bluuebunny/crossref_metadata_2025 huggingface dataset:
Promoting Leisure Participation as Part of Health and Well-Being in Children and Youth With Cerebral Palsy
Authors: Shikako-Thomas Keiko , Kolehmainen Niina , Ketelaar Marjolijn , Bult Maureen , Law Mary
Published: June 2014

Participation in leisure is a human right and is central to the health of children and youth. The World Health Organization’s International Classification of Functioning, Disability and Health for Children and Youth supported a change in thinking about what outcomes are most relevant in the context of children’s health and places participation as one of the constituent elements of health. Participation is also a fundamental rehabilitation and health promotion outcome for children with cerebral palsy as identified by youth, parents, and health professionals. Several studies have identified individual and environmental factors related to participation in leisure; new studies are now determining the best interventions to promote participation. This article summarizes recent findings and proposes important topics for neurologists to consider in exploring leisure pursuits with children with cerebral palsy and their families and in working with rehabilitation professionals to promote engagement in leisure opportunities as part of integrated care.
Spontaneous Involution of Diffuse Fibrous Dysplasia of Paranasal Sinuses
Authors: De Carlo D. , Zotto L. Dal , Carollo C. , Porzionato A. , D’Avella D. , Pomerri F. , Battistella P. A.
Published: June 2014

We report the case of a 25-year-old patient, diagnosed at age 10, with diffuse fibrous dysplasia of the paranasal sinuses, an extremely rare idiopathic condition. This diagnosis is possible only by cerebral computed tomography (CT), cerebral and anterior skull base magnetic resonance imaging (MRI), and histopathology. Surgical treatment is common. This boy had mild symptoms: moderate headache in the morning that did not affect his daily activity, and rhinitis, partially responsive to medication. The neurologic examination was abnormal. Radiographs, CT, and MRI showed a diffuse mass in the paranasal sinuses which had a histopathological diagnosis of fibrous dysplasias. The family refused to refer the patient to surgery. The boy has been monitored annually for 15 years. He has remained asymptomatic without headache since age 11, with normal, general and neurologic examinations. Serial MRIs showed a spontaneous partial involution of the mass.
Pediatric Aquatic Therapy on Motor Function and Enjoyment in Children Diagnosed With Cerebral Palsy of Various Motor Severities
Authors: Lai Chih-Jou , Liu Wen-Yu , Yang Tsui-Fen , Chen Chia-Ling , Wu Ching-Yi , Chan Rai-Chi
Published: June 2014

This study investigates the effects of pediatric aquatic therapy on motor function, enjoyment, activities of daily living, and health-related quality of life for children with spastic cerebral palsy of various motor severities. Children with spastic cerebral palsy were assigned to a pediatric aquatic therapy group (n = 11; mean age = 85.0 ± 33.1 months; male : female = 4 : 7) or a control group (n = 13; mean age = 87.6 ± 34.0 months; male : female = 9 : 4). The statistic results indicate that the pediatric aquatic therapy group had greater average 66-item Gross Motor Function Measure following intervention than the control group (η2 = 0.308, P = .007), even for children with Gross Motor Function Classification System level IV (5.0 vs 1.3). The pediatric aquatic therapy group had higher Physical Activity Enjoyment Scale scores than the control group at post-treatment ( P = .015). These findings demonstrate that pediatric aquatic therapy can be an effective and alternative therapy for children with cerebral palsy even with poor Gross Motor Function Classification System level.
Home‐Delivered Meals and Nutrition Status Among Older Adults
Authors: Sahyoun Nadine R. , Vaudin Anna
Published: June 2014

The trend among older adults in the United States is to “age in place” instead of opting for institutionalization. To maintain older adults with chronic conditions in their homes and to improve health after hospitalization, comprehensive social, health, and nutrition services are essential. Quality of dietary intake is crucial and yet often underestimated. Calorie needs decrease with age while nutrient needs remain the same, even increasing for some nutrients. This poses difficulties for individuals with functional disabilities who are unable to shop and cook due to physical or mental limitations or on a limited budget. The Older American Act home‐delivered meal (HDM) program offers at least 1 healthy meal per day, 5 or more days per week, and targets individuals homebound due to illness, disability, or social isolation and those with greatest economic or social need. This review summarizes the available literature on the relationship between HDM and health outcomes. The HDM program is difficult to evaluate because of the multifactorial effect on health status. However, national surveys and smaller studies show that it is well targeted, efficient, and well liked; provides quality food to needy individuals; and helps individuals remain living independently. Studies show that HDMs improve dietary intake, with greater health benefits when more meals reach the neediest individuals. HDMs also decrease institutionalization of older adults and resulting healthcare expenditures. However, funding has not kept up with increased demand for this program. More studies with improved designs may provide more information supporting the program's impact on nutrition status and decreased health expenditures.
Nasal Bridles for Securing Nasoenteric Tubes
Authors: Bechtold Matthew L. , Nguyen Douglas L. , Palmer Lena B. , Kiraly Laszlo N. , Martindale Robert G. , McClave Stephen A.
Published: June 2014

Background: Nasoenteric feeding tubes may easily become dislodged due to patient mental status, transfers, or positional changes. Nasal bridles were introduced to provide a better, more reliable system to secure these tubes. This meta‐analysis was performed to evaluate the effectiveness of nasal bridles compared with the traditional method of adhesive tape alone in securing enteral feeding tubes. Materials and Methods: Multiple databases were searched (October 2013). All studies that evaluated the use of nasal bridles in adult patients were included in the analysis. Meta‐analysis for the outcomes from use of a nasal bridle vs the more traditional method of adhesive tape alone for securing nasoenteric tubes was analyzed by calculating pooled estimates of dislodgement, skin complications, and sinusitis. Statistical analysis was performed using RevMan 5.1. Results: Six studies (n = 594) met the inclusion criteria. Use of a nasal bridle for securing enteral tubes resulted in a statistically significant reduction in tube dislodgement compared with traditional adhesive tape alone (odds ratio [OR], 0.16; 95% confidence interval [CI], 0.10–0.27; P < .01). The use of nasal bridles was associated with a higher rate of skin complications compared with traditional adhesive tape (OR, 4.27; 95% CI, 1.79–10.23; P < .01). Incidence of sinusitis was no different between the 2 groups (OR, 0.26; 95% CI, 0.03–2.28; P = .22). Conclusion: Nasal bridles appear to be more effective at securing nasoenteric tubes and preventing dislodgement than traditional use of tape alone.
Implementation of a Dietitian‐Led Enteral Nutrition Support Clinic Results in Quality Improvement, Reduced Readmissions, and Cost Savings
Authors: Hall Beth T. , Englehart Michael S. , Blaseg Karyl , Wessel Kandis , Stawicki Stanislaw P. A. , Evans David C.
Published: June 2014

Background: Enteral access device malfunction and breakage results in significant morbidity and healthcare cost. In many healthcare systems, enteral nutrition care is fragmented and inefficient. We describe the development and validation of an enteral nutrition support clinic (NSC) with a focus on prevention of enteral access complications. A care protocol consisting of pre‐ and postplacement visits and subsequent weekly visits was developed. Competencies were established for dietitians to staff the NSC. Methods: A retrospective quality analysis was performed in patients before and after the implementation of an enteral NSC. Enteral access complications, emergency room visits, readmissions, unplanned physician visits, and tube replacements were recorded for 90 days after tube placement. Results: Thirty patients were evaluated in the NSC pilot and compared with 22 baseline patients with adequate follow‐up. The NSC resulted in an 88.9% reduction in nutrition‐related emergency room visits (P = .016) and 78.1% reduction in readmissions (P = .027). Estimated per‐patient cost reductions amounted to $6831. Approximately 30% of patients were seen in the NSC at least once for a clogged tube and 43.3% for tube leakage. Only 1 NSC patient required a procedure for tube reinsertion. Conclusion: Implementation of a dietitian‐led nutrition support clinic resulted in improved quality, as well as reductions in hospital readmissions, tube‐related complications, and healthcare costs.
Evaluation of a Web-Based Professional Development Program (Project ACE) for Teachers of Children With Autism Spectrum Disorders
Authors: Rakap Salih , Jones Hazel A. , Emery Alice Kaye
Published: June 2014

This article describes the development, implementation, and second-year evaluation of Project Autism Competencies for Endorsement (ACE), a web-based professional development (PD) program that is designed to train teachers currently working in the field to meet the unique and diverse needs of children with autism spectrum disorders (ASDs). A description of the rationale for the project and an overview of the program of study are followed by the presentation of the second-year evaluation activities and their results. Preliminary findings of this study suggested that the web-based PD program was effective in helping teachers develop and improve their competencies, knowledge, and skills. Moreover, teachers felt comfortable using the teaching strategies they learned in the program and reported some application of these strategies in their practices. Also, most teachers reported their satisfaction with the web-based courses offered in the program. Implications for the future research and practice are presented.
Do Successful Agers Live Longer? The Vitality 90+ Study
Authors: Nosraty Lily , Enroth Linda , Raitanen Jani , Hervonen Antti , Jylhä Marja
Published: June 2014

Objective: To discover whether successful aging, understood as a multidimensional concept, predicts further survival in very old people. Method: The population sample consisted of 1,370 persons aged 90 or over in the Vitality 90+ study. Four alternative models of successful aging were constructed, each of them consisting of physical, psychological, and social dimensions. Mortality was followed up after 4 and 7 years. Results: Three out of four models significantly predicted survival at both follow-ups for the whole group. Separately, “success” in the physical, psychological, and social components was also associated with higher survival. The associations were stronger in women than in men. Discussion: Successful aging, measured using physical, psychological, and social dimensions, predicts the length of future life in nonagenarians.
Microwave-assisted synthesis and characterization of resole-type phenolic resins
Authors: Srivastava Kavita , Srivastava Deepak , Tripathi Santosh K.
Published: June 2014

Resoles were prepared under microwave irradiation with different phenols, such as phenol, o-, p-, and m-cresols, separately with formaldehyde having formaldehyde/phenol ratio of 2:1 in basic medium. Analogical synthesis was performed using conventional heating for comparing the methods. The methylolation of phenol was confirmed by Fourier transform infrared spectroscopic analysis and a reaction mechanism was proposed. The number-average molecular weight was found by gel permeation chromatography technique. On the basis of the calculated value of kinetic chain length, the structure of the resole-type phenolic resin was proposed. Differential scanning calorimetry technique was used to investigate the curing behavior. As assessed by dynamic thermogravimetry, traces of resole sample prepared from p-cresol were found to possess better thermal stability, both in conventional as well as microwave-irradiated systems, among all other resole samples. The tensile strength, elongation at break, and impact strength showed an increasing trend. The main advantage of the process is about sixfold reduction of reaction time of the process carried at microwave reactors in comparison with the conventional heating.
Optimization of the behaviour of high-speed railway tracks using a genetic algorithm approach
Authors: Rodrigues André FS , Dimitrovová Zuzana
Published: June 2014

This paper deals with a multi-objective optimization of geometrical and mechanical properties of a high-speed railway track when subjected to a moving load representative of a train axle. The model of the track employs several simplifications; it was implemented in two dimensions on the explicit dynamics module LS-DYNA for the finite element commercial software ANSYS. The design space is formed by the ballast height and by parameters representing the dynamic properties of the rail-pads. The objective function covers minimization of the maximum ascending and descending displacement and velocity in the main structural elements, namely the rail, the sleepers and the ballast. A genetic algorithm implementation is used to optimize these functions, which proved to be effective in finding quasi-optimal solutions with a low search effort. The tools presented can give insight into how the behaviour of the railway track is influenced by various design parameters.
Long-Term Temporal Tracking of Speech Rate Affects Spoken-Word Recognition
Authors: Baese-Berk Melissa M. , Heffner Christopher C. , Dilley Laura C. , Pitt Mark A. , Morrill Tuuli H. , McAuley J. Devin
Published: June 2014

Humans unconsciously track a wide array of distributional characteristics in their sensory environment. Recent research in spoken-language processing has demonstrated that the speech rate surrounding a target region within an utterance influences which words, and how many words, listeners hear later in that utterance. On the basis of hypotheses that listeners track timing information in speech over long timescales, we investigated the possibility that the perception of words is sensitive to speech rate over such a timescale (e.g., an extended conversation). Results demonstrated that listeners tracked variation in the overall pace of speech over an extended duration (analogous to that of a conversation that listeners might have outside the lab) and that this global speech rate influenced which words listeners reported hearing. The effects of speech rate became stronger over time. Our findings are consistent with the hypothesis that neural entrainment by speech occurs on multiple timescales, some lasting more than an hour.
A 5MW direct-drive generator for floating spar-buoy wind turbine: Development and analysis of a fully coupled Mechanical model
Authors: Sethuraman Latha , Xing Yihan , Gao Zhen , Venugopal Vengatesan , Mueller Markus , Moan Torgeir
Published: June 2014

This work forms the first of a two-part investigation aimed at identifying the challenges and opportunities of implementing a direct-drive generator for a spar-buoy type floating wind turbine. Preliminary specifications are presented for a fully coupled aero-hydro-servo-elastic model of a floating wind turbine with a 5 MW direct-drive generator. The drive-train model uses a low-speed, high-torque radial flux permanent magnet generator supported by two main-shaft bearings. The mechanical properties of the drive-train, including the main dimensions, mass of major nacelle equipment and details for the hub/nacelle assembly are presented. The rationale behind the adjustments to the tower and platform properties and the motivation to selection of best arrangement that is appropriate for supporting the developed system is explained. A discussion on the development of the variable speed-variable pitch control system suitable for the direct-drive system including modifications to avoid negative damping and blade-pitch instability are presented. Fully coupled simulations for the developed aero-hydro-servo elastic model were carried out in HAWC2 for the normal operating conditions of the wind turbine. The aerodynamic response of the model was verified and compared with that of a geared floating wind turbine system. Some initial results comparing the main shaft loads of the land-based and floating versions of the direct-drive wind turbine suggest satisfactory dynamic behaviour of the drive-train. The results prompt further research using a detailed drive-train model to verify the internal response, loading and durability of the components to assess their compatibility with a floating wind turbine system.
The evolution of the discipline of pharmacology amid an era of global turbulence: The unique contributions of Otto Krayer (1899–1982)
Authors: Rubin Ronald P
Published: June 2014

This article revisits the life and times of Otto Krayer, a gifted scientist, teacher and administrator. His unique contributions to the discipline of pharmacology and to the biomedical sciences are chronicled in the wake of the political upheaval that crippled German science during the 1930s. The anti-scientific attitude that pervaded Germany at the time led to the exile of Krayer and many other eminent scientists. Their fate is recounted, as well as the negative impact on science caused by a National Socialist regime that blatantly disregarded basic scientific principles. The threat of intolerance and unethical behaviour still remains a key obstacle to scientific creativity.
Social contract of academic medical centres to the community: Dr Howard Atwood Kelly (1858–1943), a historical perspective
Authors: Allen Paul
Published: June 2014

Academic medical centres have traditionally been bastions of teaching and research. Outreach to the community at large and involvement in community affairs have sometimes been lacking in the overall mission and activities of academic medical centres. This paper provides an historical perspective first on the numerous achievements of a physician and surgeon and then on the topic of involvement in community affairs by reviewing the many contributions of America’s pioneer gynaecological surgeon and one of the four physician founders of the Johns Hopkins Hospital and School of Medicine in 1889 – Dr Howard Atwood Kelly.
Dr John Dickinson (1832–1863): The man behind the bird
Authors: Conacher ID
Published: June 2014

The surgeon/naturalists Dr John Kirk, Dr Charles Meller and Dr John Dickinson, associated with the Zambezi Expedition (1857–1864) under the leadership of Dr David Livingstone are, like him, credited with the discovery of new species’ of birds. A raptor, Falco dickinsoni, is named after Dr John Dickinson. Dickinson, born in the north east of England, trained in medicine in Newcastle upon Tyne. He volunteered to join the Universities’ Mission to Central Africa and arrived as part of a second group to join Bishop Frederick Mackenzie, then attempting to build a Mission in Magomero, on the Shire Mountain Plateau in modern Malawi. Livingstone and Mackenzie had sown the seeds of disaster for the first UMCA venture while Dickinson was on his way to Central Africa, and his one meeting with Livingstone was trigger to a chain of events that threatened the whole expedition. Shortly after Dickinson’s arrival in Magomero, Bishop Mackenzie and a fellow traveller, Reverend Henry de Wint Burrup, died. Magomero was abandoned and the remaining missionaries retrenched in Chibisa’s Village on the River Shire. There, where Dickinson did most of his bird collecting, on 17 March 1863, he died of blackwater fever. Livingstone and Kirk were present at the burial. A marble cross at Chikwawa in Malawi is marker to the event that occurred on the day of Dr John Dickinson’s 32nd birthday.
Alexander Nikolaevich Scriabin (1872–1915): Enlightenment or illness?
Authors: Witztum Eliezer , Lerner Vladimir
Published: June 2014

The similarity between psychotic symptoms and aspects of mystical experiences is well known. It has long been recognized that there are similarities between mystical and spiritual and psychotic experiences. The content of an experience alone usually does not determine whether an individual is psychotic. The Russian composer Scriabin (1872–1915) was among the most famous artists of his time. Scriabin infused his music with mysticism, evolving a modernistic idiom through which he created a musical counterpart to the Symbolist literature of that period. In this paper, we discuss the question that arises from perusing Scriabin’s life is whether the composer was a mystic genius or whether he suffered from affective psychopathology with psychotic features.
Routine screening for α-thalassaemia using an immunochromatographic strip assay for haemoglobin Bart's
Authors: Prayalaw Patcharawadee , Fucharoen Goonnapa , Fucharoen Supan
Published: June 2014

Objective

To evaluate an immunochromatographic (IC) strip assay for Hb Bart's as a routine screening test for α-thalassaemia in area with a high prevalence of thalassaemia and haemoglobinopathies.

Methods

A total of 300 adult screen positive blood specimens were collected at an ongoing thalassaemia screening programme in northeast Thailand. Routine screening was done using red blood cell indices, osmotic fragility, and dichlorophenolindophenol tests. The IC strip assay for haemoglobin Bart's was performed on all samples. The result was evaluated against thalassaemia genotypes determined using standard haemoglobin and DNA analyses.

Results

Of 300 subjects investigated, Hb and DNA analyses identified 32 with normal genotype. The remaining subjects carried thalassaemia with as many as 16 different genotypes. Hb Bart's was detected in all cases, with several α0-thalassaemia (SEA type) related disorders. Of cases with α+-thalassaemia, 86.1% showed a positive result; 100 out of 103 Hb E carriers, all homozygous Hb E and β-thalassaemia trait were negative. Nine out of 17 cases with β-thalassaemia/Hb E disease, and one case of double heterozygote for Hb Q-Thailand and Hb E returned positive results. The overall sensitivity and specificity of the IC strip assay for detecting α0-thalassaemia were 100% and 73.1%, respectively.

Conclusion

The results showed a high sensitivity for screening for α0-thalassaemia using IC strip assay for Hb Bart's. This simple method, used in combination with conventional screening protocols, should lead to a significant reduction in the number of referral cases for DNA analysis. Cost effectiveness in each population should be taken into consideration.
Evidence-Based Practices in North American MSW Curricula
Authors: Bertram Rosalyn M. , Charnin Leia A. , Kerns Suzanne E. U. , Long Anna C. J.
Published: June 2014

This study examined the extent to which evidence-based practices (EBPs) are taught in North American Masters of Social Work (MSW) curricula. A web-based survey distributed through the National Association of Deans and Directors and a similar Canadian listserv facilitated exploration of which EBPs are taught, what faculty positions teach them, in what size programs, geographic areas, and other factors, as well as the barriers and implications of doing so. Fifty-eight program deans and directors responded to the survey. While the majority of programs reported teaching at least one EBP and developing EBP skill sets, challenges to curriculum integration were noted. Ideological, definitional, and practical concerns emerge as constraints to teaching EBPs, with MSW program leaders identifying faculty-related barriers as a primary constraining factor. This article presents the study and its implications for academic and practice settings.
The Organizational Context of Research-Minded Practitioners
Authors: McBeath Bowen , Austin Michael J.
Published: June 2014

If some practitioners are more research minded than others, then promising approaches for bridging the research to practice gap may be developed by describing research-minded practitioners and examining how to locate and support them. This article follows this basic logic in providing an overview of organizational development and practitioner support models for increasing knowledge use in human service organizations. The article begins with a conceptual profile of research-minded practitioners—individuals with an affinity for empirical inquiry, critical thinking, and reflection allied with a commitment to data-driven organizational improvement—and the organizational settings needed to host research-minded practice. This is followed by a description of the challenges involved in promoting practitioner involvement in using, translating, and doing research and strategies to address these challenges. We conclude with implications for supporting research-minded practitioners and aligning their efforts with organizational improvement processes. The goal of the analysis is to identify the organizational contexts in which research-minded practitioners can thrive as well as new directions for practice research.
Enacting Fall Prevention in Community Outreach Care
Authors: Shaw James A. , Connelly Denise M. , McWilliam Carol L.
Published: June 2014

Despite increased international concern about fall prevention throughout the past 20 years, only limited attention has been paid to the experiences and perspectives of health care providers who deliver fall prevention programs. The purpose of this interpretive phenomenological study was to explore the meaning of the experience of enacting fall prevention, through individual semistructured interviews, among 6 members of an interprofessional geriatric outreach team in Ontario, Canada. Findings suggest that enacting careful practice was essential to the experience of enacting fall prevention, represented by four interrelated phenomenological themes: caring fully for older clients, carefully seeing older clients in their life contexts, enacting therapeutic relationships, and experiential learning in interprofessional teams. We discuss findings in relation to literature on emotional labor, leading to suggestions for the policy and practice of fall prevention.
Identity Representations of People With Diabetes
Authors: Amorim Maria Marta Amancio , Ramos Natália , Brito Maria José Menezes , Gazzinelli Maria Flávia
Published: June 2014

In this study, we aimed to investigate the construction of identity representations by primary health care patients with type 2 diabetes mellitus and their relationship to the required self-care actions. A free word association technique required clients from a basic health unit ( N = 34) to suggest a word or expression and justify it in response to the question, “When talking about being a diabetic, what comes to your mind?” We performed, transcribed, and categorized the recordings, then interpreted them according to thematic content analysis, social representation, and social identity theories. Intentions mediated by identity processes—social comparison, social attribution, and categorization within the studied group—and also by objectification and anchoring, provided the following social constructions: normal, accepting of the disease, feeling unaccepting, and experiencing difficulties. The disease might alter patients’ identity representation within a context permeated by individuals’ subjective sense.
Strategies for Development of Palliative Care From the Perspectives of General Population and Health Care Professionals
Authors: Yoshida Saran , Miyashita Mitsunori , Morita Tatsuya , Akizuki Nobuya , Akiyama Miki , Shirahige Yutaka , Ichikawa Takayuki , Eguchi Kenji
Published: June 2014

This study primarily aimed to identify future actions required to promote palliative care in Japan. The future actions regarded as effective by the general population were “improve physicians’ skill in palliative care” (61%), “create a counseling center for cancer” (61%), and “improve nurses’ skill in palliative care” (60%). In contrast, future actions regarded as effective by the health care professionals were “set up a Web site that provides information about cancer” (72%), “promote consultation with specialists in palliative care” (71%), and “open an outpatient department specializing in palliative care” (70%). The results suggest (1) development and maintenance of settings; (2) enhancement of palliative care education and training programs for health care providers; and (3) improvement in distributing information about cancer and regional palliative care resources to the general population.
Knowledge About Hospice Care and Beliefs About Pain Management
Authors: Carrion Iraida V. , Cagle John G. , Van Dussen Daniel J. , Culler Krystal L. , Hong Seokho
Published: June 2014

Context:

Among Hispanics, incomplete knowledge about hospice care may explain low rates of utilization and culturally-specific beliefs about pain and pain treatments may contribute to disparities in pain management.

Objectives:

To compare (1) knowledge and attitudes regarding hospice, (2) and beliefs about pain and pain medication between Hispanics and non-Hispanics.

Methods:

A cross-sectional phone-based survey of adults living in the contiguous United States was conducted using randomly selected phone numbers with over-sampling for diversity. Measures assessed knowledge (a 23-item test), attitudes (an 8-item scale), experiences, preferences related to hospice and beliefs regarding pain and pain management.

Results:

123 individuals participated in the survey, 13% of whom were Hispanic. Hispanics were less likely to have heard of hospice are ( p <. 001) and, among those who had, more likely to have inaccurate information about it ( p = .05). Specifically, Hispanics were more likely to report that only individuals over age 65 are eligible for hospice services, which is incorrect (44% vs. 93% of non-Hispanics; p=.001). Only 67% of Hispanics knew that hospice helps family members as well as the dying person. More Hispanics (43%) than non-Hispanics (9.3%) reported that admitting pain is a sign of weakness ( p < .001). A greater proportion of Hispanic respondents agreed that a good patient does not talk about pain ( p = .07): 38% vs. 18% from non-Hispanics.

Conclusion:

Despite the increasing knowledge of hospice care among Hispanics, specific information about the scope of services remains limited. Cultural beliefs about pain management, along with inadequate knowledge of the role of pain management at end of life, persist.
The Cost of Inappropriate Care at the End of life
Authors: Marik Paul E.
Published: June 2014

Elderly patients patients (older than 65 years) account for only 11% of the US population yet they account for 34% of health care expenditure. The disproportionate usage of health care costs by elderly patients is in striking contrast with that of other Western Nations. It is likely that these differences are largely due to variances in hospitalization and the use of high technology health care resources at the end of life. The United States has 8 times as many intensive care unit (ICU) beds per capita when compared to other Western Nations. In the United States, elderly patients currently account for 42% to 52% of ICU admissions and for almost 60% of all ICU days. A disproportionate number of these ICU days are spent by elderly patients before their death. In many instances, aggressive life supportive measures serve only to prolong the patient’s death. Such treatment inflicts pain and suffering on the patient (with little prospects of gain) and incurs enormous financial costs to the health care system. We present the case of an 86-year-old female who spent almost 3 months in our ICU prior to her death. The fully allocated hospital costs for this patient were estimated to be US$254 945 (US$5100/d). With the increasing age of the population and the projected increased demand for ICU beds, we review the benefits and burdens of admitting elderly patients to the ICU.
Changes in and Associations Among Functional Status and Perceived Quality of Life of Patients With Metastatic/Locally Advanced Cancer Receiving Rehabilitation for General Disability
Authors: Sekine Ryuichi , Ogata Masami , Uchiyama Ikuyo , Miyakoshi Koichi , Uruma Megumi , Miyashita Mitsunori , Morita Tatsuya
Published: June 2014

The primary aims were to clarify the changes in the functional status and quality of life of patients with metastatic/locally advanced cancer who received rehabilitation therapy. This is a cohort study, and all consecutive patients who received rehabilitation therapy were evaluated before and 2 weeks after. Outcome measures were the Functional Independence Measure (FIM), perceived independence, and overall quality of life (European Organization for Research and Treatment of Cancer C30). A total of 128 patients were included. Although the FIM score significantly decreased, the overall quality of life significantly increased. Even in the patients with deteriorated FIM scores, the overall quality of life was maintained despite a significantly decreased perceived independence. Terminally ill patients with cancer who received a rehabilitation program maintained their overall quality of life despite an objective decline in the physical functional status.
A strain gradient plasticity theory with application to wire torsion
Authors: Liu JX , ElSayed T
Published: June 2014

Based on the framework of the existing strain gradient plasticity theories, we have examined three kinds of relations for the plastic strain dependence of the material intrinsic length scale, and thus developed updated strain gradient plasticity versions with deformation-dependent characteristic length scales. Wire torsion test is taken as an example to assess existing and newly built constitutive equations. For torsion tests, with increasing plastic strain, a constant intrinsic length predicts too high a torque, while a decreasing intrinsic length scale can produce better predictions instead of the increasing one, different from some published observations. If the Taylor dislocation rule is written in the Nix-Gao form, the derived constitutive equations become singular when the hardening exponent gets close to zero, which seems questionable and calls for further experimental clarifications on the exact coupling of hardening due to statistically stored dislocations and geometrically necessary dislocations. Particularly, when comparing the present model with the mechanism-based strain gradient plasticity, the present model satisfies the reciprocity relation naturally and gives different predictions even under the same parameter setting.
Psychometrics of the Symptoms and Functioning Severity Scale for High-Risk Youth
Authors: Duppong Hurley Kristin , Lambert Matthew C. , Stevens Amy
Published: June 2014

Youth in residential care have significant mental health needs, which require regular progress monitoring; however, very few emotional or behavioral assessments have been examined with this unique, high-risk population. This study examined the psychometrics of the Symptoms and Functioning Severity Scale (SFSS), a brief 24-item measure designed to assess the emotional and behavioral status of youth. This study examined the SFSS ratings from 143 youth with a disruptive behavior diagnosis living in a group-home facility in the Midwest and 52 of their service providers. Overall, the findings suggest that the psychometrics of the SFSS, when rated by staff or youth, were similar to the original outpatient clinical samples. More specifically, the Rasch analyses indicate that the SFSS items and the overall scale are performing adequately, and the confirmatory factor analyses replicated the two-factor structure for staff. However, the fit of the two-factor model was less compelling for youth ratings. In all, the brief SFSS seems a promising measure for assessing problem severity for youth in residential care.
Rapid Induction of Hypothermia by the ThermoSuit System Profoundly Reduces Infarct Size and Anatomic Zone of No Reflow Following Ischemia–Reperfusion in Rabbit and Rat Hearts
Authors: Herring Michael J. , Dai Wangde , Hale Sharon L. , Kloner Robert A.
Published: June 2014

Introduction:

Although hypothermia reduces myocardial infarct size, noninvasive and rapid cooling methods are lacking. This study tests the effectiveness of a novel cooling apparatus on myocardial infarct size and no-reflow area in 2 models of coronary artery occlusion (CAO).

Methods and Results:

Animals were randomized to normothermic (N) or hypothermic (H) groups after isolation of a proximal coronary artery. Animals were subjected to 30 minutes CAO and 3 hours reperfusion. In protocol 1 (rabbit, n = 8 per group), hypothermia was initiated, using the ThermoSuit apparatus (convective-immersion cooling), 5 minutes after the onset of CAO to a goal temperature of ∼32°C. In protocol 2 (rat, n = 5 per group), hypothermia was initiated 2 minutes after the onset of CAO to a goal temperature of ∼30°C. Goal temperature was reached in ∼20 minutes. In protocol 1, hypothermia caused an 82% reduction in infarct size as a percentage of the ischemic risk zone (N, 44% ± 5%; H; 8% ± 2%, P < 0.001) and an 89% reduction in the no-reflow area (N, 44% ± 4%; H, 5% ± 1%, P < 0.001). In protocol 2, hypothermia caused a 73% infarct size reduction (N, 51% ± 5%; H, 14% ± 6%, P < 0.01) and a 99% reduction in the no-reflow area (N, 33% ± 5%; H, 0.4% ± 0.3%, P < 0.01).

Conclusion:

The ThermoSuit device induced rapid hypothermia and limited infarct size and no reflow to the greatest extent ever observed in this laboratory with a single intervention.
Chronic Treatment With Qiliqiangxin Ameliorates Aortic Endothelial Cell Dysfunction in Diabetic Rats
Authors: Chen Fei , Wu Jia-Le , Fu Guo-Sheng , Mou Yun , Hu Shen-Jiang
Published: June 2014

Qiliqiangxin (QL), a traditional Chinese medicine, has been shown to be beneficial for chronic heart failure. However, whether QL can also improve endothelial cell function in diabetic rats remains unknown. Here, we investigated the effect of QL treatment on endothelial dysfunction by comparing the effect of QL to that of benazepril (Ben) in diabetic Sprague-Dawley rats for 8 weeks. Cardiac function was evaluated by echocardiography and catheterization. Assays for acetylcholine-induced, endothelium-dependent relaxation (EDR), sodium nitroprusside-induced endothelium-independent relaxation, serum nitric oxide (NO), and nitric oxide synthase (NOS) as well as histological analyses were performed to assess endothelial function. Diabetic rats showed significantly inhibited cardiac function and EDR, decreased expression of serum NO and phosphorylation at Ser1177 on endothelial NOS (eNOS), and impaired endothelial integrity after 8 weeks. Chronic treatment for 8 weeks with either QL or Ben prevented the inhibition of cardiac function and EDR and the decrease in serum NO and eNOS phosphorylation caused by diabetes. Moreover, either QL or Ben suppressed inducible NOS (iNOS) protein levels as well as endothelial necrosis compared with the diabetic rats. Additionally, QL prevented the increase in angiotensin-converting enzyme 1 and angiotensin II receptor type 1 in diabetes. Thus, chronic administration of QL improved serum NO production, EDR, and endothelial integrity in diabetic rat aortas, possibly through balancing eNOS and iNOS activity and decreasing renin–angiotensin system expression.
The Combination of Elevated Triglycerides and Abnormal Fasting Glucose Increases Risk of Cerebral Infarction in Patients With Mild to Moderate Hypercholesterolemia
Authors: Nakagami Tomoko , Nishimura Rimei , Sone Hirohito , Tajima Naoko
Published: June 2014

Background:

While triglycerides (TGs) and diabetes increase the risk of cardiovascular disease (CVD), their combined effects have not been quantified. We explored the combined effect of elevated TGs and glucose on CVD in a post hoc analysis of the large-scale Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese (MEGA) Study. Material and Methods: In the MEGA Study, 8214 patients with mild to moderate hypercholesterolemia were randomly allocated to the diet alone group or diet plus pravastatin group and followed for 5 years. Of those, 7832 patients included in the intention-to-treat analysis were stratified into 4 groups: abnormal fasting glucose (AFG) plus high TGs, high TGs alone, AFG alone, and normal fasting glucose plus normal TGs (reference). Cox proportional hazard models were used to compare the incidence of and mortality from CVD in the 4 groups.

Results:

Incidence of CVD and coronary heart disease was significantly higher in the groups with AFG alone (hazard ratio [HR], 2.02 and 3.38; P < .01, respectively) and AFG plus high TGs (HR, 2.87 and 3.87; P < .01, respectively) than the reference group. A similar relation was found in models adjusting for high-density lipoprotein cholesterol (HDL-C). Although the incidence of cerebral infarction was significantly higher only in the group with AFG plus high TGs (HR, 2.16; P = .01), it was marginally significantly higher than the reference group after adjustment for HDL-C (HR, 1.86; P = .06). Diet plus pravastatin treatment reduced the risk of cerebral infarction by 66% in the group with AFG plus high TGs ( P = .03).

Conclusions:

Our findings contribute to the formulation of the hypothesis that patients with hypercholesterolemia having AFG plus high TGs have an increased risk of cerebral infarction. These are compatible with the result from the main study that patients with hypercholesterolemia randomized to diet plus pravastatin had a reduced risk of cerebral infarction.
Relative Risk of Deep Vein Thrombosis in Very Elderly Patients Compared With Elderly Patients
Authors: Yayan Josef , Bals Robert
Published: June 2014

Deep vein thrombosis (DVT) and pulmonary embolism are major causes of morbidity and mortality in patients during hospitalization; previous studies have proposed that an advanced age of more than 60 years is a risk factor for these conditions. This study analyzes the relative risk of DVT in very elderly patients older than 90 years of age compared with elderly patients aged 80 to 89 years. The study was performed at the Department of Internal Medicine, University Hospital of Saarland, Homburg/Saar, Germany, between 2004 and 2012. After completing ultrasound examinations, 20 (64.52%, 12 [60%] female patients, mean age 91.8 ± 1.83 years) of the 31 patients in the study group and 132 (62.26%, 87 [65.91%] female patients, mean age 83.84 ± 2.66 years) of the 212 patients in the control group were diagnosed with DVT. An increased relative risk of DVT was not discovered in the very elderly patients (relative risk, 1.04; P = .80).
Protein Z G79A Polymorphism and Puerperal Cerebral Venous Thrombosis
Authors: Yadav Dharmendrasinh Dhansingh , De Tanima , Nagaraja Dindagur , Christopher Rita
Published: June 2014

Protein Z (PZ), a cofactor for PZ-dependent protease inhibitor, is known to play an important role in inhibiting the coagulation cascade. The aim of the study was to investigate whether PZ G79A polymorphism is a risk factor for puerperal cerebral venous thrombosis (CVT). A total of 71 patients with puerperal CVT and 98 healthy controls were genotyped for PZ 79GA polymorphism by polymerase chain reaction-restriction fragment length polymorphism method. In patients, the genotype distribution for GG, GA, and AA genotypes was 22.5%, 43.7%, and 33.8%, and in controls, 25.5%, 40.8%, and 33.7%, respectively. The risk associated with carrying the mutant genotype (GA and AA) versus the wild GG genotype was found to be 1.11 (95% confidence interval: 0.52-2.35; P = .909). There was no significant difference in the clinical features of the patients with and without the polymorphism. We therefore conclude that PZ G79A polymorphism is not a risk factor for puerperal CVT in Indian women.
Urban Political Leadership and Political Representation
Authors: Kjaer Ulrik
Published: June 2014

The concepts of political leadership and political representation are applied to urban politics, and based on a case study of four mayors in Denmark, four mayoral representational functions are identified: “representative,” “master of ceremonies,” “local secretary of state,” and “ombudsman.” The four functions separate the mayor from the councillors who act only as representatives. With regard to representational focus (who is represented), the case study demonstrates that mayors have a much broader focus than councillors. The different functions and focuses of mayors and councillors are combined into two ideal types of representation, “leader style” and “legislator style.”
Adenocarcinoma of the ampulla of Vater: What treatment options are available?
Authors: Senatore Frank J , Ynson Marie L , Dasanu Constantin A
Published: June 2014

The scientific literature on adenocarcinoma of the ampulla (papilla) of Vater suggests that it either represents a distinct entity or is more closely related to small bowel adenocarcinoma than to the biliary malignancies. The ambiguity surrounding this rare cancer has kindled research exploring its immunohistochemistry aspects and gene expression profiling. While the basis of management for resectable disease remains surgical intervention, the role of adjuvant chemotherapy is not clear. A recent large phase 3 clinical trial conducted in patients with resected ampulla of Vater adenocarcinoma favored adjuvant chemotherapy over observation alone. The standards of therapy for the advanced small bowel adenocarcinoma and biliary cancer are fluoropyrimidine derivatives and gemcitabine-based combinations, respectively. In addition, new biologic and targeted agents may enhance clinical results seen in this cancer type. Therefore, diligently designed clinical trials are necessary to establish its optimal treatment strategies. We describe herein a patient with ampulla of Vater adenocarcinoma who had an exceptional response to fluoropyrimidine-based chemotherapy. We further include a discussion reviewing the clinicopathologic aspects of this neoplasm as well as focus on currently available and future therapeutic options.
Victim Age and the Generalist Versus Specialist Distinction in Adolescent Sexual Offending
Authors: Leroux Elisabeth J. , Pullman Lesleigh E. , Motayne Gregory , Seto Michael C.
Published: June 2014

More knowledge is needed about the etiology and treatment needs of adolescent sex offenders. The current study compared adolescents who had offended against children (defined as below the age of 12 and at least 5 years younger than the adolescent), adolescents who have offended against peers or adults, and adolescents who had victims in both age groups. Based on Seto and Lalumière’s meta-analytic findings, participants were compared on theoretically derived factors, including childhood sexual abuse, atypical sexual interests, sexual experience, social competence, psychiatric history, and general delinquency factors (past criminal history, substance abuse history, and offense characteristics). The study sample consisted of 162 court-referred male adolescent sexual offenders aged 12 to 17 years. Of the six identified domains, groups significantly differed on five of them; the exceptions were variables reflecting social competence. The results further support the validity of distinguishing adolescent sex offenders by victim age.