted odds ratio: 1.62; 95% confidence interval: 1.01-2.58).

Conclusion:

Anxiety and depression are prevalent at enrollment in CSAs among patients receiving COT. Future research is needed to determine whether recognition of anxiety and depression leads to improved management and outcomes for this population.
Wellness Coaching to Improve Lifestyle Behaviors Among Adults With Prediabetes: Patients’ Experience and Perceptions to Participation
Authors: DeJesus Ramona S , Clark Matthew M , Rutten Lila J Finney , Hathaway Julie C , Wilson Patrick M , Link Sara M , Sauver Jennifer St
Published: April 2018

Background:

Health and Wellness Coaching has been shown to enhance treatment outcomes in the primary care setting. However, little is known about the experience and perceptions of patients who worked with a wellness coach as an integrated member of their primary health-care team.

Objective:

This project assessed patients’ experience and obtained their perceptions on barriers and facilitators to participation in a primary care–based wellness coaching program.

Method:

A survey was mailed to 99 primary care patients with prediabetes who participated in a 12-week wellness coaching program.

Results:

Sixty-two (63%) completed the survey; responders felt that participation in the wellness coaching program helped move them toward healthier lifestyle behavior and created a personal vision of wellness. Major themes associated with participation were supportive coaching relationship, increased self-accountability, increased goal-setting, and healthy behavior strategies. No significant barrier to participation was reported.

Conclusion:

Participants reported highly positive experience with the program; how to best integrate health and wellness coaching into the primary care setting needs to be explored.
Disagreement in Assessing Neighboring and Collective Efficacy: The Role of Social Distance
Authors: Hipp John R. , Williams Seth A. , Boessen Adam
Published: April 2018

Whereas existing research typically treats variability in residents’ reports of collective efficacy and neighboring as measurement error, the authors consider such variability as of substantive interest in itself. This variability may indicate disagreement among residents with implications for the neighborhood collectivity. The authors propose using a general measure of social distance based on several social dimensions (rather than measures based on a single dimension such as racial/ethnic heterogeneity or income inequality) to help understand this variability in assessments. The authors use data from wave I (2001) of the Los Angeles Family and Neighborhood Survey ( n = 3,570) to aggregate respondents into egohoods of two different sizes: quarter-mile and half-mile radii. Consistent with expectations, neighborhoods with higher levels of general social distance have higher variability in reports of neighboring and the two components of collective efficacy, cohesion and informal social control.
Using a Patient Decision Aid Video to Assess Current and Former Smokers’ Values About the Harms and Benefits of Lung Cancer Screening With Low-Dose Computed Tomography
Authors: Hoffman Aubri S. , Hempstead Andrea P. , Housten Ashley J. , Richards Vincent F. , Lowenstein Lisa M. , Leal Viola B. , Volk Robert J.
Published: April 2018

Background. Recent policy changes require discussing the potential benefits and harms of lung cancer screening with low-dose computed tomography. This study explored how current and former smokers value potential benefits and harms after watching a patient decision aid, and their screening intentions. Methods. Current or former smokers (quit within 15 years) with no history of lung cancer watched the decision aid and responded to items assessing the value of potential benefits and harms in their decision making, and their screening intentions. Results. After viewing the decision aid, participants ( n = 30; mean age 61.5 years, mean 30.4 pack-year history) were well-informed (mean 80.5% correct responses) and rated anticipated regret and finding cancer early as highly important in their decision (medians >9 out of 10), along with moderate but variable concerns about false positives, overdiagnosis, and radiation exposure (medians 7.0, 6.0, and 5.0, respectively). Most participants (90.0% to 96.7%) felt clear about how they personally valued the potential benefits and harms and prepared for decision making (mean 86.7 out of 100, SD = 21.3). After viewing the decision aid, most participants (90%) intended to discuss screening with their doctor. Limitations. The study is limited to current and former smokers enrolled in a tobacco treatment program, and it may not generalize to other patient populations. Conclusions. The majority of current and former smokers were strongly concerned about anticipated regret and finding cancer early, while concerns about radiation exposure, false positives, and overdiagnosis were variable. After viewing the decision aid, current and former smokers reported strong preparedness and intentions to talk with their doctor about lung cancer screening with low-dose computed tomography.
Beyond Surgical Site Bleeding
Authors: Bain Alexandra , Barkho Jouseph O. , McRae Matthew , McRae Mark
Published: April 2018

We report the case of a 66-year-old female who underwent autologous breast reconstruction and sustained a massive upper gastrointestinal bleed secondary to a duodenal ulcer after using nonsteroidal anti-inflammatory drugs (NSAIDs) consistently for 2 weeks. She required resuscitation with a massive blood transfusion protocol and definitive hemorrhage control with interventional coiling of the gastroduodenal artery. We discuss the importance of thinking beyond surgical site bleeding with NSAIDs as well as risk stratification and prevention of NSAID-induced complications.
Delayed immune reconstitution after allogeneic transplantation increases the risks of mortality and chronic GVHD
Authors: Bejanyan Nelli , Brunstein Claudio G. , Cao Qing , Lazaryan Aleksandr , Luo Xianghua , Curtsinger Julie , Mehta Rohtesh S. , Warlick Erica , Cooley Sarah A. , Blazar Bruce R. , Miller Jeffrey S. , Weisdorf Daniel , Wagner John E. , Verneris Michael R.
Published: April 2018

Key Points

UCB recipients have slower T-cell reconstitution but more robust NK and B-cell recovery after allo-HCT than MSD recipients. Delayed CD4+ total and naive T-cell reconstitution after allo-HCT increases the risk of infection, mortality, and chronic GVHD.
The clinical significance of oropharyngeal cultures in young children with cystic fibrosis
Authors: Breuer Oded , Caudri Daan , Akesson Lauren , Ranganathan Sarath , Stick Stephen M. , Schultz André
Published: April 2018

In children with cystic fibrosis (CF) the associations between oropharyngeal swabs (OPSs) for detection ofPseudomonasand lung disease have not been evaluated.

OPS and bronchoalveolar lavage (BAL) samples were obtained annually in children with CF from 2005 to 2017. OPS test characteristics were calculated using BAL as “gold standard”. Results were related to lung inflammation (BAL neutrophil elastase and interleukin-8), structural lung disease (chest computed tomography PRAGMA-CF (Perth–Rotterdam Annotated Grid Morphometric Analysis for CF) scores), respiratory exacerbations and future detection ofPseudomonason BAL.

From 181 patients, 690 paired OPS–BAL cultures were obtained. Prevalence ofPseudomonasin BAL was 7.4%. OPS sensitivity was 23.0% and specificity was 91.4%, reducing the post-test probability for a positive BAL following a negative OPS to 6.3%.Pseudomonason OPS was not associated with lung inflammation or respiratory exacerbations, but was weakly associated with current PRAGMA-CF %Disease score (p=0.043).Pseudomonason BAL was associated with positive neutrophil elastase (OR 4.17, 95% CI 2.04–8.53; p<0.001), increased interleukin-8 (p<0.001), increased all baseline PRAGMA computed tomography scores (p<0.001), progression of PRAGMA computed tomography scores (p<0.05) and increased risk of respiratory exacerbations (incidence rate ratio 2.11, 95% CI 1.15–3.87; p=0.017).

In children with CF OPSs only marginally change the probability of detecting lower airwayPseudomonasand are not associated with lung disease indices nor exacerbations risk.
Insulin Resistance, Hyperinsulinemia, and LH: Relative Roles in Peripubertal Obesity-Associated Hyperandrogenemia
Authors: Burt Solorzano Christine M , Knudsen Karen L , Anderson Amy D , Hutchens Eleanor G , Collins Jessicah S , Patrie James T , Marshall John C , McCartney Christopher R
Published: April 2018

Context

Peripubertal obesity is associated with variable hyperandrogenemia, but precise mechanisms remain unclear.

Objective

To assess insulin resistance, hyperinsulinemia, and LH roles in peripubertal obesity–associated hyperandrogenemia.

Design

Cross-sectional analysis.

Setting

Academic clinical research unit.

Participants

Eleven obese (body mass index for age ≥95%) peripubertal girls.

Intervention

Blood samples were taken during a mixed-meal tolerance test (1900 to 2100), overnight (2100 to 0700), while fasting (0700 to 0900), and during an 80 mU/m2/min hyperinsulinemic-euglycemic clamp (0900 to 1100).

Main Outcome Measures

The dependent variable was morning free testosterone level; independent variables were insulin sensitivity index (ISI), estimated 24-hour insulin, and estimated 24-hour LH levels.

Results

All participants demonstrated insulin resistance and hyperinsulinemia. ISI, but not estimated 24-hour insulin level, correlated positively with morning free testosterone level when correcting for estimated 24-hour LH level and Tanner stage (rs = 0.68, P = 0.046). The correlation between estimated 24-hour LH and free testosterone levels approached significance after adjusting for estimated 24-hour insulin level and Tanner stage (rs = 0.63, P = 0.067). Estimated 24-hour insulin level did not correlate with free testosterone level after adjusting for estimated 24-hour LH level and Tanner stage (rs = 0.47, P = 0.20).

Conclusion

In insulin-resistant obese girls with hyperinsulinemia, free testosterone levels correlated positively with insulin sensitivity and, likely, circulating LH concentrations but not with circulating insulin levels. In the setting of relatively uniform hyperinsulinemia, variable steroidogenic-cell insulin sensitivity may correlate with metabolic insulin sensitivity and contribute to variable free testosterone concentrations.