bluuebunny/crossref_metadata_2025 huggingface dataset:
Components of Mathematical Competence in Middle Childhood
Authors: Wong Tin‐Yau Terry
Published: November 2020

Mathematical competence in middle childhood predicts socioeconomic status in adulthood. Therefore, it is important to understand the components that constitute mathematical competence from kindergarten to sixth grade. Using an analytical approach, in this article, I identify three components: understanding numbers, understanding mathematical symbols and their relevant principles, and converting problems into mathematical expressions. Evidence suggests that all three components significantly predict children's mathematical competence. However, the interrelations of the three components, as well as their unique contributions to overall mathematical competence, remain largely unexaed, with most studies focusing on only one of the three components. Exploring such issues can give researchers and educators a more comprehensive view of mathematical competence in childhood, and can lead to reconsiderations of important theoretical issues. The three‐component framework of mathematical competence may also give educators insights on how to improve the mathematical competence of future generations.
Digital health interventions in children with asthma
Authors: Ferrante Giuliana , Licari Amelia , Marseglia Gian Luigi , La Grutta Stefania
Published: November 2020

Although healthcare providers are actively involved in offering education, information and interventions for asthmatic patients, medication and therapeutic adherence remain low in the paediatric population, with estimates suggesting that adherence rates hover below 50%. A range of available digital health interventions has been explored in paediatric asthma with promising but variable results, limiting their widespread adoption in clinical practice. They include emerging technologies that yield the advantage of tracking asthma symptoms and medications, setting drug reminders, improving inhaler technique and delivering asthma education, such as serious games (video games designed for medical‐ or health‐related purposes), electronic monitoring devices, speech recognition calls, text messaging, mobile apps and interactive websites. Some of the proposed digital interventions have used multiple components, including educational and behavioural strategies and interactions with medical professionals. Overall, the implementation of such interventions may offer the opportunity to improve adherence and asthma control. In a state of emergency as the COVID‐19 pandemic, telemedicine can also play a central role in supporting physicians in managing children with asthma. This review evaluates the published literature examining digital health interventions for paediatric asthma and explores the most relevant issues affecting their implementation in practice and the associated evidence gaps, research limitations and future research perspectives.
A Hybrid Lagrangian/Eulerian Collocated Velocity Advection and Projection Method for Fluid Simulation
Authors: Gagniere S. , Hyde D. , Marquez‐Razon A. , Jiang C. , Ge Z. , Han X. , Guo Q. , Teran J.
Published: November 2020

We present a hybrid particle/grid approach for simulating incompressible fluids on collocated velocity grids. Our approach supports both particle‐based Lagrangian advection in very detailed regions of the flow and efficient Eulerian grid‐based advection in other regions of the flow. A novel Backward Semi‐Lagrangian method is derived to improve accuracy of grid based advection. Our approach utilizes the implicit formula associated with solutions of the inviscid Burgers’ equation. We solve this equation using Newton's method enabled by C1 continuous grid interpolation. We enforce incompressibility over collocated, rather than staggered grids. Our projection technique is variational and designed for B‐spline interpolation over regular grids where multiquadratic interpolation is used for velocity and multilinear interpolation for pressure. Despite our use of regular grids, we extend the variational technique to allow for cut‐cell definition of irregular flow domains for both Dirichlet and free surface boundary conditions.
A Divergence‐free Mixture Model for Multiphase Fluids
Authors: Jiang Y. , Li C. , Deng S. , Hu S. M.
Published: November 2020

We present a novel divergence free mixture model for multiphase flows and the related fluid‐solid coupling. The new mixture model is built upon a volume‐weighted mixture velocity so that the divergence free condition is satisfied for miscible and immiscible multiphase fluids. The proposed mixture velocity can be solved efficiently by adapted single phase incompressible solvers, allowing for larger time steps and smaller volume deviations. Besides, the drift velocity formulation is corrected to ensure mass conservation during the simulation. The new approach increases the accuracy of multiphase fluid simulation by several orders. The capability of the new divergence‐free mixture model is demonstrated by simulating different multiphase flow phenomena including mixing and unmixing of multiple fluids, fluid‐solid coupling involving deformable solids and granular materials.
Particle‐based Liquid Control using Animation Templates
Authors: Schoentgen Arnaud , Poulin Pierre , Darles Emmanuelle , Meseure Philippe
Published: November 2020

It is notoriously difficult for artists to control liquids while generating plausible animations. We introduce a new liquid control tool that allows users to load, transform, and apply precomputed liquid simulation templates in a scene in order to control a particle‐based simulation. Each template instance generates control forces that drive the global simulated liquid to locally reproduce the templated liquid behavior. Our system is augmented with a variable proportion of temporary particles to help efficiently reproduce the templated liquid density, with fewer requirements on the surrounding environment. The resulting control strategy adds only a small computational overhead, leading to quick visual feedback for resolutions allowing interactive simulation. We demonstrate the robustness and ease of use of our method on various examples in 2D and 3D.
Probabilistic Character Motion Synthesis using a Hierarchical Deep Latent Variable Model
Authors: Ghorbani S. , Wloka C. , Etemad A. , Brubaker M. A. , Troje N. F.
Published: November 2020

We present a probabilistic framework to generate character animations based on weak control signals, such that the synthesized motions are realistic while retaining the stochastic nature of human movement. The proposed architecture, which is designed as a hierarchical recurrent model, maps each sub‐sequence of motions into a stochastic latent code using a variational autoencoder extended over the temporal domain. We also propose an objective function which respects the impact of each joint on the pose and compares the joint angles based on angular distance. We use two novel quantitative protocols and human qualitative assessment to demonstrate the ability of our model to generate convincing and diverse periodic and non‐periodic motion sequences without the need for strong control signals.
Lower body positive pressure affects systemic but not cerebral haemodynamics during incremental hyperthermia
Authors: Perry Blake G. , Mündel Toby
Published: November 2020

Hyperthermia produces profound redistribution of blood and circulatory reflex function. We investigated the potential for lower body positive pressure (LBPP) to maintain or restore haemodynamics during graded hyperthermia. Eight healthy adults rested supine in a custom‐made LBPP box, sealed distal to the iliac crest. Following 5 min of normothermic rest, 20 mmHg of LBPP was applied and repeated when core temperature (Tcore) had increased passively by +0.5 and +1°C. Primary dependent variables included mean middle cerebral artery blood velocity (MCAvmean, transcranial Doppler), mean arterial blood pressure (MAP, finger photoplethysmography), heart rate (HR) and partial pressure of end‐tidal carbon dioxide (PETCO2). The absolute increase in MAP during LBPP was lower at Tcore +1°C (2 ± 3 mmHg), compared with normothermia (7 ± 3 p = .01). The modest increase in MCAvmean was unchanged by Tcore (normothermia, 2 ± 3 cm/s; +0.5°C, 3 ± 3 cm/s and +1°C, 3 ± 4 cm/s, p = .74). By design, PETCO2 was unchanged in all conditions from normothermic baseline (42 ± 1, p = .81). LBPP‐induced changes in HR were greater at +0.5°C (−13 ± 4 b/min) and +1°C (−12 ± 6 b/min) compared with normothermia (−3 ± 3 b/min, p = .01 and p = .01, respectively). These data indicate that despite a significant attenuation in MAP to LBPP with moderate hyperthermia, MCAvmean dynamics were unchanged among the thermal manipulations.
Spatial modelling of temporal dynamics in stream fish communities under anthropogenic change
Authors: Mota‐Ferreira Mário , Filipe Ana Filipa , Filomena Magalhães Maria , Carona Sara , Beja Pedro
Published: November 2020

Aim

Understanding temporal changes in aquatic communities is essential to address the freshwater biodiversity crisis. In particular, it is important to understand the patterns and drivers of spatial variation in local community dynamics, generalizing temporal trends from discrete locations to entire landscapes that are the main focus of management. Here, we present a framework for producing spatially continuous views of community dynamics, focusing on stream fish affected by hydropower development.

Location

River Sabor, NE Portugal.

Methods

We sampled stream fish at thirty sites between 2012 and 2019. Community trajectory analysis was used to quantify the directionality and velocity of community change, and the geometric resemblance of community trajectories between sites. Geostatistical models for stream networks were used to relate metrics describing community dynamics to environmental variables, while controlling for Euclidean and hydrologic spatial dependencies, and to map spatial variation in community dynamics across the watershed.

Results

Trajectories in multivariate space underlined strong temporal dynamics, with local communities deviating and returning to previous states, but without evidence for directional changes. Accordingly, directionality values were low and not consistently affected by environmental variables. The velocity of community change varied markedly across the watershed and it was strongly affected by stream order and elevation, with faster changes observed in lowland streams draining into hydroelectric reservoirs and with a high proportion of exotic species. Pairwise distances between community trajectories were strongly related to hydrologic and environmental distances between sites.

Main conclusions

Local stream fish communities were in a loose equilibrium across the watershed, but they fluctuated at a faster rate closer to a hydroelectric reservoir. Integrating community trajectory analysis and geostatistical modelling provides a relatively simple framework to understand how, where and why temporal community dynamics vary across dendritic stream networks and to visualize spatial patterns of community change over time in relation to anthropogenic impacts.
Metformin dose increase versus added linagliptin in non‐alcoholic fatty liver disease and type 2 diabetes: An analysis of the J‐LINK study
Authors: Komorizono Yasuji , Hosoyamada Kaori , Imamura Naoko , Kajiya Shoko , Hashiguchi Yasuhiro , Ueyama Norio , Shinmaki Hirohiko , Koriyama Nobuyuki , Tsukasa Masako , Kamada Tetsuro
Published: November 2020

We validated the effect of linagliptin, an oral dipeptidyl peptidase‐4 inhibitor, on nonalcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (T2DM). A total of 50 patients with NAFLD and T2DM treated with metformin were randomized (1:1) to metformin plus add‐on linagliptin (linagliptin group) or to an increased dose of metformin (metformin group) for 52 weeks. The primary endpoint was change in hepatic steatosis from baseline to week 52 as quantified by unenhanced computed tomography imaging. Secondary endpoints included changes in the levels of anthropometric, biochemical and adipokinetic markers. The linagliptin group showed no statistically significant reduction in hepatic steatosis as compared to the metformin group (P = 0.97), although changes in hepatic steatosis were significantly correlated with decreased liver enzymes in both groups. Body weight was significantly reduced in the metformin group but not in the linagliptin group (P = 0.002). Serum leptin levels were significantly increased in the linagliptin group compared to the metformin group (P = 0.003), and were correlated with the changes body weight in whole samples. Adverse events were not different between the two groups (P = 0.78). Add‐on linagliptin demonstrated a safe profile but was not superior to increased metformin in reducing hepatic steatosis.
Measuring the Market Size for Cannabis: A New Approach Using Forensic Economics
Authors: Parey Matthias , Rasul Imran
Published: November 2020

Quantifying the market size for cannabis is important given vigorous policy debates about how to intervene in this market. We develop a new approach to measuring the size of the cannabis market using forensic economics. The key insight is that cannabis consumption often requires the use of complementary legal inputs: roll‐your‐own tobacco and rolling papers. The forensic approach specifies how legal and illegal inputs are combined in the production of hand‐rolled cigarettes and cannabis joints. These input relationships, along with market adding‐up conditions, can be used to infer the size of the cannabis market. We provide proof‐of‐concept that this approach can be readily calibrated using: (i) point‐of‐sale data on legal inputs of roll‐your‐own tobacco and rolling papers; (ii) input parameter estimates drawn from a wide‐ranging interdisciplinary evidence base. We implement the approach using data from 2008–9. For those years, the forensic estimates for the UK cannabis market are near double those derived from standard demand‐side approaches. We make precise what drives the measurement gap between methods by establishing the adjustments needed to match estimates from alternative approaches. Our analysis develops an agenda on measurement and data collection that allows for credible cost–benefit analysis of policy interventions in illicit drug markets.
Frequency of hypertensive response to dobutamine stress and diminished diagnostic value in patients with end‐stage renal disease awaiting renal transplant
Authors: Aftab Waqas , Motabar Ali , Pai Ramdas G. , Varadarajan Padmini
Published: November 2020

Background

Patients with end‐stage renal disease (ESRD) have a cardiovascular mortality about 15–30 times the general population and this is reduced by about 70% with renal transplant. Dobutamine stress echocardiography (DSE) is commonly performed for preoperative cardiac evaluation before renal transplantation. Hypertensive response during DSE occurs in about 1%–5% of DSE studies. However, it seems to be more frequent in patients with ESRD. But its frequency and clinical implications are not known.

Methods and Results

Of the 249‐consecutive adult ESRD patients undergoing DSE for pre‐kidney transplant cardiac risk assessment at our dedicated clinic, 53 (21%) had a hypertensive response. Half of the patients with a hypertensive response had stress‐induced segmental wall motion abnormalities, of whom only half had angiographically significant coronary artery disease by quantitative coronary angiography. The hypertensive response was not a predictor of survival. Stress‐induced segmental wall motion abnormalities predicted poor survival in those with a normotensive response, but not in those with a hypertensive response. The main and independent predictor of a hypertensive response was higher baseline systolic blood pressure (P < .0001).

Conclusions

Hypertensive response to dobutamine stress is common in ESRD patients and is not a predictor of survival. Stress‐induced segmental wall motion abnormalities occur nearly thrice as frequently with a hypertensive response, but this is a poor predictor of angiographically significant coronary artery disease and does not predict survival.
Inside Out: Head‐Based Ontologies, Vision, and Temporality in the First Neuroturn
Authors: Baker Bernadette M.
Published: November 2020

Abstract

Since the early 1800s, mainstream Western discourses that entwined racializing and ableizing discourses have involved, among other things, particular notions of temporality and ways of privileging scopic regimes that presume surface‐depth relations mediated by a theory of time and materiality. In this essay, Bernadette Baker analyzes the link between the production of visual surface‐depth relations, the theorization of time, and the conception of matter in a high profile movement that today has been discredited. She takes as her case an instance of the first neuroturn (nineteenth century), specifically the physiognomy and phrenology in a textbook‐style volume written by F. J. Gall. Translated and published in 1835, Gall's treatise discusses morality and the brain in relation to the shape of the head. The reconstitution of entitlement emerges through Gall's treatise via unexpected epistemological alliances that mark a shift in the architecture of medical perception and that build a bridge from the spirit to the flesh. While relatively humble in tone, Gall's content draws upon empirical and metaphysical reference points that have, in turn, become major legacies for the second neuroturn, education, and other social sciences to deal with. This essay thus examines pivotal horizons in the Gallian approach that, while discredited now as a pseudoscientific fad, raise many difficult questions that expose the link between seemingly oppositional political and intellectual commitments.
What Might Dewey Think of Knowledge Insertion?
Authors: Obelleiro Gonzalo
Published: November 2020

In two articles, “Might Knowledge Be Insertable?” and “Is Knowledge Insertion Desirable?,” John Tillson argues that knowledge insertion is conceivable and desirable for the person who has it inserted. By knowledge insertion, he means the immediate or almost immediate acquisition of knowledge by means other than traditional processes of learning. He takes the case presented in the science fiction film The Matrix as paradigmatic and characterizes it as a special case of direct intervention, which begin with change in brain structure and function and result in in changes in thought patterns and behavior, by contrast to indirect interventions, which begin with changes in thought patterns and behavior and result in rewiring brain structure and functioning. Here, Gonzalo Obelleiro follows Tillson's argument and offers one special case in which knowledge insertion is not desirable and that is not fully elucidated by Tillson's conditions for desirability. John Dewey's notion of growth as summum bonum depends in important ways on gradual, progressive, traditional processes of learning. Deweyan growth constitutes a case of intrinsically valuable learning that can be tragically jeopardized by calculation errors in knowledge insertion. This is a significant risk that Tillson does not consider in his articles.
The Readiness Potential reflects the internal source of action, rather than decision uncertainty
Authors: Travers Eoin , Haggard Patrick
Published: November 2020

Voluntary actions are preceded by a Readiness Potential (RP), a slow EEG (electroencephalogram) component generated in medial frontal cortical areas. The RP is classically thought to be specific to internally‐driven decisions to act, and to reflect post‐decision motor preparation. Recent work suggests instead that it may reflect noise or conflict during the decision itself, with internally driven decisions tending to be more random, more conflicted and thus more uncertain than externally driven actions. To contrast accounts based on endogenicity with accounts based on uncertainty, we recorded EEG in a task where participants decided to act or withhold action to accept or reject visually presented gambles, and used multivariate methods to extract an RP‐like component. We found no difference in amplitude of this component between actions driven by strong versus weak evidence, suggesting that the RP may not reflect uncertainty. In contrast, the same RP‐like component showed higher amplitudes prior to actions performed without any external evidence (guesses) than for actions performed in response to equivocal, conflicting evidence. This supports the view that the RP reflects the internal source of action, rather than decision uncertainty.
Development and Validation of an Automatic Item Generation System for English Idioms
Authors: Rafatbakhsh Elaheh , Ahmadi Alireza , Moloodi Amirsaeid , Mehrpour Saeed
Published: November 2020

Test development is a crucial, yet difficult and time‐consuming part of any educational system, and the task often falls all on teachers. Automatic item generation systems have recently drawn attention as they can reduce this burden and make test development more convenient. Such systems have been developed to generate items for vocabulary, grammar, reading, and writing. However, the literature lacks such a system for idioms. Informed by corpus linguistics, we aimed at developing a system that can generate items on idioms using the Corpus of Contemporary American English. The result was a system capable of generating two types of multiple‐choice items, that is, fill‐in‐the‐blank and definition. To validate the system output, we asked ten experts of Teaching English as a Foreign Language to evaluate 400 generated items for content issues. Also, a sample test of 40 items was administered to 110 upper‐intermediate and advanced EFL learners, and then validated through the Rasch model. The results manifested that a large number of generated items were acceptable based on both experts’ judgments and Rasch analysis. The study is an example of the application of corpus linguistics to language testing and a step toward automatic generation of items for assessment purposes.
Boolean Analysis of Interobserver Agreement: Formal and Functional Evidence Sampling in Complex Coding Endeavors
Authors: Solano‐Flores Guillermo
Published: November 2020

This article proposes a Boolean approach to representing and analyzing interobserver agreement in dichotomous coding. Building on the notion that observations are samples of a universe of observations, it submits that coding can be viewed as a process in which observers sample pieces of evidence on constructs. It distinguishes between formal and functional interobserver agreement based on whether events coded by observers are, respectively, the same or different but equivalent samples of the same classes of events. Formal and functional agreement are defined as Boolean functions. The article reports on an investigation in which a Boolean approach was used to examine agreement in the coding of teacher–student social interactions. Agreement maps (devices that represent the relative frequencies of coding cases—different combinations of 1s and 0s in the observers’ coding) allowed detail examination of how interobserver agreement was shaped by the nature of the events coded and the characteristics of the individuals whose behaviors were coded. Results provide empirical evidence of formal and functional agreement as distinguishable forms of interobserver agreement. Results also show that Boolean coding analysis allows detection of ways in which coding procedures confound absence of evidence with evidence of absence. Practical and methodological implications are discussed.
Contextual Expertise and the Development of Organization and Management Theory
Authors: Gümüsay Ali Aslan , Amis John M.
Published: November 2020

Generating theory from research settings requires researchers to adeptly engage with the social intricacies of the field. They need to develop a contextual understanding by gaining in‐depth insights into the setting, while retaining a critical distance from it. Researchers must practice this along the entire research journey, from site selection, through data collection and analyses, to theory development and explanation. However, contextual expertise has been assumed rather than actively considered as a critical component in organization and management studies. We lay out steps for understanding the nature of contextual expertise, offer systematic advice for research projects and outline methodological practices across the research process to choose, capture, comprehend, convey, and confirm contextual specificities. The growing social complexity of research settings renders the development of contextual expertise increasingly important for the generation of enriched and more diverse theory. It also has implications for organization and management studies as a scientific community.
Contemporaneous evaluation of patient experience, surgical strategy, and seizure outcomes in patients undergoing stereoelectroencephalography or subdural electrode monitoring
Authors: Kim Lily H. , Parker Jonathon J. , Ho Allen L. , Feng Austin Y. , Kumar Kevin K. , Chen Kevin S. , Ojukwu Disep I. , Shuer Lawrence M. , Grant Gerald A. , Graber Kevin D. , Halpern Casey H.
Published: November 2020

Objective

Intracranial electrographic localization of the seizure onset zone (SOZ) can guide surgical approaches for medically refractory epilepsy patients, especially when the presurgical workup is discordant or functional cortical mapping is required. Minimally invasive stereotactic placement of depth electrodes, stereoelectroencephalography (SEEG), has garnered increasing use, but limited data exist to evaluate its postoperative outcomes in the context of the contemporaneous availability of both SEEG and subdural electrode (SDE) monitoring. We aimed to assess the patient experience, surgical intervention, and seizure outcomes associated with these two epileptic focus mapping techniques during a period of rapid adoption of neuromodulatory and ablative epilepsy treatments.

Methods

We retrospectively reviewed 66 consecutive adult intracranial electrode monitoring cases at our institution between 2014 and 2017. Monitoring was performed with either SEEG (n = 47) or SDEs (n = 19).

Results

Both groups had high rates of SOZ identification (SEEG 91.5%, SDE 88.2%, P = .69). The majority of patients achieved Engel class I (SEEG 29.3%, SDE 35.3%) or II outcomes (SEEG 31.7%, SDE 29.4%) after epilepsy surgery, with no significant difference between groups (P = .79). SEEG patients reported lower median pain scores (P = .03) and required less narcotic pain medication (median = 94.5 vs 594.6 milligram morphine equivalents, P = .0003). Both groups had low rates of symptomatic hemorrhage (SEEG 0%, SDE 5.3%, P = .11). On multivariate logistic regression, undergoing resection or ablation (vs responsive neurostimulation/vagus nerve stimulation) was the only significant independent predictor of a favorable outcome (adjusted odds ratio = 25.4, 95% confidence interval = 3.48‐185.7, P = .001).

Significance

Although both SEEG and SDE monitoring result in favorable seizure control, SEEG has the advantage of superior pain control, decreased narcotic usage, and lack of routine need for intensive care unit stay. Despite a heterogenous collection of epileptic semiologies, seizure outcome was associated with the therapeutic surgical modality and not the intracranial monitoring technique. The potential for an improved postoperative experience makes SEEG a promising method for intracranial electrode monitoring.
Diallelic self‐incompatibility is the main determinant of fertilization patterns in olive orchards
Authors: Mariotti Roberto , Pandolfi Saverio , De Cauwer Isabelle , Saumitou‐Laprade Pierre , Vernet Philippe , Rossi Martina , Baglivo Federica , Baldoni Luciana , Mousavi Soraya
Published: November 2020

Self‐incompatibility (SI) in flowering plants potentially represents a major obstacle for sexual reproduction, especially when the number of S‐alleles is low. The situation is extreme in the commercially important olive tree, where in vitro pollination assays suggested the existence of a diallelic SI (DSI) system involving only two groups (G1 and G2). Varieties belonging to the same SI group cannot fertilize each other, such that successful fruit production is predicted to require pollination between varieties of different groups. To test this prediction, we explored the extent to which the DSI system determines fertilization patterns under field conditions. One hundred and seventeen olive cultivars were first genotyped using 10 highly polymorphic dinucleotide Simple Sequence Repeat (SSR) markers to ascertain varietal identity. Cultivars were then phenotyped through controlled pollination tests to assign each of them to one of the two SI groups. We then collected and genotyped 1440 open pollinated embryos from five different orchards constituted of seven local cultivars with known group of incompatibility groups. Embryos genotype information were used: (i) to assign embryos to the most likely pollen donor genotype in the neighbourhood using paternity analysis, and (ii) to compare the composition of the pollen cloud genetic among recipient trees in the five sites. The paternity analysis showed that the DSI system is the main determinant of fertilization success under field open pollination conditions: G1 cultivars sired seeds exclusively on G2 cultivars, and reciprocally. No self‐fertilization events were observed. Our results demonstrate that DSI is a potent force determining pollination success among varieties within olive orchards used for production. They have the potential to improve management practices by guiding the selection of compatible varieties to avoid planting orchards containing sets of varieties with strongly unbalanced SI groups, as these would lead to suboptimal olive production.
The Dual Process of Intuitive Responsivity and Reflective Self‐supervision: About the Therapist in Family Therapy Practice
Authors: Rober Peter
Published: November 2020

Psychotherapy research shows that—in individual therapy as in family therapy—some therapists are more effective than others. This highlights the crucial role the therapist plays in a client’s improvement. Furthermore, it seems that training may make a difference, as deliberate practice can improve the therapist’s effectiveness. In the context of the current renewed awareness of the importance of the person of the therapist in the psychotherapy field, this paper’s focus is specifically on the therapist in family therapy practice. There is a long tradition of reflecting on the person of the therapist in the family therapy field, often inspired by the metaphor of the wounded healer. In contrast, focusing on the person op the therapist in the present moment of the therapy session is fairly new. In this paper, we use of the dual process models from cognitive psychology as a frame to reflect on the person of the therapist. We review these dual process models and propose that the intuitive responsivity of the therapist relies on the fast, implicit cognitive system (system 1) and the therapist’s self‐reflection on the slow, deliberate system (system 2). The therapist’s actions in therapy practice then emerge moment‐by‐moment as an echo of the way these two cognitive systems balance each other. It is optimal if the therapist, attuned to the family’s rhythm, can flexibly oscillate between the two systems. In the concluding comments of this paper, reflective questions are posed about what this perspective may mean for family therapy practice, training, and supervision.
Cumulative Risk and Substance Use in Adoptees: Moderation by Adoptive Parent Stress
Authors: Blake Austin J. , Waterman Jill M. , Kiff Cara J. , Guzman Jose , Langley Audra K.
Published: November 2020

Objective

To test whether low adoptive parent stress buffers the effect of preadoptive risk on substance use among adoptees.

Background

Adoptees are especially susceptible to substance use in adolescence, potentially because they often experience multiple early risk factors. Because caregiver stress and child behavior problems are linked, degree of parenting stress may serve as a buffer in reducing adoptee substance use.

Method

In a longitudinal study of 82 adoptees, we tested whether cumulative preadoptive risk, parenting stress, and their interaction predicted substance use in adolescence.

Results

Parents' parenting stress, but not children's preadoptive risk, predicted later substance use. Higher risk children were more positively and negatively affected by variations in parent stress.

Conclusions

Parenting stress is a malleable risk and protective factor in the development of substance use among adoptees.

Implications

Prevention and intervention programs for adoptive families should target parenting stress to reduce the risk of later youth substance use.
Secondary analysis of gut hormone data from children with and without in utero exposure to gestational diabetes: Differences in the associations among ghrelin, GLP‐1, and insulin secretion
Authors: Zengul Ayse G. , Hoover Sarah ET , Chandler‐Laney Paula C.
Published: November 2020

Background

Intrauterine exposure to gestational diabetes mellitus (GDM) increases risk for type 2 diabetes (T2D). Ghrelin and GLP‐1 have opposite functions in nutritional homeostasis and are associated with insulin secretion, but it is not known if individuals exposed to GDM exhibit dysregulation in these associations.

Objective

Test the hypothesis that children exposed to GDM in utero will exhibit dysregulation among ghrelin, GLP‐1, and C‐peptide (reflecting insulin secretion).

Methods

Data from N = 43 children aged 5 to 10 years were included in this secondary analysis of ghrelin, GLP‐1, and C‐peptide response to a liquid meal test. Repeated measures mixed model analyses were used to measure associations among hormones.

Results

The association of ghrelin and GLP‐1 was moderated by GDM group (P < .01), such that ghrelin was inversely associated with GLP‐1 in children without GDM exposure, but not for those exposed to GDM. GLP‐1 was positively associated with C‐peptide in both groups, but the association was stronger in those exposed to GDM (estimate = 1.06 vs 1.01).

Conclusions

Differences in the associations among ghrelin, GLP‐1, and C‐peptide displayed here suggest novel lines of research about whether the regulation of gut hormones and insulin secretion contribute to obesity and risk for T2D in children exposed to GDM.
Transitional discharge model for community mental health integration: A focused ethnographic study of clients’ perspectives
Authors: Forchuk Cheryl , Gyamfi Sebastian , Martin Mary‐Lou , Corring Deborah , Srivastava Rani , Harerimana Boniface
Published: November 2020

Clients' perceptions of continuous support during the transition from hospital to the community have been understudied. The present study evaluated clients' perceptions of the benefits and potential adjustments to the implementation of a transitional discharge model (TDM), an intervention for community integration of clients with mental health issues. A focused ethnography methodology was used to investigate the effectiveness of the TDM. Data were collected using two sets of focus groups which involved 87 clients with mental illness seeking care from nine hospitals across the Province of Ontario, Canada. One focus group was conducted at six months and another at the one‐year time point of the study. Data analysis followed a four‐step ethnographic approach proposed by Leininger (1985) for thematic analysis in qualitative research. Four main themes emerged: (i) clients' perceived benefits of the TDM. These came in the form of reassurance about transitioning from hospitalization to community, reduced feelings of isolation, and enhanced continuity of care and recovery, (ii) TDM for community integration; clients believed that the intervention offered suitable friendships, was a tool for social connectedness, and helped to reduce stigma, (iii) encountered challenges, which included issues with trust, perceiving peer supporters as intruders, issues with communication, and initial fears about discharge and (4) suggestions for improving the TDM, such as, more in‐person interactions, formalizing the TDM and raising awareness about community resources. The TDM implementation may facilitate the transition from hospital to the community by offering social support that enhances recovery.
Management of incontinence‐associated dermatitis: A systematic review of monetary data
Authors: Raepsaet Charlotte , Fourie Anika , Van Hecke Ann , Verhaeghe Sofie , Beeckman Dimitri
Published: November 2020

The objective was to systematically review monetary data related to management of incontinence‐associated dermatitis (IAD) in an adult population. Six electronic databases were searched: MEDLINE, CINAHL, Web of Science, EMBASE, The Cochrane Library and EconLit. The search string combined index terms and text words related to IAD and monetary data. The quality of the articles was assessed using the consensus on Health Economic Criteria. Results were synthesised narratively because of methodological heterogeneity. Nine studies were included. Only direct medical costs were reported. The product cost per application for prevention ranged between $0.05 and $0.52, and for treatment between $0.20 and $0.35. The product cost per patient/day for prevention ranged between $0.23 and $20.17. The product cost of IAD prevention and treatment per patient/day ranged between $0.57 and $1.08. The cost to treat IAD did not consider the treatment of secondary infection. The calculation of labour cost and total cost differed considerably between studies. Summarising monetary data is a challenge because of heterogeneity in currencies, settings, samples, time horizons, health‐ and cost outcome valuation, IAD definition and measurements, and included costs. Procedures for health economic evaluations are to be clarified to guarantee valid interpretation and comparison with other studies.
Negative pressure wound therapy for burn patients: A meta‐analysis and systematic review
Authors: Lin Dai‐Zhu , Kao Yu‐Chien , Chen Chiehfeng , Wang Hsian‐Jenn , Chiu Wen‐Kuan
Published: November 2020

Negative pressure wound therapy (NPWT), which has been applied in various medical specialties to accelerate wound healing, has been the object of a few investigations. We explored the effectiveness of NPWT and the possibility of its inclusion in burn management guidelines. Randomised controlled trials comparing NPWT with non‐NPWT treatments for burn wounds were extracted from PubMed. For the risk of bias analysis, all included studies were evaluated according to the Cochrane risk of bias tool and the approaches outlined in the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) Handbook. Outcomes such as graft take rate in the first week, infection rate, and overall complication rate were analysed. Six studies that included a total of 701 patients met our inclusion criteria. Qualitative analysis revealed that the NPWT group had a significantly better overall graft rate in the first week (P = 0.001) and a significantly lower infection rate (P = 0.04). No significant difference in the overall complication rate was found. Our results indicate that NPWT is a safe method for stimulating healing and lowering the infection rate of burn wounds. NPWT can be part of general burn management, and its incorporation into burn treatment guidelines is recommended.
Groin wound infection after vascular exposure (GIVE) multicentre cohort study
Authors:   Groin wound Infection after Vascular Exposure (GIVE) Study Group
Published: November 2020

Surgical site infections (SSIs) of groin wounds are a common and potentially preventable cause of morbidity, mortality, and healthcare costs in vascular surgery. Our aim was to define the contemporaneous rate of groin SSIs, determine clinical sequelae, and identify risk factors for SSI.

An international multicentre prospective observational cohort study of consecutive patients undergoing groin incision for femoral vessel access in vascular surgery was undertaken over 3 months, follow‐up was 90 days. The primary outcome was the incidence of groin wound SSI.

1337 groin incisions (1039 patients) from 37 centres were included. 115 groin incisions (8.6%) developed SSI, of which 62 (4.6%) were superficial. Patients who developed an SSI had a significantly longer length of hospital stay (6 versus 5 days, P = .005), a significantly higher rate of post‐operative acute kidney injury (19.6% versus 11.7%, P = .018), with no significant difference in 90‐day mortality. Female sex, Body mass index≥30 kg/m2, ischaemic heart disease, aqueous betadine skin preparation, bypass/patch use (vein, xenograft, or prosthetic), and increased operative time were independent predictors of SSI.

Groin infections, which are clinically apparent to the treating vascular unit, are frequent and their development carries significant clinical sequelae. Risk factors include modifiable and non‐modifiable variables.
A perspective on the safety of parabens as preservatives in wound care products
Authors: Torfs Eveline , Brackman Gilles
Published: November 2020

Antimicrobial and/or preservative ingredients incorporated in wound care products are subjected to certain safety restrictions. However, several of those agents, and paraben preservatives in particular, have been criticised. Conflicting reports on the potential of parabens to induce allergic contact dermatitis, and their assumed oestrogen‐like activity, raised public health concerns about their overall safety. Here, we seek to provide a balanced perspective on the most significant purported adverse health effects, and thereby allay the many misconceptions regarding the safety of parabens. Extensive and long‐term monitoring of paraben allergy frequencies illustrate that allergic reactions are quite uncommon, especially when compared with other antimicrobial and preservative agents. The estrogenic potential of parabens was illustrated to be far less potent than that of natural oestrogen receptor ligands, and the etiological significance of their presence in human tissue has not been established. The general consensus based on investigations by both the scientific community and regulatory agencies indicates that, with current safety regulations regarding their use in place, this effective and well‐documented group of preservatives should not warrant drastic measures to replace them. As such, despite the ongoing concern, it is indicated that, when used at typical concentrations, parabens are unlikely to affect human health.
Lymphoedema, a significant health problem in Israel: A descriptive community‐based study
Authors: Tidhar Dorit , Deutscher Daniel , Armer Jane M.
Published: November 2020

Lymphoedema (LE) is recognised as a chronic disabling disease. Knowledge on patient characteristics, treatments, and outcomes in Israel is lacking. The aim of the study was to (a) describe demographic and health characteristics, treatments, utilisation, and functional outcomes of patients receiving physical therapy due to LE in a large nationwide healthcare provider in Israel; and (b) assess the feasibility of conducting a future practice‐based evidence (PBE) study. This is a retrospective observational cohort study. Descriptive analyses of an electronic medical record database were performed. Data from 6013 patient episodes were analysed. A high proportion of patients had two or more comorbidities (80%) and chronic medication use (85%) with increasing rates over the 8‐year period. The most frequent LE classification was stage 2 (45%). A majority of LE was in the lower limbs (51%) with increasing rates over the years. The most frequent treatment‐related activity was measuring limb circumference and the most frequent intervention was educating for self‐management. This study provides a first comprehensive description of patient characteristics receiving physical therapy for LE in Israel. The available database offers an opportunity for PBE studies. Recommendations for improvements in specific data collection processes were identified.
Digitoxin Studies
Authors: Gjerdrum Kjell
Published: November 2020

Serum digitoxin has been determined in 144 patients by a modified Rb‐ATPase method. Mean digitoxin concentration during maintenance therapy increased with the daily dose: 0.036 mg/day – 10.8 ng/ml, 0.05 mg/day – 11.2 ng/ml, 0.071 mg/day – 16.1 ng/ml, 0.1 mg/day – 18.1 ng/ml. The increase in serum after different loading doses is presented. After withdrawal of maintenance therapy in patients the mean serum half life was 6.9 days (S.D. = 2.7 days). The correlation serum half life—serum creatinine was significant. After determination of serum concentration and serum half life in a particular patient it is possible to calculate the “proper maintenance dose” which should keep his total body store of digitoxin at an optimal value.
THE DETERIORATIVE EFFECT OF MYOCARDIAL INFARCTION UPON PHYSIOLOGICAL INDICES OF WORK CAPACITY
Authors: Benestad Arne M.
Published: November 2020

The present study has been performed in order to investigate the deteriorative effect of myocardial infarction upon physiological indices of work capacity. Sixteen male patients, averaging 52 years of age, have been tested 12 weeks after the acute episode by means of bicycle ergometry in the upright position. Each patient exercised at several loads, starting at low levels and increasing the loading until the criteria of maximality were reached. All patients tolerated well the strain of heavy muscular exercise. Their maximal oxygen uptake averaged 2.05 1/min or 26.8 ml/min/kg b.wt., which is about 25% lower than average for healthy men of corresponding age. The highest recorded heart rate averaged 163 beats/min, which is lower than for healthy people. A low maximal oxygen pulse indicates reduced stroke volume. These findings suggest a reduction of the pumping capacity of the heart. The arterial systolic B.P. showed a tendency to levelling‐off at high levels of work rate, which suggests a reduced contractile power of the cardiac muscle. In 13 patients ECG changes indicating impaired oxygenation of the myocardium occurred when the work level exceeded two‐thirds of their maximal aerobic power. At lower levels of submaximal exercise the physiological response pattern of the cardiacs was similar to that of normals, except for a tendency to higher pulmonary ventilation. The cause of this hyperventilation, which was related to an increased tidal volume, is suggested to be a change of the ventilation/perfusion rate brought about by the heart infarction.