bluuebunny/crossref_metadata_2025 huggingface dataset:
3D Printing of Biosamples: A Concise Review
Authors: Zhao Victoria Xin Ting , Wong Ten It , Zhou Xiaodong
Published: January 2017

This paper reviews the recent development of 3D printing of biosamples, in terms of the 3D structure design, suitable printing technology, and available materials. Successfully printed 3D biosamples should possess the properties of high cell viability, vascularization and good biocompatibility. These goals are attained by printing the materials of hydrogels, polymers and cells, with a carefully selected 3D printer from the categories of inkjet printing, extrusion printing and laser printing, based on the uniqueness, advantages and disadvantages of these technologies. For recent developments, we introduce the 3D applications of creating scaffolds, printing cells for self-assembly and testing platforms. We foresee more bio-applications of 3D printing will be developed, with the advancements on materials and 3D printing machines.
Worst-Case Response Time Analysis of a Synchronous Dataflow Graph in a Multiprocessor System with Real-Time Tasks
Authors: Choi Junchul , Ha Soonhoi
Published: January 2017

In this article, we propose a novel technique that estimates a tight upper bound of the worst-case response time (WCRT) of a synchronous dataflow (SDF) graph when the SDF graph shares processors with other real-time tasks. When an SDF graph is executed at runtime under a self-timed or static assignment scheduling policy on a multi-processor system, static scheduling of the SDF graph does not guarantee the satisfaction of latency constraints since changes to the schedule may result in timing anomalies. To estimate the WCRT of an SDF graph with a given mapping and scheduling result, we first construct a task instance dependency graph that depicts the dependency between node executions in a static schedule. The proposed technique combines two techniques in a novel way: schedule time bound analysis and response time analysis. The former is used to consider the interference between task instances in the same SDF graph, and the latter is used to consider the interference from other real-time tasks. Through extensive experiments with synthetic examples and benchmarks, we verify the superior performance of the proposed technique compared to other existent techniques.
A Survey of Parametric Dataflow Models of Computation
Authors: Bouakaz Adnan , Fradet Pascal , Girault Alain
Published: January 2017

Dataflow models of computation (MoCs) are widely used to design embedded signal processing and streaming systems. Dozens of dataflow MoCs have been proposed in the past few decades. More recently, several
parametric
dataflow MoCs have been presented as an interesting tradeoff between analyzability and expressiveness. They offer a controlled form of dynamism under the form of parameters (e.g., parametric rates), along with runtime parameter configuration. This survey provides a comprehensive description of the existing parametric dataflow MoCs (constructs, constraints, properties, static analyses) and compares them using a common example. The main objectives are to help designers of streaming applications choose the most suitable model for their needs and pave the way for the design of new parametric MoCs.
Are computer chips the new security threat?
Authors: Greengard Samuel
Published: January 2017

Security researchers have identified a technique for installing a backdoor on computer chips, a security flaw that could profoundly change the computing industry.
A messy state of the union
Authors: Beurdouche Benjamin , Bhargavan Karthikeyan , Delignat-Lavaud Antoine , Fournet Cédric , Kohlweiss Markulf , Pironti Alfredo , Strub Pierre-Yves , Zinzindohoue Jean Karim
Published: January 2017

The Transport Layer Security (TLS) protocol supports various authentication modes, key exchange methods, and protocol extensions. Confusingly, each combination may prescribe a different message sequence between the client and the server, and thus a key challenge for TLS implementations is to define a composite state machine that correctly handles these combinations. If the state machine is too restrictive, the implementation may fail to interoperate with others; if it is too liberal, it may allow unexpected message sequences that break the security of the protocol. We systematically test popular TLS implementations and find unexpected transitions in many of their state machines that have stayed hidden for years. We show how some of these flaws lead to critical security vulnerabilities, such as FREAK. While testing can help find such bugs, formal verification can prevent them entirely. To this end, we implement and formally verify a new composite state machine for OpenSSL, a popular TLS library.
The unholy trinity of software development
Authors: Neville-Neil George V.
Published: January 2017

Tests, documentation, and code.
Broadening participation opportunities in 2017
Authors: Barnes Tiffany
Published: January 2017

Since long before President Obama's call for "Computer Science for All" (#CSforAll) in January 2016, momentum has been building to bring computing education to more people, and to be inclusive and equitable in these efforts. But now seems to be a key turning point, where many more people are searching for ways to bring computing to K-12 and to help students in all fields learn about computational thinking. And the community is growing to meet the demand. The IEEE Special Technical Community on Broadening Participation has over 300 members, and has held two annual RESPECT conferences publishing 27 papers along with posters and lightning talks since 2015. One in five accepted SIGCSE 2017 papers focuses on broadening participation.
A Process Mining Based Service Composition Approach for Mobile Information Systems
Authors: Huang Chengxi , Cai Hongming , Li Yulai , Du Jiawei , Bu Fenglin , Jiang Lihong
Published: January 2017

Due to the growing trend in applying big data and cloud computing technologies in information systems, it is becoming an important issue to handle the connection between large scale of data and the associated business processes in the Internet of Everything (IoE) environment. Service composition as a widely used phase in system development has some limits when the complexity of relationship among data increases. Considering the expanding scale and the variety of devices in mobile information systems, a process mining based service composition approach is proposed in this paper in order to improve the adaptiveness and efficiency of compositions. Firstly, a preprocessing is conducted to extract existing service execution information from server-side logs. Then process mining algorithms are applied to discover the overall event sequence with preprocessed data. After that, a scene-based service composition is applied to aggregate scene information and relocate services of the system. Finally, a case study that applied the work in mobile medical application proves that the approach is practical and valuable in improving service composition adaptiveness and efficiency.
Consensus on the Definition of Advanced Parkinson’s Disease: A Neurologists-Based Delphi Study (CEPA Study)
Authors: Luquin Maria-Rosario , Kulisevsky Jaime , Martinez-Martin Pablo , Mir Pablo , Tolosa Eduardo S.
Published: January 2017

To date, no consensus exists on the key factors for diagnosing advanced Parkinson disease (APD). To obtain consensus on the definition of APD, we performed a prospective, multicenter, Spanish nationwide, 3-round Delphi study (CEPA study). An ad hoc questionnaire was designed with 33 questions concerning the relevance of several clinical features for APD diagnosis. In the first-round, 240 neurologists of the Spanish Movement Disorders Group participated in the study. The results obtained were incorporated into the questionnaire and both, results and questionnaire, were sent out to and fulfilled by 26 experts in Movement Disorders. Review of results from the second-round led to a classification of symptoms as indicative of “definitive,” “probable,” and “possible” APD. This classification was confirmed by 149 previous participating neurologists in a third-round, where 92% completely or very much agreed with the classification. Definitive symptoms of APD included disability requiring help for the activities of daily living, presence of motor fluctuations with limitations to perform basic activities of daily living without help, severe dysphagia, recurrent falls, and dementia. These results will help neurologists to identify some key factors in APD diagnosis, thus allowing users to categorize the patients for a homogeneous recognition of this condition.
Progenitor Cells for Arterial Repair: Incremental Advancements towards Therapeutic Reality
Authors: Simard Trevor , Jung Richard G. , Motazedian Pouya , Di Santo Pietro , Ramirez F. Daniel , Russo Juan J. , Labinaz Alisha , Yousef Altayyeb , Anantharam Brijesh , Pourdjabbar Ali , Hibbert Benjamin
Published: January 2017

Coronary revascularization remains the standard treatment for obstructive coronary artery disease and can be accomplished by either percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery. Considerable advances have rendered PCI the most common form of revascularization and improved clinical outcomes. However, numerous challenges to modern PCI remain, namely, in-stent restenosis and stent thrombosis, underscoring the importance of understanding the vessel wall response to injury to identify targets for intervention. Among recent promising discoveries, endothelial progenitor cells (EPCs) have garnered considerable interest given an increasing appreciation of their role in vascular homeostasis and their ability to promote vascular repair after stent placement. Circulating EPC numbers have been inversely correlated with cardiovascular risk, while administration of EPCs in humans has demonstrated improved clinical outcomes. Despite these encouraging results, however, advancing EPCs as a therapeutic modality has been hampered by a fundamental roadblock: what constitutes an EPC? We review current definitions and sources of EPCs as well as the proposed mechanisms of EPC-mediated vascular repair. Additionally, we discuss the current state of EPCs as therapeutic agents, focusing on endogenous augmentation and transplantation.
Management of Chronic Kidney Disease Patients in the Intensive Care Unit: Mixing Acute and Chronic Illness
Authors: De Rosa Silvia , Samoni Sara , Villa Gianluca , Ronco Claudio
Published: January 2017

Patients with chronic kidney disease (CKD) are at high risk for developing critical illness and for admission to intensive care units (ICU). ‘Critically ill CKD patients' frequently develop an acute worsening of renal function (i.e. acute-on-chronic, AoC) that contributes to long-term kidney dysfunction, potentially leading to end-stage kidney disease (ESKD). An integrated multidisciplinary effort is thus necessary to adequately manage the multi-organ damage of those kidney patients and contemporaneously reduce the progression of kidney dysfunction when they are critically ill. The aim of this review is to describe (1) the pathophysiological mechanisms underlying the development of AoC kidney dysfunction and its role in the progression toward ESKD; (2) the most common clinical presentations of critical illness among CKD/ESKD patients; and (3) the continuum of care for CKD/ESKD patients from maintenance hemodialysis/peritoneal dialysis to acute renal replacement therapy performed in ICU and, vice-versa, for AoC patients who develop ESKD.
Intravenous Fluids and Acute Kidney Injury
Authors: Ding Xiaoqiang , Cheng Zhen , Qian Qi
Published: January 2017

Over 50% of the human body is comprised of fluids that are distributed in defined compartments. Although compartmentalized, these fluids are dynamically connected. Fluids, electrolytes, and acid-base balance in each compartment are tightly regulated, mostly in an energy-dependent manner to achieve their designed functions. For over a century, our understanding of the microvascular fluid homeostasis has evolved from hypothesized Ernest Starling principle to evidence-based and the revised Starling principle, incorporating the functional endothelial surface layer. The kidney is a highly vascular and encapsulated organ that is exquisitely sensitive to inadequate (insufficient or excess) blood flow. The kidney is particularly sensitive to venous congestion, and studies show that reduced venous return triggers a greater degree of kidney damage than that from lacking arterial flow. Thus, fluid overload can induce severe and sustained kidney injury. In the setting of established acute kidney injury, fluid management can be challenging. Impaired capacity of urine output and urine concentration and dilution should be taken into consideration when designing fluid therapy. Video Journal Club ‘Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=452702.
Uric Acid, Vascular Stiffness, and Chronic Kidney Disease: Is There a Link?
Authors: Ramirez-Sandoval Juan C. , Sanchez-Lozada L. Gabriela , Madero Magdalena
Published: January 2017

Controversy exists with regard to the causal role of hyperuricemia in chronic kidney disease. Vascular stiffness may be the link that explains the relation between hyperuricemia and kidney disease. Hyperuricemia is associated with a number of effects on the vascular endothelium and vascular smooth muscle cells, including an increase in oxidative stress, production of vasoconstrictors, and changes on the structural properties of the large artery wall. Observational evidence in large epidemiological cross-sectional studies suggests that there is an independent association between uric acid and arterial stiffness. The limited evidence from cohort studies or clinical trials does not support treatment of hyperuricemia to reduce vascular stiffness in order to prevent kidney disease. Nevertheless, vascular stiffness may be a valid, reproducible, and useful surrogate endpoint. At this point there seems to be sufficient evidence to warrant larger clinical trials to determine whether lowering uric acid concentrations would be useful for prevention or treatment of vascular stiffness and, subsequently, of cardiovascular and kidney diseases. Video Journal Club ‘Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=452726.
Lipid-Lowering Therapy in CKD: Should We Use It and in Which Patients
Authors: Kaysen George A.
Published: January 2017

Background: Chronic kidney disease is associated with a 15-fold increase in the risk of death and a 30-fold increase in the risk of cardiovascular events even prior to dialysis initiation, and this situation remains unchanged following the initiation of the dialysis procedure. Lipoprotein structure and function, especially the anti-oxidative properties of high-density lipoprotein, are altered. In this study, the effectiveness of lipid-lowering therapy on mortality and cardiovascular outcomes is explored. Summary: Mortality is inversely associated with the cholesterol level. The degree of inflammation and wasting is a stronger predictor of mortality than are cholesterol levels. Treatment with statins reduces the risk of death and cardiovascular outcomes among patients not yet requiring renal replacement therapy, but is not effective once dialysis is initiated, most likely because other processes, such as inflammation, not affected by lipid-lowering therapy, dominate in the causal pathway leading to adverse outcomes. Fenofibrate is also useful in reducing cardiovascular outcomes and the progression of renal disease among patients with type 2 diabetes not yet requiring dialysis. While the lipid-lowering therapy is effective in patients with the nephrotic syndrome, no long-term outcome studies regarding hard outcomes are available. Key Points: The great increase in cardiovascular outcomes in patients with kidney disease is likely due to a consequence of properties that are unresponsive to the lipid-lowering therapy, most likely inflammation. The lipid-lowering therapy is useful in patients who are not yet in need of dialysis but does not reduce mortality in dialysis patients.
Comportamento mecânico do solo em operações agrícolas
Authors:   Universidade de São Paulo. Escola Superior de Agricultura ", Molina Junior Walter Francisco ,   Luiz de Queiroz",   . Piracicaba, SP, Brasil
Published: January 2017

Este livro tem como finalidade discutir o comportamento mecânico do solo agrícola, mediante compilação de conhecimentos obtidos de publicações especializadas das engenharias civil, de solos, agrícola e agronômica. Seu objetivo é fornecer subsídios a estudantes e profissionais do setor de ciências agrárias para auxílio na solução de problemas básicos relacionados ao cultivo e à tração, nas atividades produtivas. A primeira parte procura relativizar no tempo a atividade agropecuária, o período de existência do homem moderno e sua consequência na história do planeta, recorda os principais fatores que influenciam a fertilidade dos solos agrícolas e busca definir, de acordo com os conhecimentos de engenharia de solos, as bases gerais do seu comportamento mecânico com maiores interesses para a agricultura. A segunda parte estuda o comportamento do solo como um corpo rígido e sua resposta à mobilização pelas ferramentas, assim como sua capacidade de suporte quando submetido a tensões pelos dispositivos de rodados das máquinas que transitam e desenvolvem tração na sua superfície.
USO DAS ALAVANCAS DE CONTROLE DE SIMONS (1995) NA GESTÃO DE UMA COOPERATIVA AGROINDUSTRIAL
Authors: Pletsch Caroline Sulzbach , Lavarda Carlos Eduardo Facin
Published: January 2017

O estudo teve como objetivo verificar como as alavancas de controle de Simons (1995) são utilizadas na gestão de uma Cooperativa Agroindustrial. Trata-se de um estudo de caso em uma Cooperativa Agroindustrial, com característica descritiva e qualitativa. Para a coleta de dados se utilizou de entrevistas, documentos e observação. Foi utilizado a análise de conteúdo categorizada por temas, com o auxílio do software Nvivo® e nuvens de palavras para a análise dos dados. Verificou-se que sistemas de diagnóstico (monitoramento das atividades) e sistemas interativos (envolvimento dos gestores, incentivo a aprendizagem organizacional e o surgimento de novas ideias) são os de maior utilização na organização, pois estes são utilizados constantemente e fazem parte do dia a dia da organização objeto do estudo.  As crenças não são disseminadas de forma clara e os sistemas de fronteiras são utilizados somente quando existe a necessidade de se estabelecer limites de atuação e comportamentais, não sendo utilizados constantemente.
Percepção dos professores de contabilidade quanto aos espaços formativos para o ofício da docência no Brasil
Authors: Farias Raissa Silveira de , Araújo Adriana Maria Procópio de
Published: January 2017

O objetivo do estudo foi analisar a formação dos docentes, mestres e doutores em contabilidade no Brasil, a partir dos espaços formativos propostos por Swain & Stout (2000): Programa de Pós-graduação, Instituição de Ensino Superior (IES) e esforço individual. O estudo foi caracterizado como descritivo, com abordagem quantitativa, por meio da análise descritiva e, do teste estatístico de Wilcoxon. Utilizou-se como estratégia de pesquisa um levantamento, com dados coletados por meio de questionário online, desenvolvido, validado e autorizado por Swain & Stout (2000). No total, foram obtidos 425 questionários de 328 mestres e 97 doutores, sendo 378 docentes representando todos os Estados Federativos do Brasil. O principal resultado do estudo indicou que, a responsabilidade pela formação para a docência, tanto do Programa de Pós-graduação quanto das IES é maior do que a formação proporcionada por esses espaços formativos. Como contribuição, tem-se a perspectiva de debate sobre como os programas de pós-graduação estão formando seus docentes.
Simulated Atmospheric Response to Regional and Pan-Arctic Sea Ice Loss
Authors: Screen James A.
Published: January 2017

The loss of Arctic sea ice is already having profound environmental, societal, and ecological impacts locally. A highly uncertain area of scientific research, however, is whether such Arctic change has a tangible effect on weather and climate at lower latitudes. There is emerging evidence that the geographical location of sea ice loss is critically important in determining the large-scale atmospheric circulation response and associated midlatitude impacts. However, such regional dependencies have not been explored in a thorough and systematic manner. To make progress on this issue, this study analyzes ensemble simulations with an atmospheric general circulation model prescribed with sea ice loss separately in nine regions of the Arctic, to elucidate the distinct responses to regional sea ice loss. The results suggest that in some regions, sea ice loss triggers large-scale dynamical responses, whereas in other regions sea ice loss induces only local thermodynamical changes. Sea ice loss in the Barents–Kara Seas is unique in driving a weakening of the stratospheric polar vortex, followed in time by a tropospheric circulation response that resembles the North Atlantic Oscillation. For October–March, the largest spatial-scale responses are driven by sea ice loss in the Barents–Kara Seas and the Sea of Okhotsk; however, different regions assume greater importance in other seasons. The atmosphere responds very differently to regional sea ice losses than to pan-Arctic sea ice loss, and the response to pan-Arctic sea ice loss cannot be obtained by the linear addition of the responses to regional sea ice losses. The results imply that diversity in past studies of the simulated response to Arctic sea ice loss can be partly explained by the different spatial patterns of sea ice loss imposed.
Barrier Effect of the Indo-Pacific Maritime Continent on the MJO: Perspectives from Tracking MJO Precipitation
Authors: Zhang Chidong , Ling Jian
Published: January 2017

Explanations for the barrier effect of the Indo-Pacific Maritime Continent (MC) on the MJO should satisfy two criteria. First, they should include specific features of the MC, namely, its intricate land–sea distributions and elevated terrains. Second, they should include mechanisms for both the barrier effect and its overcoming by some MJO events. Guided by these two criteria, a precipitation-tracking method is applied to identify MJO events that propagate across the MC (MJO-C) and those that are blocked by the MC (MJO-B). About a half of MJO events that form over the Indian Ocean propagate through the MC. Most of them (>75%) become weakened over the MC. The barrier effect cannot be explained in terms of the strength, horizontal scale, or spatial distribution of MJO convection when it approaches the MC from the west. A distinction between MJO-B and MJO-C is their precipitation over the sea versus land in the MC region. MJO-C events rain much more over the sea than over land, whereas rainfall over the sea never becomes dominant for MJO-B. This suggests that inhibiting convective development over the sea could be a possible mechanism for the barrier effect of the MC. Preceding conditions for MJO-C include stronger low-level zonal moisture flux convergence and higher SST in the MC region. Possible connections between these large-scale conditions and the land versus sea distributions of MJO rainfall through the diurnal cycle are discussed.
Revised Parameterization of Air–Sea Exchanges in High Winds for Operational Numerical Prediction: Impact on Tropical Cyclone Track, Intensity, and Rapid Intensification
Authors: Ma Yimin , Davidson Noel E. , Xiao Yi , Bao Jian-Wen
Published: January 2017

In high-wind conditions, sea spray, in conjunction with a generally decreasing drag coefficient for increasing winds, greatly modulates surface heat and momentum fluxes. It has been suggested that the process can be particularly important for the prediction of tropical cyclones (TCs), yet its robust application in operational forecast systems has remained elusive. A sea spray inclusion scheme and a modified algorithm for momentum exchange have been implemented in the Australian Bureau of Meteorology’s current operational TC model. Forecasts for a limited sample of TCs demonstrate that the revised parameterizations improve initialized and forecast intensities, while mostly maintaining track prediction skill. TC Yasi (2011) has been studied for impacts of the revised parameterization on rapid intensification (RI). Compared with the conventional bulk air–sea exchange parameterization, the revised version simulates a cooler and moister region near the surface in the eyewall/eye region, adjusts the RI evolution by an earlier and stronger subsidence in the eye, and simulates a stronger radial pulsating of the eye and eyewall convection on relatively short time scales. The inclusion of the new scheme enhances RI features characterized by eyewall ascent, radial convergence, and inertial stability inside the radius of azimuthal-mean maximum wind over low- to midlevels, and by a ringlike radial distribution of relative vorticity above the boundary layer. In addition, it allows a higher maximum intensity wind speed based on Emanuel’s maximum potential intensity theory. It is shown that, as expected, this is mainly because of a larger ratio of enthalpy and momentum exchange coefficients.
Looking race in the face
Authors: Mitchell Derek , Hinueber Jesse , Edwards Brian
Published: January 2017

Schools that achieve strong results for black students address racial dynamics directly, empower students to bring their whole selves to school, and teach in ways that leverage students’ experiences and cultures. These schools do four things to ensure success with their black students: They direct attention, strategies, and resources to black student achievement; they provide opportunities for adult learning about race, culture, class, and power; they foster strong relationships between educators and black students; and they create classroom environments that emphasize excellence and empower students to exercise agency over their own learning.
Diet quality of individuals with rheumatoid arthritis using the Healthy Eating Index (HEI)-2010
Authors: Berube Lauren Thomas , Kiely Mary , Yazici Yusuf , Woolf Kathleen
Published: January 2017

Background:

Rheumatoid arthritis (RA) afflicts approximately 1.5 million American adults and is a major cause of disability. As disease severity worsens, individuals with RA may experience functional decline that can impact dietary intake.

Objective:

The objective of this study is to assess the diet quality of individuals with RA using the Healthy Eating Index (HEI)-2010 and examine associations between diet quality and disease activity and functional status.

Methods:

This cross-sectional study assessed diet quality and disease activity and functional status in adults with RA. Participants completed seven-day weighed food records, which were scored using the HEI-2010. Participants had a fasting blood draw and completed the Multidimensional Health Assessment Questionnaire to determine disease activity and functional status.

Results:

The mean age of individuals with RA ( N = 84) was 53 ± 14 years, and 86.9% were female. The mean HEI-2010 total score was 58.7 ± 15.9, with 7.1% of participants scoring “good”, 58.3% “fair”, and 34.5% “poor”. Most participants did not adhere to recommended intakes of total fruit, total vegetables, whole grains, fatty acids, refined grains, sodium, and empty calories. An unadjusted multiple linear regression model found duration of morning stiffness and C-reactive protein concentration to be significant variables to inversely predict HEI-2010 total score.

Conclusions:

The diet quality of many individuals with RA needs improvement and may be related to functional disability associated with RA. Healthcare providers should encourage individuals with RA to meet dietary guidelines and maintain a healthy diet. Moreover, healthcare providers should be aware of the potential impacts of functional disability on diet quality in individuals with RA.
Oncotic pressure and paediatric cardiopulmonary bypass: establishing baseline data for complex congenital cardiac surgery and its relation to risk stratification.
Authors: Crook Richard , Issitt Richard
Published: January 2017

Objectives:

Colloid osmotic pressure (COP) is a major determinant of fluid shift in paediatric patients undergoing corrective surgery for congenital heart disease (CHD) using cardiopulmonary bypass (CPB). However, very few baseline data are available for those patients requiring surgery within the first few weeks and months of life. Our aim was to determine if our CHD population exhibited COP similar to that of other extremely ill subsets of patients and, if so, whether this related to risk stratification model scores.

Methods:

Thirty consecutive patients under 10 kg underwent cardiac surgery with CPB. Data were collected on COP, albumin concentration, prime composition, post-operative length of ventilation and intensive care unit (ICU) stay as well as risk stratification utilising Risk Adjustment for Congenital Heart Surgery (RACHS-1) and Partial Risk Adjustment in Surgery (PRAiS) scoring systems.

Results:

The patients had a mean pre-bypass COP of 13.9±2.5 mmHg. A significant negative correlation was observed between pre-operative baseline COP and length of ventilation (r=0.7; p<0.001) and a significant negative correlation between PRAiS (r=0.64; p<0.001) and RACHS-1 (r=0.5; p=0.004) scores and baseline COP was seen.

Conclusions:

Neonatal and paediatric patients requiring surgical correction of complex congenital cardiac malformations exhibit extremely low baseline COP, comparable to other sick neonatal populations, and are lower than those previously reported. Baseline COP correlates significantly with predicted survival rates and time spent on a ventilator.
Regulator Loss Functions and Hierarchical Modeling for Safety Decision Making
Authors: Hatfield Laura A. , Baugh Christine M. , Azzone Vanessa , Normand Sharon-Lise T.
Published: January 2017

Background. Regulators must act to protect the public when evidence indicates safety problems with medical devices. This requires complex tradeoffs among risks and benefits, which conventional safety surveillance methods do not incorporate. Objective. To combine explicit regulator loss functions with statistical evidence on medical device safety signals to improve decision making. Methods. In the Hospital Cost and Utilization Project National Inpatient Sample, we select pediatric inpatient admissions and identify adverse medical device events (AMDEs). We fit hierarchical Bayesian models to the annual hospital-level AMDE rates, accounting for patient and hospital characteristics. These models produce expected AMDE rates (a safety target), against which we compare the observed rates in a test year to compute a safety signal. We specify a set of loss functions that quantify the costs and benefits of each action as a function of the safety signal. We integrate the loss functions over the posterior distribution of the safety signal to obtain the posterior (Bayes) risk; the preferred action has the smallest Bayes risk. Using simulation and an analysis of AMDE data, we compare our minimum-risk decisions to a conventional Z score approach for classifying safety signals. Results. The 2 rules produced different actions for nearly half of hospitals (45%). In the simulation, decisions that minimize Bayes risk outperform Z score–based decisions, even when the loss functions or hierarchical models are misspecified. Limitations. Our method is sensitive to the choice of loss functions; eliciting quantitative inputs to the loss functions from regulators is challenging. Conclusions. A decision-theoretic approach to acting on safety signals is potentially promising but requires careful specification of loss functions in consultation with subject matter experts.
The Effect of Pacing on Learners’ Perceptions of Pedagogical Agents
Authors: Schroeder Noah L. , Craig Scotty D.
Published: January 2017

This study examined the influence of three levels of learner control on learners’ perceptions when learning with a pedagogical agent. Pedagogical agents have shown promise for improving learning and connections with learning materials within video-based instruction, and research has shown that agent design choices can influence how agents are perceived by learners. However, it is unclear the effect that the pacing of the video could have on the way the agent is perceived by the learner. The pacing of the learning environment refers to the amount of control a learner has over their learning experience. The question of how much control to provide the learner, in what situations, and for whom, is a persisting question in the literature. Using a three-group randomized experimental procedure, our analyses revealed that providing the learners with increased control of their learning experience was not associated with more positive perceptions of the agent. These results, although preliminary due to the dearth of literature in the area, suggest that learner control may not be an important factor in how pedagogical agents are perceived.
“No High Like a Brownie High”: A Content Analysis of Edible Marijuana Tweets
Authors: Cavazos-Rehg Patricia A. , Zewdie Kidist , Krauss Melissa J. , Sowles Shaina J.
Published: January 2017

Purpose:

To investigate tweets about marijuana edibles for surveillance into the content of edibles-related tweets among individuals socially networking about this topic on Twitter.

Design:

Cross-sectional analysis of tweets containing edible marijuana-related key words during 1 month.

Setting:

Twitter.

Participants:

Tweets sent during January 1 to 31, 2015.

Methods:

A random sample of 5000 tweets containing edibles-related key words was coded for sentiment (positive, negative, and neutral) by crowdsourced workers. Tweets normalizing or promoting edibles use were further analyzed, and demographic characteristics of the Twitter handles sending these tweets were inferred.

Results:

Of the 5000 tweets, 4166 (83%) were about marijuana edibles, and of those 75% (3134 of 4166) normalized or encouraged edibles use. Nearly half (48%, 1509 of 3134) of the tweets normalizing edibles mentioned wanting or planning to consume, currently consuming, or recently consuming edibles, and 12% (378 of 3134) described the intense or long-lasting effects following use. Individuals whose tweets promoted/encouraged edibles use were more likely to be young (between 17 and 24 years old) and of a racial/ethnic minority (52% black; 12% Hispanic) when compared to the Twitter average.

Conclusion:

Tweets that normalize edibles use have the potential to increase their popularity. The prevalence of tweets about edibles’ intense high could have implications for tailoring prevention messages that could be important for youth and young adult minorities who were inferred to be disproportionately socially networking about edibles on Twitter.
Expanding Ambulatory Care Pharmacy Residency Education Through a Multisite University-Affiliated Model
Authors: Schweiss Sarah K. , Westberg Sarah M. , Moon Jean Y. , Sorensen Todd D.
Published: January 2017

Introduction:

As the health-care system evolves and shifts to value-based payment systems, there is a recognized need to increase the number of ambulatory care trained pharmacists.

Objective:

The objective of this article is to describe the administrative structure of the University of Minnesota Postgraduate Year 1 (PGY1) Pharmacy Residency program and to encourage adoption of similar models nationally in order to expand ambulatory care residency training opportunities and meet the demand for pharmacist practitioners.

Program Structure:

The University of Minnesota PGY1 Pharmacy Residency program is a multisite program centered on the practice of pharmaceutical care and provision of comprehensive medication management (CMM) services in ambulatory care settings. The centralized administration of a multisite academic-affiliated training model creates efficiency in the administration process, while allowing sites to focus on clinical training. This model also offers many innovative and unique opportunities to residents.

Conclusion:

A multisite university-affiliated ambulatory care residency training model provides efficiency in program administration, while successfully accelerating the growth of quality ambulatory care residency training and supporting innovative delivery of shared core learning experiences. Consequently, practice sites grow in their service delivery capacity and quality of care.
Portal Vein Thrombosis in Patients With Cirrhosis Undergoing Elective Transjugular Intrahepatic Portosystemic Shunt: Risk Factors, Warfarin Efficacy, and Clinical Outcomes
Authors: Yue-Meng Wan , Li Yu-Hua , Wu Hua-Mei , Yang Jing , Yang Li-Hong , Xu Ying
Published: January 2017

Portal vein thrombosis (PVT) is a common complication in cirrhosis. The aim of this study was to determine risk factors for PVT, assess the efficacy of anticoagulant therapy, and evaluate the effects of PVT on patients with cirrhosis undergoing elective transjugular intrahepatic portosystemic shunt (TIPSS). A total of 101 patients with cirrhosis undergoing elective TIPSS were prospectively studied. After TIPSS, all patients received preventive therapy for PVT and were followed up at 3, 6, 12, and 24 months. Clinical outcomes were compared between patients who developed PVT after TIPSS and those who did not. Multivariate analysis showed that white blood cell count (relative risk [RR]: 0.377; 95% confidence interval [CI]: 0.132-0.579; P = .001), Child-Turcotte-Pugh score (RR: 1.547; 95% CI: 1.029-2.365; P = .032), and ascites (RR: 1.264; 95% CI: 1.019-1.742; P = .040) were independent predictors for PVT. Warfarin treatment within 12 months achieved significantly higher rates of complete recanalization than aspirin or clopidogrel in patients with PVT (54.5% vs 31.3%; P = .013), although adverse events were similar between the 2 groups ( P > .05). Patients without PVT had significantly lower 2-year cumulative rates of variceal rebleeding (15.9% vs 36.6%; P = .023), shunt dysfunction (27.0% vs 46.8%; P = .039), hepatic encephalopathy (24.1% vs 42.6%; P = .045), and hepatocellular carcinoma (11.4% vs 31.2%; P = .024) and markedly higher 2-year cumulative survival rates (89.8% vs 72.9%; P = .041) than those with PVT. The PVT is associated with poorer clinical outcomes in TIPSS-treated patients, and warfarin is both safe and more effective in recanalizing PVT than aspirin or clopidogrel.
Self-esteem moderates the associations between body-related self-conscious emotions and depressive symptoms
Authors: Brunet Jennifer , Pila Eva , Solomon-Krakus Shauna , Sabiston Catherine M , O’Loughlin Jennifer
Published: January 2017

The objectives of this study were to describe the cross-sectional associations between body-related self-conscious emotions and depressive symptoms in young adults and examine self-esteem as a moderator of these associations. Data from a population-based sample of 811 young adults were analyzed using hierarchical multivariate linear regression analysis. Body-related shame ( β = .26) and guilt ( β = .25) were positively related to frequency of depressive symptoms. Self-esteem was negatively related to frequency of depressive symptoms ( β = −.46). Self-esteem moderated the association between body-related guilt and frequency of depressive symptoms. These findings suggest promoting self-esteem may help to reduce the negative effects of body-related guilt on depressive symptoms.
Stigma-related experiences in non-communicable respiratory diseases: A systematic review
Authors: Rose Shiho , Paul Christine , Boyes Allison , Kelly Brian , Roach Della
Published: January 2017

The stigma of non-communicable respiratory diseases (NCRDs), whether perceived or otherwise, can be an important element of a patient’s experience of his/her illness and a contributing factor to poor psychosocial, treatment and clinical outcomes. This systematic review examines the evidence regarding the associations between stigma-related experiences and patient outcomes, comparing findings across a range of common NCRDs. Electronic databases and manual searches were conducted to identify original quantitative research published to December 2015. Articles focussing on adult patient samples diagnosed with asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis, lung cancer or mesothelioma, and included a measurement of stigma-related experience (i.e. perceived stigma, shame, blame or guilt), were eligible for inclusion. Included articles were described for study characteristics, outcome scores, correlates between stigma-related experiences and patient outcomes and methodological rigor. Twenty-five articles were eligible for this review, with most ( n = 20) related to lung cancer. No articles for cystic fibrosis were identified. Twenty unique scales were used, with low to moderate stigma-related experiences reported overall. The stigma-related experiences significantly correlated with all six patient-related domains explored (psychosocial, quality of life, behavioral, physical, treatment and work), which were investigated more widely in COPD and lung cancer samples. No studies adequately met all criteria for methodological rigor. The inter-connectedness of stigma-related experiences to other aspects of patient experiences highlight that an integrated approach is needed to address this important issue. Future studies should adopt more rigorous methodology, including streamlining measures, to provide robust evidence.
Tablet terminals: a useful tool to explain in vitro fertilization treatment
Authors: Yanaihara Atsushi , Ohgi Shirei , Motomura Kenichirou , Yanaihara Takumi
Published: January 2017

Background

Explanations that involve medical care treatment take time. This also applies to explanations of in vitro fertilization (IVF) in the field of infertility treatment. This is because the cause of infertility differs from couple to couple, and because the explanations must begin with the mechanism of pregnancy. Recently, explanations facilitated by tablet terminals have been used in the field of medicine. In the present study, the efficacy and problems of explanations facilitated by tablet terminals were evaluated and compared with the explanations of IVF facilitated by paper-based pamphlets.

Methods

A total of 249 couples were asked to read a paper-based pamphlet explaining IVF treatment, while 252 couples were asked to view an explanation on a tablet terminal. The patients then answered a seven-item questionnaire. The answers to the questionnaire were based on a three-point scale, and statistical analysis was performed with the Mann-Whitney U test.

Results

Patients responded that the explanation facilitated by the tablet terminal was significantly easier to understand for all seven questionnaire items (p <0.05).

The answer ‘I did not understand’ was selected for the items related to ‘The treatment fees’ (4.8% of answers) and ‘Things to take note of, such as consultation times’ (6.7% of answers).

Conclusion

While patients generally did not understand the mechanism of pregnancy, explanations of IVF treatment facilitated by a tablet terminal were found to be more effective than paper-based explanations, although there is room for improvement.
Treatment of Hypogonadism: Current and Future Therapies
Authors: Thirumalai Arthi , Berkseth Kathryn E. , Amory John K.
Published: January 2017

The treatment of hypogonadism in men is of great interest to both patients and providers. There are a number of testosterone formulations currently available and several additional formulations under development. In addition, there are some lesser-used alternative therapies for the management of male hypogonadism, which may have advantages for certain patient groups. The future of hypogonadism therapy may lie in the development of selective androgen receptor modulators that allow the benefits of androgens whilst minimizing unwanted side effects.
Road to nowhere
Authors: Maxine Solicitor
Published: January 2017

Many practices consider outsourcing to offer greater efficiency but be on guard – there are risks with any short cuts, warns solicitor Maxine Park
Socially yours
Authors: Young Caroline
Published: January 2017

With Twitter and Facebook an everyday part of life, GP practices must make sure they have a social media policy in place
Perfect engagement
Authors: Yeaman Tony
Published: January 2017

Ring the changes with a new leadership culture
A guide to contraceptive devices
Authors: Robinson Gina
Published: January 2017

Gina Robinson presents a guide to the range of contraceptive methods available for women and the considerations for prescribing contraception in primary care
Clinical pharmacists in general practice
Authors: Hancock Dave
Published: January 2017

With many pharmacists already integrated into general practice and more on the way, what lessons are being learned from this pilot? Dave Hancock investigates
Why the need for a partnership deed?
Authors: Cumberlege Justin
Published: January 2017

Healthcare specialist Justin Cumberlege explains why, despite many GP practices not having a proper signed partnership deed, it is a necessity to avoid conflict
A seven-day service: What's the plan?
Authors: Moffat Polly
Published: January 2017

The concept of a ‘seven-day’ NHS has been debated ad infinitum – but are there benefits to extending GP services?
In the driving seat
Authors: Simon
Published: January 2017

In a world of digital revolution, let's go back to the drawing board when it comes to customer service
Top ten tips for safe sharps management
Authors: Marsh Amie
Published: January 2017

Amie Marsh shares her top tips to help practices dispose of sharps correctly and reduce the risk of needlestick injury
Paternalism vs partnership
Authors: Lister Scott
Published: January 2017

Scott Lister explores how a recent legal case will change the practice of nurses and health professionals
If the app fits: Getting patients online
Authors: Watson Chloe
Published: January 2017

Chloe Watson at NHS England explains how online GP services can help make the day-to-day running of your practice more effective
Data protection: A risky business
Authors: Cassidy James
Published: January 2017

James Cassidy looks at what has changed in terms of the Data Protection Act and what practice managers should be doing to ensure compliance
On the record: Employing locum staff
Authors: Price Liz
Published: January 2017

Employing a locum or agency clinician can be expensive and, if you get it wrong, can end up costing you more than you realise, says Liz Price
Top ten questions: Tick-borne encephalitis
Authors: Umeed Margaret
Published: January 2017

Tick-borne encephalitis is transmitted to humans through the bite of an infected tick, with around 10,000–12,000 cases reported each year globally. Margaret Umeed looks at what practice managers should consider when advising travellers
High-quality asthma clinics for children
Authors: Cuffwright Margaret
Published: January 2017

Primary care is the cornerstone of child-centred asthma care. This article will discuss how investing in children's asthma, through effective asthma management in primary care, will have positive outcomes for children now and in the future
Where would we be without overseas staff?
Authors: Ainsworth Steve
Published: January 2017

Whatever views individual politicians may have on immigration, one thing that almost all agree upon is that the NHS owes an enormous debt to doctors and nurses from overseas, says Steve Ainsworth
The DNA of a successful practice
Authors: Bensley Paul
Published: January 2017

More than 300,000 GP appointments are missed every week due to patients not turning up, at a cost to the NHS of around £300m every year. Despite the accumulation of such a huge bill, many surgeries do not fully recognise the severity of the problem
Getting to grips with GP drawings
Authors: Robson Andrew
Published: January 2017

Practices often struggle to cope with the calculation of regular drawings for their GP partners. Andrew Robson offers a guide to the process
Yellow fever immunisation update
Authors: Sellors Michelle
Published: January 2017

After a recently reported rise in cases of yellow fever, Michelle Sellors, Travel Health Specialist at MASTA, presents a guide for GP practices on regulations and immunisation