bluuebunny/crossref_metadata_2025 huggingface dataset:
Access for all? Assessing vertical and horizontal inequities in healthcare utilization among young people in northern Sweden
Authors: Wagenius Cecilia M. , San Sebastián Miguel , Gustafsson Per E. , Goicolea Isabel
Published: May 2018

Background: Previous studies in Sweden have detected socioeconomic inequities in access to healthcare services. However, there is limited information regarding access in younger populations. The aim of this study was to explore vertical and horizontal inequities in access to healthcare services in young adults in the north of Sweden. Methods: The study used data from the Health on Equal Terms survey (age group 16–24 years, n = 2726) for the health and healthcare variables and from national registers for the sociodemographic characteristics. Self-rated healthcare utilization was measured as visits to general practitioners, youth clinics and nurses. Crude and multivariable binomial regression analysis, stratified by sex, was used to assess vertical equity, adjusting for sociodemographic characteristics, and horizontal equity, adjusting for need variables. Results: Vertical inequity was detected for all three healthcare services (youth clinics, general practitioners and nurses), with variations for men and women. Horizontal inequities were also found for both men and women in relation to all three healthcare services. Conclusions: These findings suggest that both vertical and horizontal inequities in access exist for young people in northern Sweden and that the associations between sociodemographic characteristics and healthcare utilization are complex and need further investigation.
Blurring boundaries: Exploring tweets as a legitimate journalism artifact
Authors: Liu Zhaoxi (Josie) , Berkowitz Dan
Published: May 2018

This study explores journalists’ use of Twitter and what it means for their craft. Based on 8 weeks newsroom observation and more than a dozen in-depth interviews with reporters and editors at a big metro newspaper, the study found that journalists had contradicting views on whether or not to accept tweets, a form of snippet artifact, as a legitimate journalism artifact, leading to the blurring artifact boundary. Related, journalists faced uncertainties and ambiguities regarding the implications of such snippet artifact for the journalism craft and its core mission of informing the public.
What does knowledge look like? Interpreting diagrams as contemporary hieroglyphics
Authors: Bowen Tracey , Evans M Max
Published: May 2018

A significant challenge in interpreting and analyzing graphic representations is to understand the many reference points a graphically depicted object may have across its producer’s personal and cultural experiences. An individual’s exposure to socially constructed representations drives his or her propensity to use specific shared graphic objects, especially when attempting to articulate complex or abstract concepts. This multidisciplinary research study focuses on interpreting graphic representation types and analyzing the graphic objects individuals use to depict the abstract concept of knowledge. A sample of 833 individuals aged 5–65 participated in the study by constructing a drawing to answer the question, ‘What does knowledge look like?’. Engelhardt’s Language of Graphics (2002) graphic representation taxonomy was used to identify grouping and linking diagrams in the drawings. Next, graphic objects were coded and categorized within the drawings to identify the common representations, shared symbols, and non-depictive elements used to group and link. Using drawings fitting Engelhardt’s grouping and linking graphic representation types, and Tversky’s theories for constructing meaning through diagrams, this article examines how study participants combine and arrange common graphic objects to depict the concept of ‘knowledge’. The results illustrate that individuals organize and arrange common graphic objects into groupings to communicate taxonomies or hierarchies based on spatial proximity; or connect and link them together using glyphs (e.g. arrows, dotted or straight lines) to communicate causal relationships. The findings also demonstrate how individuals employ common socially constructed graphic representations (or objects) as a visual communication tool and, through the exercise of drawing, as a tool for meaning or sense making. The graphic objects possess a shared meaning that the participants have seen circulating within their culture. The common ground that emerges from sharing graphic objects suggests a form of contemporary hieroglyphics that communicates meaning both inside and outside the community.
Parenting and young children’s emotional self-regulation in urban Korean families
Authors: Kim Soojung , Holloway Susan D
Published: May 2018

The present study was designed to examine the relationship of Korean mothers’ psychological resources and discipline style to their children’s emotional self-regulation development. Structural equation modeling was conducted with a sample of 234 Korean mothers of kindergarten-aged children in the Incheon area in South Korea. The results indicated that maternal harshness negatively predicted and inconsistency positively predicted children’s emotional self-regulation development. Second, mothers’ psychological resources (i.e. parenting self-efficacy, enjoyment of parenting) predicted less harshness, inconsistency, and permissiveness and more responsiveness. Third, the direct path from enjoyment of parenting to permissiveness in parenting behaviors was moderated by the child’s gender. The results indicated that certain parenting behaviors, particularly permissiveness and inconsistency, may have culturally distinctive effects on children’s development in Korea.
Alignment of learning experiences from prekindergarten to kindergarten: Exploring group classifications using cluster analysis
Authors: Franko Meg Deane , Zhang Duan , Hesbol Kristina
Published: May 2018

This study explored children’s experiences of instructional alignment from prekindergarten through kindergarten. Using cluster analysis to analyze data from over 1300 children in the 2009 Head Start Family and Child Experiences Survey, the study found that children have distinct and definable experiences of prekindergarten–kindergarten alignment, with Hispanic/Latino children more likely to attend Head Start programs with poor support for prekindergarten–kindergarten transitions and poor kindergarten classroom structures, and most children experiencing a decline in developmentally appropriate practices between prekindergarten and kindergarten.
The ecology of outdoor rape: The case of Stockholm, Sweden
Authors: Ceccato Vania , Li Guangquan , Haining Robert
Published: May 2018

The objective of this article is to report the results of an ecological study into the geography of rape in Stockholm, Sweden, using small area data. In order to test the importance of factors indicating opportunity, accessibility and anonymity to the understanding of the geography of rape, a two-stage modelling approach is implemented. First, the overall risk factors associated with the occurrence of rape are identified using a standard Poisson regression, then a local analysis using profile regression is performed. Findings from the whole-map analysis show that accessibility, opportunity and anonymity are all, to different degrees, important in explaining the overall geography of rape - examples of these risk factors are the presence of subway stations or whether a basområde is close to the city centre. The local analysis reveals two groupings of high risk of rape areas associated with a variety of risk factors: city centre areas with a concentration of alcohol outlets, high residential population turnover and high counts of robbery; and poor suburban areas with schools and large female residential populations where subway stations are located and where people express a high fear of crime. The article concludes by reflecting upon the importance of these results for future research as well as indicating the implications of these results for policy.
Determinants of reporting cybercrime: A comparison between identity theft, consumer fraud, and hacking
Authors: van de Weijer Steve G.A. , Leukfeldt Rutger , Bernasco Wim
Published: May 2018

Although the prevalence of cybercrime has increased rapidly, most victims do not report these offenses to the police. This is the first study that compares associations between victim characteristics and crime reporting behavior for traditional crimes versus cybercrimes. Data from four waves of a Dutch cross-sectional population survey are used ( N = 97,186 victims). Results show that cybercrimes are among the least reported types of crime. Moreover, the determinants of crime reporting differ between traditional crimes and cybercrimes, between different types of cybercrime (that is, identity theft, consumer fraud, hacking), and between reporting cybercrimes to the police and to other organizations. Implications for future research and practice are discussed.
Making drug harms: Punishments for drugs offenders who pose risks to children
Authors: Flacks Simon
Published: May 2018

Images of children are routinely used in discourses on drugs, offering a compelling rationale for adopting particular policy positions or legislative reforms. However, the importance of childhood to the constitution of drug harms, and the punishment and subjectification of drug users and offenders, have rarely been the subject of enquiry, whether within drug and alcohol studies, criminology or legal studies. Scholarship on criminal sentencing in England and Wales is also relatively sparse, and has been dominated by analyses of the ‘legal-rational’ logic of particular provisions or reforms. This paper, which relies on the premise that drugs and their effects are constituted through discourse, and are thus contingent, variable and unstable, identifies the ‘collateral realities’ (Law, 2011) that are enacted during legislative and judicial attempts to stabilize the harms caused by drugs to children and communities.
The role of music among prisoners and prison staff: A qualitative research study
Authors: Edri Ortal , Bensimon Moshe
Published: May 2018

Music is an integral part of every subculture, including that of prisons. However, no research has yet examined the meaning of music for prisoners and prison staff. The present research examined the role of music in the world of prisoners in Israel and how prison staff experience it. Content analysis of interviews with 10 convicted prisoners and 9 prison staff members indicated four central themes: the different ways prisoners consume and are exposed to music; the role of music in provoking positive and negative feelings; the role of music in the relationships among inmates – closeness and conflicts; and the role of music in the relationships between prisoners and prison staff, particularly in terms of prison regulation of music consumption.
PPARD rs7770619 polymorphism in a Korean population: Association with plasma malondialdehyde and impaired fasting glucose or newly diagnosed type 2 diabetes
Authors: Kim Minjoo , Kim Minkyung , Yoo Hye Jin , Sun Yao , Lee Sang-Hyun , Lee Jong Ho
Published: May 2018

Both the peroxisome proliferator-activated receptor delta gene ( PPARD) and malondialdehyde plasma concentrations may play a role in impaired glucose metabolism. The aim of this work was to determine whether PPARD is a candidate gene for impaired fasting glucose or type 2 diabetes and whether a particular genetic variant shows association with plasma malondialdehyde levels. Among the 10 single-nucleotide polymorphisms that were most strongly associated with malondialdehyde, the rs7770619 polymorphism in PPARD was analysed in 1798 subjects with normal fasting glucose, impaired fasting glucose and newly diagnosed type 2 diabetes. Our data demonstrate that the CT genotype of the rs7770619 is associated with a lower risk of impaired fasting glucose or type 2 diabetes together with lower plasma levels of malondialdehyde in both groups ( p < 0.05). Glucose levels and the rs7770619 are significantly associated in individuals with normal fasting glucose, and a trend towards an association between glucose levels and rs7770619 is also observed in individuals with impaired fasting glucose or type 2 diabetes. In conclusion, PPARD rs7770619 is a novel candidate variant for impaired fasting glucose and type 2 diabetes and shows association with malondialdehyde levels. Future work is required to understand the mechanisms for these associations and the clinical implications of our findings.
A Systematic Review of Reviews of the Outcome of Severe Neglect in Underresourced Childcare Institutions
Authors: Carr Alan , Duff Hollie , Craddock Fiona
Published: May 2018

The aim of the systematic review described in this article was to determine the outcomes for individuals exposed to severe neglect in congregate care institutions such as orphanages. In this context, severe neglect refers to failure to meet children’s basic physical, developmental, and emotional needs due to inadequate resources. In this systematic review of previous systematic reviews and meta-analyses, searches of 10 databases were conducted, 18 papers that met inclusion and exclusion criteria were selected for review, their quality was assessed, and data were extracted and synthesized. The 550 primary studies included in the 18 systematic reviews and meta-analyses were relatively well designed, allowing confidence to be placed in their results. Severe neglect was associated with a wide range of problems in the domains of physical development, cognitive development, attachment, and mental health. The severity of adverse outcomes was partly influenced by the duration and severity of deprivation and a constellation of risk and protective factors. Prevention policies should aim to eliminate large underresourced congregate care institutions for infants. In taking steps toward this, policies should aim to adequately resource congregate care institutions to meet children’s developmental needs for nutrition, stimulation, and attachment to a stable primary caregiver with adequate parenting skills and training. Early placement in adoptive or foster families, with access to routine physical and mental health-care service available in developed countries, is the most viable effective intervention for child survivors of severe neglect.
Secure performance analysis and detection of pilot attack in massive multiple-input multiple-output system
Authors: Zhang Xianyu , Guo Daoxing , Guo Kefeng , Niu Hehao
Published: May 2018

This article studies the physical layer security of massive multiple-input multiple-output system in time-division-duplex mode. Specifically, a single-cell downlink massive multiple-input multiple-output communication system is considered. The resulting achievable secrecy rate is investigated in the presence of passive or active eavesdroppers. The analytical results reveal that the massive multiple-input multiple-output system is naturally immune to passive eavesdroppers, but will be dramatically degraded by active attack. On account of the risk caused by active attack, a simple and effective detection algorithm is proposed. Uplink pilots with random phases are transmitted during the detection operation. By comparing the phase deviation change of the received pilot signals’ cross product, the active eavesdroppers can be detected exactly. The closed-form expressions for probabilities of detection, false alarm, and false rejection are obtained respectively, which can demonstrate the robust performance of the proposed detection scheme. To maximize the secrecy energy efficiency of the system, the optimal power allocation strategy is studied under total power constraints. This optimization problem is efficiently solved by fractional programming. Numerical simulation results are derived to validate the secrecy performance of the massive multiple-input multiple-output system, the active pilot attacker detection performance, and the energy efficiency optimization effect.
Exploring teaching staff’s experiences of implementing a Finnish master’s degree programme in teacher education in Indonesia
Authors: Juusola Henna , Räihä Pekka
Published: May 2018

In this paper, we analyse the motivation and experiences of teaching staff participating in a novel exported Finnish degree programme in teacher education for Indonesian students. The data are based on online questionnaires sent to the teachers in March 2017. Huberman’s professional career path and Mezirow’s module for transformative learning are applied to construct the analytical framework. We also use our own experiences from our involvement in this exported programme, as a teacher (Pekka Räihä) and as a PhD candidate (Henna Juusola). In addition, we have taken into account Finnish higher education policy in terms of education export. The findings of this analysis demonstrate that education export projects can extend university teachers’ professional career opportunities and offer a starting point for transformative learning. However, more flexible administrative practices and an adaptive organizational culture at both faculty and institutional levels are required.
Spatial reorientation with non-visual cues: Failure to spontaneously use auditory information
Authors: Nardi Daniele , Anzures Brian J , Clark Josie M , Griffith Brittany V
Published: May 2018

Among the environmental stimuli that can guide navigation in space, most attention has been dedicated to visual information. The process of determining where you are and which direction you are facing (called reorientation) has been extensively examined by providing the navigator with two sources of information—typically the shape of the environment and its features—with an interest in the extent to which they are used. Similar questions with non-visual cues are lacking. Here, blindfolded sighted participants had to learn the location of a target in a real-world, circular search space. In Experiment 1, two ecologically relevant non-visual cues were provided: the slope of the floor and an array of two identical auditory landmarks. Slope successfully guided behaviour, suggesting that proprioceptive/kinesthetic access is sufficient to navigate on a slanted environment. However, despite the fact that participants could localise the auditory sources, this information was not encoded. In Experiment 2, the auditory cue was made more useful for the task because it had greater predictive value and there were no competing spatial cues. Nonetheless, again, the auditory landmark was not encoded. Finally, in Experiment 3, after being prompted, participants were able to reorient by using the auditory landmark. Overall, participants failed to spontaneously rely on the auditory cue, regardless of how informative it was.
Aerodynamic and surface comparisons between Telstar 18 and Brazuca
Authors: Goff John Eric , Hong Sungchan , Asai Takeshi
Published: May 2018

Aerodynamic coefficients were determined for Telstar 18 and Brazuca, match balls for the 2018 and 2014 World Cups, respectively. Experimental determination of aerodynamic coefficients prompted the development of computationally determined soccer ball trajectories for most launch speeds experienced in actual play. Although Telstar 18’s horizontal range will be nearly 10% shorter than Brazuca’s horizontal range for high-speed kicks, both Telstar 18 and Brazuca have similar knuckling effects due to nearly equal critical speeds and high-speed drag coefficients that differ by less than 10%. Surface comparisons suggest why aerodynamic properties for the two World Cup balls are so similar.
Power– and velocity–load relationships to improve resistance exercise performance
Authors: Garnacho-Castaño Manuel V , Muñoz-González Arturo , Garnacho-Castaño María A , Maté-Muñoz José L
Published: May 2018

Knowledge of the power– and velocity–load relationships is a key factor to guide loads during resistance training and optimize sports performance. This study compares mean velocity–, peak velocity– and power–load relationships, and determines the load which elicits maximal power output in the military press and bench press. Fifty-seven healthy, active men were randomly assigned to a bench press (n = 28) or military press (n = 29) group. In separate test sessions, concentric-only or eccentric-concentric sequences of each exercise were performed in random order as incremental isoinertial load tests. Both mean velocity and peak velocity were highly related with the load lifted (% 1RM) in both bench press and military press (mean velocity: R2 = 0.94 and 0.95; peak velocity: R2 = 0.93 and 0.93, respectively). The loads maximizing mean power and peak power output were similar for the eccentric-concentric versus concentric sequences in bench press and military press. The loads maximizing mean power and peak power were between 54% and 57.5% 1RM for the bench press and 59.8%–63.1% 1RM for the military press. For the bench press, no significant differences were observed in mean power from 30% to 80% 1RM and peak power from 30% to 95% 1RM. For the military press, no significant differences were observed in mean power from 40% to 80% 1RM and peak power from 30% to 90%/95% 1RM. The close relationship detected between mean velocity or peak velocity and load means that the % 1RM can be estimated according to mean velocity and peak velocity. In both exercises, a broad range of relative intensities could be used at which power output is not significantly different than that at maximized power output (mean = 30%/40%–80% 1RM; peak = 30%–90%/95%). Mean velocity lower than approximately 0.33 m s−1 for bench press and 0.4 m s−1 for military press, as well as peak velocity lower than approximately 0.4 m s−1 for bench press and 0.5 m s−1 for military press do not optimize power output responses. The eccentric action was a determining factor for increasing power output only in bench press.
Screening for Middle East respiratory syndrome coronavirus among febrile Indonesian Hajj pilgrims: A study on 28,197 returning pilgrims
Authors: Amin M , Bakhtiar A , Subarjo M , Aksono EB , Widiyanti P , Shimizu K , Mori Y
Published: May 2018

There were 211,000 Indonesian Hajj pilgrims going to Mecca through 11 main airports in 2015 who were at risk of contracting the Middle East respiratory syndrome coronavirus (MERS-CoV). We aimed to find out whether there was any occurrence of MERS-CoV by performing screening on 28,197 returning pilgrims. Those with a body temperature of > 38 °C and respiratory symptoms were sent to the airport clinic to have an oropharyngeal swab and a bacterial culture. Fifteen pilgrims had fever (> 38 °C) accompanied by respiratory symptoms; of these, 12 patients were diagnosed with upper and lower respiratory tract infections and three patients with pneumonia. However, none of them were found to be infected with MERS-CoV. The bacterial cultures showed evidence of normal flora growth.
Impact of an antimicrobial stewardship program on healthcare-associated Clostridium difficile rates at a community-based teaching hospital
Authors: Moffa Matthew A , Walsh Thomas L , Tang Amy , Bremmer Derek N
Published: May 2018

We conducted a pre-intervention/post-intervention study to assess the rate of healthcare-associated Clostridium difficile infections (HA-CDI) before and after the implementation of an antimicrobial stewardship program (ASP). Upon implementation of our ASP, the usage of targeted antimicrobials, including ceftriaxone, clindamycin, fluoroquinolones and carbapenem antibiotics, were significantly reduced. There was also a significant reduction in HA-CDI/1000 patient-days following ASP implementation (0.84 vs. 0.28; P = 0.035).
The role of the JAK/STAT signal pathway in rheumatoid arthritis
Authors: Malemud Charles J.
Published: May 2018

Proinflammatory cytokine activation of the Janus kinase/signal transducers and activators of transcription (JAK/STAT) signal transduction pathway is a critical event in the pathogenesis and progression of rheumatoid arthritis. Under normal conditions, JAK/STAT signaling reflects the influence of negative regulators of JAK/STAT, exemplified by the suppressor of cytokine signaling and protein inhibitor of activated STAT. However, in rheumatoid arthritis (RA) both of these regulators are dysfunctional. Thus, continuous activation of JAK/STAT signaling in RA synovial joints results in the elevated level of matrix metalloproteinase gene expression, increased frequency of apoptotic chondrocytes and most prominently ‘apoptosis resistance’ in the inflamed synovial tissue. Tofacitinib, a JAK small molecule inhibitor, with selectivity for JAK2/JAK3 was approved by the United States Food and Drug Administration (US FDA) for the therapy of RA. Importantly, tofacitinib has demonstrated significant clinical efficacy for RA in the post-US FDA-approval surveillance period. Of note, the success of tofacitinib has spurred the development of JAK1, JAK2 and other JAK3-selective small molecule inhibitors, some of which have also entered the clinical setting, whereas other JAK inhibitors are currently being evaluated in RA clinical trials.
A Feasibility Study Comparing Platelet-Rich Plasma Injection With Saline for the Treatment of Plantar Fasciitis Using a Prospective, Randomized Trial Design
Authors: Johnson-Lynn Sarah , Cooney Alan , Ferguson Diarmaid , Bunn Deborah , Gray William , Coorsh Jonathan , Kakwani Rajesh , Townshend David
Published: May 2018

Platelet-rich plasma (PRP) has been advocated for treatment of plantar fasciitis but there are few good-quality clinical trials to support its use. We conducted a feasibility study of PRP versus saline for treatment of plantar fasciitis. Patients with 6 months or more of magnetic resonance imaging–proven plantar fasciitis, who had failed conservative treatment were invited to participate in the study. Patients were block randomized to either PRP or an equivalent volume of saline. The techniques used for injection and rehabilitation were standardized for both groups. The patient and assessor were blinded. Visual analogue scale (VAS) for pain and painDETECT score were recorded preoperatively and at 6 months follow-up. From 35 patients approached, 28 (19 female, mean age 50 years) were recruited, with 14 randomized to each arm. At 6 months, 8 patients (28.6%) were lost to follow-up. There was a significant change in VAS score from baseline to follow-up in both intervention (mean change 37.2, P = .008) and control (mean change 42.2, P = .003) groups. There was no correlation between preoperative painDETECT score and change in VAS. Recruitment and loss to follow-up rates were relatively high. Both treatments resulted in a similar, significant, improvement in symptoms.

Levels of Evidence: Level II
Validity of electronic hospital discharge prescription records as a source of medication data for pharmacoepidemiological research
Authors: Fanning Laura , Vo Lilian , Ilomäki Jenni , Bell J. Simon , Elliott Rohan A. , Dārziņš Pēteris
Published: May 2018

Background:

The advent of hospital electronic medical records (EMRs) with electronic prescribing provides considerable opportunity for pharmacoepidemiological research. However, validity of EMR prescribing data for research purposes is not well established. Validity concerns the percentage of cases in which medications and characteristics (name, type, formulation, dose) are true when verified with an independent data source. This study evaluated the validity of EMR discharge prescription data within the Eastern Health hospital network in Melbourne, Australia.

Methods:

A random sample of patients were selected who had a diagnosis of atrial fibrillation (AF) and were prescribed at least five medications. Prescription records from 2012 to 2015 were compared with pharmacy dispensing and hospital medical records (reference standards). Medication name, dose, directions and route of administration were compared. Discrepancies between data sources were categorized as omissions, additions, discrepancies in dose, medication form or route of administration or discrepancies in reordering. Sensitivities and 95% confidence intervals (CIs) for intended medication exposure were estimated for therapeutic classes.

Results:

A total of 5724 prescription orders for 479 patients for whom reference standards were available were included. There were 163 discrepancies (2.8%) between prescription records and reference standards. Additions were the most common data discrepancy ( n = 65; ~1.1% of total prescriptions evaluated), followed by discrepancies in reordering ( n = 34; 0.59%). Sensitivities for intended patient exposure to a medication for each therapeutic class at the first level of the Anatomical Therapeutic Chemical (ATC) classification system were between 97% and 100%. The genitourinary system and sex hormone level of the ATC system demonstrated the lowest sensitivity, (97.3%; 95% CI 92.0%–100%) and the cardiovascular system level demonstrated the highest sensitivity (99.9%; 95% CI 99.7%–100%).

Conclusion:

EMR discharge prescription records for patients with AF are a valid information source for conducting pharmacoepidemiological research within Eastern Health in Melbourne, Australia. Further studies in different regions, countries and patient cohorts are required to establish validity of hospital EMR prescription records for pharmacoepidemiological research.
Clear cell carcinoma of the penis
Authors: Rocco Nicholas , Trask DC , Zuckerman JM
Published: May 2018

Level of evidence: 5
Linguistic violence and online political communications in China: The example of 鸡的屁 (Ji De Pi) as an ironic spoof of gross domestic product in online debates around environmental issues
Authors: Wang Qingning
Published: May 2018

This article discusses the function of linguistic violence in online political communication in China, by using the specific example of 鸡的屁 (pronounced “ji de pi”), an ironic metaphor for gross domestic product. By using systemic functional linguistics as its methodology, the article demonstrates that the term is linguistically violent, and reveals that such a term is used to represent gross domestic product but also means “the fart of a chicken.” It is used in online discussions to show disagreement with and disdain toward the government’s gross domestic product-centric policies. The article argues the use of 鸡的屁, demonstrates Chinese Internet users’ creativities in online discourses, and their use of language to resist government policies that fail to serve their interests. It is not only a way to express oppositional opinions but also the public’s strong emotion of anger.
Zimbabwean General Education Preschool Teacher Needs in Inclusion
Authors: Majoko Tawanda
Published: May 2018

As Zimbabwe’s education system shifted from exclusion to inclusion in 1994, in alignment with the global world, the population of learners with disabilities educated in general education preschool settings has remarkably increased. Teachers experience diverse challenges in including learners with disabilities into general education preschool settings. Embedded in the core expertise of inclusive pedagogical philosophy, the current interpretive qualitative research gleaned from 24 purposively sampled Zimbabwean general education preschool teachers. A constant comparative approach, which entailed organization of data from individual interviews, nonparticipant observations and document analysis with continuous adjustment, was utilized all through the analysis. Despite teachers being ill-prepared for inclusion, coupled with individual and institutional needs in its practice, they had positive attitudes toward it. The study recommends that training of general education preschool teachers in the practice and theory of inclusion, collaborative pooling of resources of stakeholders, and the incorporation of sociocultural aspects in preschool curricula could optimize inclusivity. This study is a springboard for future studies on the subject.
Self-Reported Physical Activity Among Individuals With Parkinson’s Disease
Authors: Johnson A. M. , Jimenez-Pardo J. , Jenkins M. E. , Holmes J. D. , Burke S. M.
Published: May 2018

Although physical activity is generally thought to be beneficial for individuals with Parkinson’s disease (PD), there is limited information regarding current rates of physical activity within this population. In this study, we measured self-reported physical activity levels of individuals with PD and explored factors that affected physical activity engagement. Sixty-one individuals living with PD completed a modified form of the Physical Activity Scale for Individuals With Physical Disabilities. Reported activity was high and exceeds published guidelines for individuals with limited mobility. Major facilitators of physical activity included (a) positive impact on PD-related symptoms, (b) social motivation, and (c) regularity or predictability of the activity. The major barrier to physical activity was PD symptom severity (e.g., lack of balance, gait impairment, tremor, and fatigue).
ART Attrition across Health Facilities Implementing Option B+ in Haiti
Authors: Myrtil Martine Pamphile , Puttkammer Nancy , Gloyd Stephen , Robinson Julia , Yuhas Krista , Domercant Jean Wysler , Honoré Jean Guy , Francois Kesner
Published: May 2018

Background:

Describing factors related to high attrition is important in order to improve the implementation of the Option B+ strategy in Haiti.

Methods:

We conducted a retrospective cohort study to describe the variability of antiretroviral therapy (ART) retention across health facilities among pregnant and lactating women and assess for differences in ART retention between Option B+ clients and other ART patients.

Results:

There were 1989 Option B+ clients who initiated ART in 45 health facilities. The percentage of attrition varied from 9% to 81% across the facilities. The largest health facilities had 38% higher risk of attrition (relative risk [RR]: 1.38, 95% confidence interval [CI]: 1.08-1.77, P = .009). Private institutions had 18% less risk of attrition (RR: 0.82, 95% CI: 0.70-0.96, P = .020). Health facilities located in the West department and the South region had lower risk of attrition.

Conclusion:

Being on treatment in a large or public health facility or a facility located in the North region was a significant risk factor associated with high attrition among Option B+ clients. The implementation of the Option B+ strategy must be reevaluated in order to effectively eliminate mother-to-child HIV transmission.
Protein‐coding genes combined with long noncoding RNA as a novel transcriptome molecular staging model to predict the survival of patients with esophageal squamous cell carcinoma
Authors: Guo Jin‐Cheng , Wu Yang , Chen Yang , Pan Feng , Wu Zhi‐Yong , Zhang Jia‐Sheng , Wu Jian‐Yi , Xu Xiu‐E , Zhao Jian‐Mei , Li En‐Min , Zhao Yi , Xu Li‐Yan
Published: May 2018

Background

Esophageal squamous cell carcinoma (ESCC) is the predominant subtype of esophageal carcinoma in China. This study was to develop a staging model to predict outcomes of patients with ESCC.

Methods

Using Cox regression analysis, principal component analysis (PCA), partitioning clustering, Kaplan–Meier analysis, receiver operating characteristic (ROC) curve analysis, and classification and regression tree (CART) analysis, we mined the Gene Expression Omnibus database to determine the expression profiles of genes in 179 patients with ESCC from GSE63624 and GSE63622 dataset.

Results

Univariate cox regression analysis of the GSE63624 dataset revealed that 2404 protein‐coding genes (PCGs) and 635 long non‐coding RNAs (lncRNAs) were associated with the survival of patients with ESCC. PCA categorized these PCGs and lncRNAs into three principal components (PCs), which were used to cluster the patients into three groups. ROC analysis demonstrated that the predictive ability of PCG‐lncRNA PCs when applied to new patients was better than that of the tumor‐node‐metastasis staging (area under ROC curve [AUC]: 0.69 vs. 0.65, P < 0.05). Accordingly, we constructed a molecular disaggregated model comprising one lncRNA and two PCGs, which we designated as the LSB staging model using CART analysis in the GSE63624 dataset. This LSB staging model classified the GSE63622 dataset of patients into three different groups, and its effectiveness was validated by analysis of another cohort of 105 patients.

Conclusions

The LSB staging model has clinical significance for the prognosis prediction of patients with ESCC and may serve as a three‐gene staging microarray.
Evaluating Patient-Centered Outcomes in Clinical Trials of Procedural Sedation, Part 2 Safety: Sedation Consortium on Endpoints and Procedures for Treatment, Education, and Research Recommendations
Authors: Ward Denham S. , Williams Mark R. , Berkenbosch John W. , Bhatt Maala , Carlson Douglas , Chappell Phillip , Clark Randall M. , Constant Isabelle , Conway Aaron , Cravero Joseph , Dahan Albert , Dexter Franklin , Dionne Raymond , Dworkin Robert H. , Gan Tong J. , Gozal David , Green Steven , Irwin Michael G. , Karan Suzanne , Kochman Michael , Lerman Jerrold , Lightdale Jenifer R. , Litman Ronald S. , Mason Keira P. , Miner James , O’Connor Robert E. , Pandharipande Pratik , Riker Richard R. , Roback Mark G. , Sessler Daniel I. , Sexton Anne , Tobin Joseph R. , Turk Dennis C. , Twersky Rebecca S. , Urman Richard D. , Weiss Mark , Wunsch Hannah , Zhao-Wong Anna
Published: May 2018

The Sedation Consortium on Endpoints and Procedures for Treatment, Education, and Research, established by the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks, a public–private partnership with the US Food and Drug Administration, convened a second meeting of sedation experts from a variety of clinical specialties and research backgrounds to develop recommendations for procedural sedation research. The previous meeting addressed efficacy and patient- and/or family-centered outcomes. This meeting addressed issues of safety, which was defined as “the avoidance of physical or psychological harm.” A literature review identified 133 articles addressing safety measures in procedural sedation clinical trials. After basic reporting of vital signs, the most commonly measured safety parameter was oxygen saturation. Adverse events were inconsistently defined throughout the studies. Only 6 of the 133 studies used a previously validated measure of safety. The meeting identified methodological problems associated with measuring infrequent adverse events. With a consensus discussion, a set of core and supplemental measures were recommended to code for safety in future procedural clinical trials. When adopted, these measures should improve the integration of safety data across studies and facilitate comparisons in systematic reviews and meta-analyses.
Population Pharmacokinetics and Pharmacodynamics of Dexmedetomidine in Children Undergoing Ambulatory Surgery
Authors: Pérez-Guillé María-Gabriela , Toledo-López Alejandra , Rivera-Espinosa Liliana , Alemon-Medina Radames , Murata Chiharu , Lares-Asseff Ismael , Chávez-Pacheco Juan Luis , Gómez-Garduño Josefina , Zamora Gutiérrez Ana-Lilia , Orozco-Galicia Claudia , Ramírez-Morales Karina , Lugo-Goytia Gustavo
Published: May 2018

BACKGROUND:

Dexmedetomidine (DEX) is an α-2 adrenergic agonist with sedative and analgesic properties. Although not approved for pediatric use by the Food and Drug Administration, DEX is increasingly used in pediatric anesthesia and critical care. However, very limited information is available regarding the pharmacokinetics of DEX in children. The aim of this study was to investigate DEX pharmacokinetics and pharmacodynamics (PK–PD) in Mexican children 2–18 years of age who were undergoing outpatient surgical procedures.

METHODS:

Thirty children 2–18 years of age with American Society of Anesthesiologists physical status score of I/II were enrolled in this study. DEX (0.7 μg/kg) was administered as a single-dose intravenous infusion. Venous blood samples were collected, and plasma DEX concentrations were analyzed with a combination of high-performance liquid chromatography and electrospray ionization-tandem mass spectrometry. Population PK–PD models were constructed using the Monolix program.

RESULTS:

A 2-compartment model adequately described the concentration–time relationship. The parameters were standardized for a body weight of 70 kg by using an allometric model. Population parameters estimates were as follows: mean (between-subject variability): clearance (Cl) (L/h × 70 kg) = 20.8 (27%); central volume of distribution (V1) (L × 70 kg) = 21.9 (20%); peripheral volume of distribution (V2) (L × 70 kg) = 81.2 (21%); and intercompartmental clearance (Q) (L/h × 70 kg) = 75.8 (25%). The PK–PD model predicted a maximum mean arterial blood pressure reduction of 45% with an IC50 of 0.501 ng/ml, and a maximum heart rate reduction of 28.9% with an IC50 of 0.552 ng/ml.

CONCLUSIONS:

Our results suggest that in Mexican children 2–18 years of age with American Society of Anesthesiologists score of I/II, the DEX dose should be adjusted in accordance with lower DEX clearance.
Benefit and Harm of Adding Epinephrine to a Local Anesthetic for Neuraxial and Locoregional Anesthesia: A Meta-analysis of Randomized Controlled Trials With Trial Sequential Analyses
Authors: Tschopp Clément , Tramèr Martin R. , Schneider Alexis , Zaarour Maroun , Elia Nadia
Published: May 2018

BACKGROUND:

This systematic review examines the benefit and harm of adding epinephrine to local anesthetics for epidural, intrathecal, or locoregional anesthesia.

METHODS:

We searched electronic databases to October 2017 for randomized trials comparing any local anesthetic regimen combined with epinephrine, with the same local anesthetic regimen without epinephrine, reporting on duration of analgesia, time to 2 segments regression, or any adverse effects. Trial quality was assessed using the Cochrane risk of bias tool and a random-effects model was used. Trial sequential analyses (TSA) were applied to identify the information size (IS; number of patients needed to reach a definite conclusion) and were set to detect an increase or decrease of effect of 30%–50%, depending on the end point considered. Alpha levels were adjusted (1%) for multiple outcome testing.

RESULTS:

We identified 70 trials (3644 patients, 17 countries, from 1970 to 2017). Median number of patients per trial was 44 (range, 9–174). Thirty-seven trials (1781 patients) tested epinephrine for epidural, 27 (1660) for intrathecal, and 6 (203) for locoregional anesthesia (sciatic, femoral, popliteal, axillary blocks). TSA enabled us to conclude that adding epinephrine to epidural local anesthetics could not decrease postoperative pain intensity by 30%, and did not impact the risk of intraoperative arterial hypotension. IS was insufficient to conclude on the impact of epinephrine on the risk of motor block (IS, 4%), arterial hypotension (20%), urinary retention (23%), or pain intensity at rest (27%) during labor. TSA confirmed that adding epinephrine to intrathecal local anesthetics increased the duration of motor block (weighted mean difference [WMD] 64 minutes; 99% CI, 37–91), analgesia (WMD 34 minutes; 99% CI, 6–62), and the time to 2 segments regression (WMD 20 minutes; 99% CI, 11–28). IS was insufficient to conclude on its impact on arterial hypotension (IS, 15%), or when administrated in a combined spinal-epidural, on motor block (IS, 11%) or arterial hypotension (IS, 11%). Adding epinephrine to local anesthetics for a locoregional block increased the duration of analgesia (WMD 66 minutes; 98% CI, 32–100]).

CONCLUSIONS:

Adding epinephrine to intrathecal or locoregional local anesthetics prolongs analgesia and motor block by no more than 60 minutes. The impact of adding epinephrine to epidural local anesthetics or to a combined spinal-epidural remains uncertain.
Frozen in Time: A History of the Synthesis of Nitrous Oxide and How the Process Remained Unchanged for Over 2 Centuries
Authors: Buslov Alexander , Carroll Matthew , Desai Manisha S.
Published: May 2018

Three major factors have contributed to the unrivaled popularity of nitrous oxide (N2O) among anesthetists in the 20th century and beyond: its impressive safety profile, its affordability, and its rapid induction and emergence times. These 3 characteristics of N2O have been discussed and written about extensively throughout the medical literature. Nonetheless, the characteristic that contributed most to N2O’s initial discovery—the elegance and simplicity of its synthesis—has received substantially less attention. Although N2O was first used as an anesthetic in Hartford, CT, in 1844, it had been identified and synthesized as a distinct gas in the late 18th century. In this article, we track the developments in the recognition and early synthesis of N2O, highlight the major players credited with its discovery, and examine its evolution from the late 1700s to today. The discovery and assimilation of N2O into common medical practice, alongside ether and chloroform, heralded a new paradigm in surgical medicine—one that no longer viewed pain as a fundamental component of surgical medicine. Its continued usage in modern medicine speaks to the brilliance and skill of the chemists and scientists involved in its initial discovery.
The Impact of Anesthesia-Influenced Process Measure Compliance on Length of Stay: Results From an Enhanced Recovery After Surgery for Colorectal Surgery Cohort
Authors: Grant Michael C. , Pio Roda Claro M. , Canner Joseph K. , Sommer Philip , Galante Daniel , Hobson Deborah , Gearhart Susan , Wu Christopher L. , Wick Elizabeth
Published: May 2018

BACKGROUND:

Process measure compliance has been associated with improved outcomes in enhanced recovery after surgery (ERAS) programs. Herein, we sought to assess the impact of compliance with measures directly influenced by anesthesiology in an ERAS for colorectal surgery cohort.

METHODS:

From January 2013 to April 2015, data from 1140 consecutive patients were collected for all patients before (pre-ERAS) and after (ERAS) implementation of an ERAS program. Compliance with 9 specific process measures directly influenced by the anesthesiologist or acute pain service was analyzed to determine the impact on hospital length of stay (LOS).

RESULTS:

Process measure compliance was associated with a stepwise reduction in LOS. Patients who received >4 process measures (high compliance) had a significantly shorter LOS (incident rate ratio [IRR], 0.77; 95% CI, 0.70–0.85); P < .001) compared to low compliance (0–2 process measures) counterparts. Multivariable regression suggests that utilization of multimodal nausea and vomiting prophylaxis (IRR, 0.78; 95% CI, 0.68–0.89; P < .001), scheduled postoperative nonsteroidal pain medication use (IRR, 0.76; 95% CI, 0.67–0.85; P < .001), and strict adherence to a postoperative opioid administration (IRR, 0.58; 95% CI, 0.51–0.67; P < .001) protocol for breakthrough pain were independently associated with reduced LOS.

CONCLUSIONS:

Our findings suggest that increased compliance with process measures directly influenced by the anesthesiologists and in concert with a formal anesthesia protocol is associated with reduced LOS. Engaging anesthesiology colleagues throughout the surgical encounter increases the overall value of perioperative care.
Symmetric duality for Bonvex multiobjective fractional continuous time programming problems
Authors: Ojha Deo Brat
Published: May 2018

We introduced a symmetric dual for multi objective fractional variational programs in second order. Under invexity assumptions, we established weak, strong and converse duality as well as self duality relations .We work with properly efficient solutions in strong and converse duality theorems. The weak duality theorems involves efficient solutions .