bluuebunny/crossref_metadata_2025 huggingface dataset:
Holocene cultural and climate shifts in NW Africa as inferred from stable isotopes of archeological land snail shells
Authors: Padgett Abigail , Yanes Yurena , Lubell David , Faber Meredith L
Published: March 2019

Cultural transitions or even societal collapses have often been associated with long-term drought events. Linkages between humans and the environment are best documented in well-constrained archeological records that offer multi-centennial to multi-millennial cultural and paleoclimate data. Two Holocene Capsian sites, Kef Zoura D and Aïn Misteheyia, from NE Algeria document a marked change in subsistence strategies near 8200 cal. yr BP. Radiocarbon dated archeological shells (from 10,300 to 6700 cal. yr BP) of the terrestrial gastropod Helix melanostoma were studied to examine the role of climate change on cultural shifts. Oxygen (δ18O) and carbon (δ13C) stable isotopes were measured from whole shells and time-series profiles along shell ontogeny to assess average annual paleoclimate and degree of seasonality, respectively. Shell δ18O values illustrate that conditions were wetter between 10,300 and 9000 cal. yr BP, coinciding with the ‘African Humid Period’, whereas the environment turned drier at 8000–7600 cal. yr BP, immediately after the 8.2-ka climate event, feasibly comparable in magnitude to the drought episode initiated in 1968 in the Sahel and N Africa. A snail evaporative steady-state flux balance-mixing model suggests that snails at around 8000 years ago precipitated shells under notably lower relative humidity conditions than previous wetter scenarios of the earlier Holocene. The well-known 8.2 ka cold event of the Northern Hemisphere was detected as a drought event that seems to have lasted several centuries in Algeria. The δ13C values indicate that snails only consumed and assimilated C3 plants without noticeable shifts. This study points to multi-millennial humidity fluctuations in NE Algeria, which likely affected the economy and subsistence strategies of prehistoric human groups in the area.
A grain size and n-alkanes record of Holocene environmental evolution from a groundwater recharge lake in Badain Jaran Desert, Northwestern China
Authors: Kai Ning , Naiang Wang , Xiaonan Lv , Zhuolun Li , Jiaqi1 Sun , Ran An , Lvlv Zhang
Published: March 2019

Vertical water transport plays an important role in the development and maintenance of lakes in arid zones. However, previous study of this phenomenon has focused mainly on the effects of regional precipitation, rather than effects of groundwater recharge, on arid-zone environmental change. We selected a sedimentary profile from a seasonal lake basin located in the hinterland of the Badain Jaran Desert, northwestern China, to assess the Holocene environmental evolution of this region and its response to climate change. Our results show that peat deposition from 11 to 10 ka indicates humidification after Younger Dryas (YD) event; the lake sediment and lower EM2 and lower principal component analysis (PCA)-1 scores indicate relative more humid environment from 10 to 7.8 ka; the lake sediment and higher EM2 and higher PCA-1 scores indicate most humid environment from 7.8 to 5.8 ka; the transition from lacustrine facies to limnetic facies and increasing salinity indicate drying trend from 5.8 to 2.5 ka; the aeolian sand sediment and lowest EM2 and lowest PCA-1 scores indicate driest environment from 2.5 to 0.8 ka; and lacustrine facies and finest grain size indicate relative humid environment during the ‘Little Ice Age’ period. The environment was relative humid in early Holocene, most Humid in mid-Holocene, and dry in mid-late Holocene. The moisture pattern in the hinterland of the Badain Jaran Desert was synchronous with that in the northeastern of Tibetan Plateau, which implies that the groundwater recharge lake was dominated by the intensity of groundwater recharge from monsoon margin area, especially the northeastern of Tibetan Plateau. As a record from groundwater recharge lake without runoff, our study provides the groundwater output quantity record from northeastern of Tibetan Plateau and would benefit the environment change research and regional water resources allocation around the Tibetan Plateau.
Inclusive Clinical Practice and Policy for Muslim Nursing Students
Authors: Hopkins Amanda F. , Kooken Wendy Carter , Winger Elyse Nelson
Published: March 2019

Purpose: Increasing diversity in nursing offers opportunities and challenges. This article addresses considerations for clinical and educational policies when working with Muslim nursing students and suggests changes to facilitate inclusive environments. Approach: This article describes the twofold response of a school of nursing where Muslim nursing students encountered potential limitations in clinical experiences. Faculty conducted a review of literature and examined policies to determine barriers to inclusivity for Muslim nursing students in clinical practice. Outcomes: Few research articles exist to guide construction of inclusive practices. The review of policies for the school of nursing and clinical agencies revealed problematic language and wording that could lead to exclusive practices. Clinical Relevance: For the nursing profession to embrace diversity, faculty must be aware of the discrimination and general lack of knowledge toward Muslim nurses/students in the United States and reasonable accommodation for cultural and religious beliefs.
Measurement Invariance of the UPPS-P Impulsive Behavior Scale Across Age and Sex Across the Adult Life Span
Authors: Argyriou Evangelia , Um Miji , Wu Wei , Cyders Melissa A.
Published: March 2019

Impulsive personality is a widely used construct for the prediction of multiple clinical problems; however, research has often disregarded important differences in its conceptualization and measurement across age and sex. The goals of this article are to test the invariance of, to compare mean differences in, and to examine the differential validity of the Urgency (negative), Premeditation (lack of), Perseverance (lack of), Sensation Seeking, with added subscale of Positive Urgency (UPPS-P) Impulsive Behavior Scale across adult age and sex. The data for this study were obtained from 799 participants in the Nathan Kline Institute’s Rockland Sample. Multigroup invariance analysis indicated full invariance of the UPPS-P Impulsive Behavior Scale across age and sex. However, invariance analysis as a function of age using Multiple-Indicators Multiple-Causes modeling identified three items with differential item functioning. Sensation Seeking was higher in males and lower as age increased. In general, age and sex did not moderate the relationships between UPPS-P traits and risk-taking behaviors, with the exception of cannabis use. Overall, the results of this study support that the UPPS-P scale can be validly used to assess and compare impulsive personality across the adult life span and sex. We suggest the removal of Items 5, 28, and 51 when using the UPPS-P with older adults to be overly cautious to age invariance effects.
Alternative Approaches: Implementing Mindfulness Practices in the Classroom to Improve Challenging Behaviors
Authors: Zolkoski Staci M. , Lewis-Chiu Calli
Published: March 2019

Managing challenging student behaviors can be difficult for any educator. Lacking knowledge of research-based, positively oriented behavior interventions, educators may resort to punitive, reactive disciplinary strategies. Mindfulness is a positive, proactive approach that may help students with emotional and behavioral disorders improve their ability to regulate their own behaviors. This discussion paper describes research-informed mindfulness practices that teachers can use in their classrooms to address challenging behavior.
Design and control performance of a frictional tuned mass damper with bearing–shaft assemblies
Authors: Jiang Jinwei , Ho Siu Chun Michael , Markle Nathanael J , Wang Ning , Song Gangbing
Published: March 2019

This paper explores the feasibility of leveraging the damping generated by the friction between movable flange-mounted ball bearings and a stationary shaft. This bearing–shaft assembly is integrated with a tuned mass damper to form a frictional tuned mass damper (FTMD). The friction coefficient and the equivalent viscous damping ratio of the proposed FTMD were experimentally obtained based on different cases of glass, steel, and aluminum slide shafts. The proposed FTMD was modeled and simulated numerically to study its ability to suppress vibrations on a single degree of freedom structure. Furthermore, a parallel experimental validation of the FTMD was also executed to verify simulation results. Results from both experiments and simulations demonstrated that the proposed FTMD device was able to significantly improve the damping ratio of the primary structure from 0.35% to 5.326% during free vibration, and also to suppress around 90% of uncontrolled structural response at a tuned frequency. In particular, the frequency responses, among the tested shaft materials, suggested that the selected steel slide shaft practically provided a near-optimal damping coefficient, thus the proposed FTMD was able to considerably reduce structural resonant peak amplitudes over the tested excitation frequency domain.
A Scoping Review of Health Literacy Measurement Tools in the Context of Cardiovascular Health
Authors: Chan Rita Wai Yu , Kisa Adnan
Published: March 2019

Background. Despite the strong link between health literacy and cardiovascular health outcomes, health literacy measurements remain flawed and fragmented. There exists a gap in the knowledge when formulating a valid measurement to capture the broad concept of health literacy. The existence of various tools for health literacy measurement also hampers the availability of health literacy data. Additionally, little research is available on a valid measurement tool for cardiovascular health literacy. Objective. This study aims to provide an overview of the health literacy measurement tools used in the context of cardiovascular health. Method. A scoping review was conducted. Two electronic databases, Medline and Embase, were searched to identify studies that described a tool for the measurement of health literacy in the context of cardiovascular health. Results. After reviewing the available studies, 53 studies met the inclusion criteria. A total of 26 health literacy measurement tools were identified in the studies. Among the 26 tools, 16 used an objective measurement approach, 9 adopted a subjective approach, and 1 employed a mixed approach. Additionally, 28 studies used tools to measure print literacy, 15 studies measured print literacy and numeracy, and 5 studies measured print literacy, oral literacy, and numeracy. Conclusions. STOFHLA, TOFHLA, and REALM were the mostly commonly used tools in the selected studies. The majority of tools were based heavily on reading skills and word recognition. Researchers should focus on the development of more comprehensive and reliable health literacy measurement tool(s) specific to cardiovascular health to assist health care providers to more efficiently and accurately identify people with cardiovascular problems who have inadequate health literacy.
How not to waste a crisis: a qualitative study of problem definition and its consequences in three hospitals
Authors: Martin Graham , Ozieranski Piotr , Leslie Myles , Dixon-Woods Mary
Published: March 2019

Objectives

The prominence given to issues of patient safety in health care organizations varies, but little is known about how or why this variation occurs. We sought to compare and contrast how three English hospitals came to identify, prioritize and address patient safety issues, drawing on insights from the sociological and political science literature on the process of problem definition.

Methods

In-depth qualitative fieldwork, involving 99 interviews, 246 hours of ethnographic observation, and document collection, was carried out in three case-study hospitals as part of a wider mixed-methods study. Data analysis was based on the constant comparative method.

Results

How problems of patient safety came to be recognized, conceptualized, prioritized and matched to solutions varied across the three hospitals. In each organization, it took certain ‘triggers’ to problematize safety, with crises having a particularly important role. How problems were constructed – and whose definitions were prioritized in the process – was highly consequential for organizational response, influencing which solutions were seen as most appropriate, and allocation of responsibility for implementing them.

Conclusions

A process of problem definition is crucial to raising the profile of patient safety and to rendering problems amenable to intervention. How problems of patient safety are defined and constructed is highly consequential, influencing selection of solutions and their likely sustainability.
Unique aspects of peripheral artery disease in patients with chronic kidney disease
Authors: Arinze Nkiruka V , Gregory Andrew , Francis Jean M , Farber Alik , Chitalia Vipul C
Published: March 2019

Peripheral artery disease (PAD) represents a major health care burden. Despite the advent of screening and interventional procedures, the long-term clinical outcomes remain suboptimal, especially in patients with chronic kidney disease (CKD). While CKD and PAD share common predisposing factors, emerging studies indicate that their co-existence is not merely an association; instead, CKD represents a strong, independent risk factor for PAD. These findings implicate CKD-specific mediators of PAD that remain incompletely understood. Moreover, there is a need to understand the mechanisms underlying poor outcomes after interventions for PAD in CKD. This review discusses unique clinical aspects of PAD in patients with CKD, including high prevalence and worse outcomes after vascular interventions and the influence of renal allograft transplantation. In doing so, it also highlights underappreciated aspects of PAD in patients with CKD, such as disparities in revascularization and higher peri-procedural mortality. While previous reviews have discussed general mechanisms of PAD pathogenesis, focusing on PAD in CKD, this review underscores a need to probe for CKD-specific pathogenic pathways that may unravel novel biomarkers and therapeutic targets in PAD and ultimately improve the risk stratification and management of patients with CKD and PAD.
Why the “real” numbers on Roma are fictitious: Revisiting practices of ethnic quantification
Authors: Surdu Mihai
Published: March 2019

This article scrutinizes the administrative and scientific practices by which the Gypsy/Roma category has been historically constructed in Europe, particularly in Central and South Eastern Europe. Censuses, police-led inquiries, social surveys and expert estimates made the ‘Roma’ category appear objective, making invisible the multiple technical and political decisions behind their interpretations. This paper examines the technologies behind the production of ethnic categories and that of Roma in particular: namely, guidelines and manuals for field workers, recruitment and census campaigns, consent forms, questionnaires, data processing, basic assumptions and interpretation of data.

 While expert networks give objectivity and flexibility to the collection and circulation of data, the labour involved in crafting ethnic statistics often remains obscure. This paper follows the historical departures and continuities of Roma categorization from the 18th century to present times. The category ‘Roma’ was produced and reproduced through quantification practices with the justification that ethnic data (or categorization) would help solve social problems and contribute to Roma integration. The technical literature reviewed in this paper and the auto-ethnographic analysis shed light on the machinery of ethnic categorization, and allows us to assess the impact of various kinds of labour upon this categorization: from the more visible work performed by ethnopolitical entrepreneurs and scholars – to the relatively invisible contributions of field workers, administrators and census takers. This article calls for a critical scrutiny of how Roma ethnicity is crafted through practices of ethnic quantification and encourages researchers to use methodological prudence and more self-reflection in their own academic practices.
The monument to the children of Villatina: commemorating innocent child victims in the context of lethally stigmatized youth in Colombia
Authors: Reyes Ana María
Published: March 2019

This article examines the monument for the children of Villatina (2004, Medellín, Colombia) that resulted from the Masacre Villatina v. Colombia Friendly Agreement put forward by the Grupo Interdisciplinario de Derechos Humanos (GIDH) to the Inter-American Commission on Human Rights (IACHR). In 1992, the Colombian police murdered eight youths ranging in age from 8 to 22 years in the Villatina neighborhood of Medellín. After long and difficult negotiations, the GIDH and IACHR brokered a Friendly Agreement (2002) between the victims’ families and the government of Colombia. As a part of the reparations program, the Colombian State committed to installing a commemorative monument in a public park in downtown Medellín. While the monument was designed to recognize the dignity and honor of the youthful victims, the author argues that its emphasis on innocence tacitly endorsed the extermination of non-innocent children and young men caught in the vortex of war. Following Judith Butler’s arguments regarding ‘grievable’ lives in Frames of War: When Is Life Grievable? (2004) and the condition of the human, the author contends that both the process of the Friendly Agreement negotiations and the resulting monument rehearse a hierarchy of humanity that casts some lives, but not all, as grievable.
Cluster analysis of acoustic emission signals and tensile properties of carbon/glass fiber–reinforced hybrid composites
Authors: Zhao Wen-zheng , Zhou Wei
Published: March 2019

Understanding the damage and failure of carbon/glass epoxy hybrid woven composites under tensile loading based on acoustic emission signals is a challenging task in their practical uses. In this study, an approach based on fuzzy c-means algorithm is proposed to process the acoustic emission signals from tensile loading of composites monitored by combining acoustic emission technology and digital image correlation method. The results show that the acoustic emission signals from tensile loading can be divided into three clusters. The three clusters correspond to three kinds of damage modes including matrix cracking, fiber/matrix debonding, delamination, and fiber breakage. By comparing the acoustic characteristics of these classes, a correlation procedure between the clusters and the damage mechanisms observed is proposed. Meanwhile, it can be found that debonding and fiber break signals for glass fiber correspond to a lower frequency range than that for carbon fiber. Moreover, the method combining acoustic emission and digital image correlation can effectively monitor the damage process of the specimen both on the inside and outside, which can provide a reference for the health monitoring of composite structure.
Tensile behavior of virgin and recycled polyester nonwoven filter fabrics
Authors: Chauhan Vinay Kumar , Singh Jitendra Pratap , Debnath Sanjoy
Published: March 2019

This study deals with two different categories of needle-punched nonwoven fabric samples developed from virgin and recycled polyester fibers. To understand the effect of tensile behavior (strength and extension) of these filters, fabric samples have been developed varying fabric weight, needling density and depth of needle penetration. This study also established the efficacy of use of recycled polyester for preparation of filter fabric. The study revealed that the tensile strength of fabric made using recycled fiber is 8–10% lower compared to virgin. Tensile strength is more in cross direction as compared to machine direction for both virgin and recycled polyester fabrics due to the higher number of fibers oriented in cross direction during cross lapping process. Increase in needling density and depth of penetration has resulted in increase in the extent of tensile strength initially but decrease in the extent of tensile strength later in all the cases of fabric weight. The study further reveals that heavy weight fabric, needling density and depth of penetration results in decrease of elongation at break (%). The elongation at break (%) of fabric prepared from recycled fiber was found to be 7–8% higher in machine as well as in cross direction compared to virgin. Since strength parameter is not very essential in case of filter fabric made of recycled polyester, which is lesser in strength (8-10%) compared to virgin polyester may be considered.
The Influence of Socioeconomic Status on the Presence and Degree of Erectile Dysfunction in Men With Coronary Artery Disease—A Cross-Sectional Study
Authors: Rusiecki Lesław , Zdrojowy Romuald , Gebala Jana , Sobieszczańska Małgorzata , Smoliński Ryszard , Pilecki Witold , Piestrak Piotr , Janocha Anna , Kawałko Wiktor , Womperski Maciej , Kałka Dariusz
Published: March 2019

Impairment of social functioning and low economic status may lead to the development of cardiovascular disease (CVD). This study aimed to evaluate the relationship between socioeconomic status (SES) and erectile dysfunction (ED) in patients with clinically significant CVD. A total of 808 male patients with ischemic heart disease (IHD) were recruited. Socioeconomic and demographic data as well as occupational data and the presence of modifiable risk factors were collected. Erection quality was assessed using the International Index of Erectile Function 5 (IIEF-5), while physical activity was evaluated using a modified Framingham questionnaire. Relationships among the presence of socioeconomic factors (marital status, education, income, occupational status, nature of work conducted, and demographic data), intensity of ED, and time from diagnosis of IHD were assessed. ED was diagnosed in 618 men (76.49% overall; severe in 23.14%, moderate to severe in 13.11%, moderate in 32.20%, mild in 31.55%). Patients with ED were older (61 ± 8.6 vs. 53 ± 9.1 years; p < .0001), were less active (6.97 ± 2.18 vs. 8.31 ± 2.34 Metabolic Equivalent [METs]; p < .0001), and had more modifiable risk factors (3.4 ± 1.1 vs. 3.2 ± 1.0; p < .0300). Higher education was associated with a lower probability of the occurrence of ED (OR = 0.7546; 95% CI [0.6221, 0.9153]). In patients with newly diagnosed IHD, SES correlated significantly with the presence of ED ( p = .009). Education in patients suffering from CVD has a significant relationship with both the occurrence and degree of ED. Economic status was significantly linked to the presence and degree of ED only in patients with IHD diagnosed less than 2 months before entering the study.
Co-operation of long-term and working memory representations in simultaneous chaining by rhesus monkeys (Macaca mulatta)
Authors: Templer Victoria L , Gazes Regina Paxton , Hampton Robert R
Published: March 2019

We studied the memory representations that control execution of action sequences by training rhesus monkeys ( Macaca mulatta) to touch sets of five images in a predetermined arbitrary order (simultaneous chaining). In Experiment 1, we found that this training resulted in mental representations of ordinal position rather than learning associative chains, replicating the work of others. We conducted novel analyses of performance on probe tests consisting of two images “derived” from the full five-image lists (i.e., test B, D from list A→B→C→D→E). We found a “first item effect” such that monkeys responded most quickly to images that occurred early in the list in which they had been learned, indicating that monkeys covertly execute known lists mentally until an image on the screen matches the one stored in memory. Monkeys also made an ordinal comparison of the two images presented at test based on long-term memory of positional information, resulting in a “symbolic distance effect.” Experiment 2 indicated that ordinal representations were based on absolute, rather than on relative, positional information because subjects did not link two lists into one large list after linking training, unlike what occurs in transitive inference. We further examined the contents of working memory during list execution in Experiments 3 and 4 and found evidence for a prospective, rather than a retrospective, coding of position in the lists. These results indicate that serial expertise in simultaneous chaining results in robust absolute ordinal coding in long-term memory, with rapidly updating prospective coding of position in working memory during list execution.
Judging social interaction in the Heider and Simmel movie
Authors: Rasmussen Carly E , Jiang Yuhong V
Published: March 2019

Simple displays of moving shapes can give rise to percepts of animacy. These films elicit impoverished narratives in some individuals, such as those with an autism spectrum disorder. However, the verbal demand of producing a narrative limits the utility of this task. Non-verbal tasks have so far focused on detecting animate objects. Lacking from previous research is a task that relies less on verbal description but more than animacy perception. Here, we presented data using a new social interaction judgement task. Healthy young adults viewed the Heider and Simmel movie and pressed one button whenever they perceived social interaction and another button when no social interaction was perceived. We measured the time points at which social judgement began, the fluctuation of the judgement in relation to stimulus kinematic properties, and the overall mean of social judgement. Participants with higher autism traits reported lower levels of social interaction. Reversing the film in time produced lower social interaction judgements, though the temporal profile was preserved. Our study suggests that both low-level motion characteristics and high-level understanding contribute to social interaction judgement. The finding may facilitate future research on other populations and stimulate computational vision work on factors that drive social judgements.
Dealing with the dark side: The effects of right-wing extremist and Islamist extremist propaganda from a social identity perspective
Authors: Rieger Diana , Frischlich Lena , Bente Gary
Published: March 2019

Right-wing extremists and Islamist extremists try to recruit new followers by addressing their national (for instance, German) or religious (Muslim) social identity via online propaganda videos. Two studies examined whether capitalizing on a shared group-membership affects the emotional and cognitive response towards extremist propaganda. In both studies, Germans/non-migrants, Muslim migrants and control participants ( N = 235) were confronted with right-wing extremist and Islamist extremist videos. Emotional and cognitive effects of students (Study 1) and apprentices (Study 2) were assessed. Results showed a general negative evaluation of extremist videos. More relevant, in-group propaganda led to more emotional costs in both studies. Yet, the responses varied depending on educational level: students reported more negative emotions and cognitions after in-group directed videos, while apprentices reported more positive emotions and cognitions after in-group directed propaganda. Results are discussed considering negative social identities.
Serum chitotriosidase and neopterin levels in patients with ankylosing spondylitis
Authors: Yavuz Ferdi , Kesikburun Bilge , Öztürk Özlem , Güzelküçük Ümüt
Published: March 2019

Background:

The aim of this study was to assess the serum chitotriosidase (ChT) and neopterin levels in patients with ankylosing spondylitis (AS) and to evaluate whether serum ChT and neopterin levels are related to disease activity.

Methods:

A total of 86 patients with AS were included in the study. Patients were divided into two groups based on Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores: The active AS patients group included 40 patients who had a BASDAI score ⩾4. The inactive AS patients group included 46 patients who had a BASDAI score <4. We compared the serum level of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ChT and neopterin between the two groups.

Results:

Active AS patients had significantly higher ESR, CRP, serum ChT and neopterin levels compared with the inactive AS patients group ( p < 0.05). Positive correlations were found between serum ChT levels and ESR ( r = 0.87, p = 0.005), and CRP levels ( r = 0.86, p = 0.006). Also, there was a positive significant correlation between serum ChT levels and BASDAI scores ( r = 0.67, p = 0.03). No correlation was found between serum neopterin levels and the BASDAI scores, ESR, and CRP levels ( p > 0.05). Higher disease activity (BASDAI score ⩾4) was found to be associated with ChT ( p = 0.012) in the multiple logistic regression analysis.

Conclusion:

The present study emphasized that serum ChT levels can be useful in the determination of the disease activity of AS patients.
Mobile health and implantable cardiac devices: Patients' expectations
Authors: Villani Giovanni Q , Villani Andrea , Zanni Alessia , Sticozzi Concetta , Maceda Diego Penela , Rossi Luca , Pisati Maria Sole , Piepoli Massimo F
Published: March 2019

Background

Mobile computing and communication technologies in health services and information (so-called mHealth) have modified the traditional approach in the follow-up of patients with implantable cardiac devices, increased patient engagement and empowerment, reduced healthcare costs and improved patients' outcome. Recent developments in mobile technology, with the introduction of smartphone-compatible devices that can measure various health parameters and transfer automatically generated data, have increased the potential application of remote monitoring and the interest towards mHealth. However, little is known about the patients' interest and expectations of this new technology.

Objective

The patients' interest in the possibility of receiving data from their implantable cardiac device, clinical and health advice via remote monitoring on their smartphones were investigated.

Methods

A questionnaire entitled ‘Expectations for future possibility of self-management of device data’ (Likert scale scored) was submitted to 300 consecutive implantable cardiac device outpatients. The questionnaire was focused on collecting patients’ expectations in receiving direct information regarding their implantable cardiac device status (item 1, five questions), their own clinical status (item 2, seven questions) and advice on healthy lifestyle promotion (item 3, nine questions). Patient characteristics associated with greater interest towards mHealth were also investigated.

Results

Questionnaires were completed by 268 patients (221 men, aged 69 ± 14 years). The Cronbach test reported an alpha value of 0.98 for item 1, 0.94 for item 2 and 0.97 for item 3. Patients declared to be mainly interested in the device interventions (62%) and in severe arrhythmia occurrence (61%), followed by data on heart failure severity (54%) and their performed physical activity (48%). Patients showed very little interest in ECG tracing (37%), but the lowest interest was expressed towards healthy lifestyle promotion advice (<40%). A higher education degree and the presence of the caregiver positively affected the interest towards remote monitoring information ( P < 0.001).

Conclusions

The patients' interests were mainly directed at receiving information related to technical data of the implantable cardiac device and not to the overall management of the disease, underlying the insufficient awareness of patients towards the key role of self-control health status and the promotion of a healthy lifestyle.
Rotating Shifts Negatively Impacts Health and Wellness Among Intensive Care Nurses
Authors: Imes Christopher C. , Chasens Eileen R.
Published: March 2019

The impact of shift work on sleep and health has been examined in the past, but most studies utilized cross-sectional designs relying on between-subject differences. The purpose this study was to examine the within-subject differences in self-report measures of health and wellness among a group of nurses engaged in rotating shifts. Patient-Reported Outcomes Measurement Information System (PROMIS) measures, collected post-day and post-night shift, were used to assess health, sleep disturbances and sleep-related impairment, fatigue, emotional distress (anger), satisfaction with social roles outside of work, and applied cognitive abilities. Among the sample of 23 White, mostly female (91.3%) nurses, all PROMIS measures were worse indicting lower health and wellness after working night shifts compare to after working day shifts ( p values from .167 to < .001). During both time points of assessment, sleep-related impairment was highly correlated with greater emotional distress, greater fatigue, and worse memory and concentration. Study findings support prior studies that shift work can negatively impact health and wellness.
Women’s Smoking: Relationships Among Emotional Labor, Occupational Stress, and Health Promotion
Authors: Boo Sunjoo , Oh Hyunjin
Published: March 2019

Call centers in Korea have been found to be operated mainly by women, and they experience high levels of job-related stress. Compared with the general population, the prevalence of smoking among women in Korea’s call centers is strikingly high. Little attention has been paid to the associations between smoking behavior and their emotional labor, occupational stress, and health-promotion behaviors. For this cross-sectional study, a paper-based survey was conducted in a sample of female employees in a credit card call center ( N = 309). Among the participants, about 20% ( n = 62) were current smokers. Smokers were less engaged in health-promotion behaviors than nonsmokers, and occupational stress was negatively associated with health-promoting behaviors in nonsmokers, but not in smokers. Smokers may use cigarettes as a way of alleviating the emotional burden of their work.
To Role Model or Not? Nurses’ Challenges in Promoting a Healthy Lifestyle
Authors: Keele Rebecca
Published: March 2019

Nurses often struggle with maintaining a healthy lifestyle. While nurses are often assumed to have the knowledge to participate in health-promoting behaviors, this knowledge may not translate into sustainable change in behavior. The purpose of this descriptive study was to compare nurses’ health behaviors with residents in the community where the nurses were employed. Participants ( N = 166) completed the Health Promoting Lifestyle Profile–II survey (HPLP-II) along with a demographic survey. The HPLP-II consists of six dimensions of a health-promoting lifestyle: (a) spiritual growth, (b) health responsibility, (c) physical activity, (d) nutrition, (e) interpersonal relations, and (f) stress management. Both groups scored the highest in spirituality followed by interpersonal relations. However, scores for the other HPLP-II dimensions ranked differently between the two groups. Nurses scored higher in health responsibility while the community participants scored higher on nutrition. Both groups scored the lowest on stress management and physical activity. Significant differences between groups were found only on the health responsibility dimension of the HPLP-II survey with nurses scoring higher. While nurses overall did not do any better than the general population in participating in a healthy lifestyle, patient stakeholders feel strongly that nurses should role model healthy behaviors. Employers need to be better prepared to support nurses to participate in a healthy lifestyle. Success can come from even small incremental changes (e.g., walking groups, team challenges, taking stairs) within the work environment. Furthermore, evidence-based practice teams that include administration, management, and staff are positioned to contribute through education and development of innovative workplace wellness programs.
Music and the Social and Emotional Challenges of Undergraduate Instrumental Music Students
Authors: Edgar Scott N.
Published: March 2019

This study explored perceptions of four undergraduate instrumental music students. The purpose of this study was to describe social and emotional challenges of college instrumental music students and to explore the music connection with these challenges. Questions guiding this inquiry were as follows: (a) What social and emotional challenges do instrumental music students encounter at the college level and how does music relate to these? and (b) What is the role of music in the participants’ lives? Findings suggest undergraduate music students encounter a variety of challenges, and that music had a profound connection to these challenges either as a catalyst or as relief. The most common challenge was struggling with time management and overcommitting. Participants articulated differences between performing and listening to music in relation to their social and emotional challenges. Further findings suggest that for these participants there has been a music culture shift away from communal, ensemble-based music making to a more individual activity.
Identification of genetic alterations associated with primary resistance to EGFR‐TKIs in advanced non‐small‐cell lung cancer patients with EGFR sensitive mutations
Authors: Wang Fang , Diao Xia‐Yao , Zhang Xiao , Shao Qiong , Feng Yan‐Fen , An Xin , Wang Hai‐Yun
Published: March 2019

Background

Identification of activated epidermal growth factor receptor (EGFR) mutations and application of EGFR‐tyrosine kinase inhibitors (EGFR‐TKIs) have greatly changed the therapeutic strategies of non‐small‐cell lung cancer (NSCLC). However, the long‐term efficacy of EGFR‐TKI therapy is limited due to the development of drug resistance. The aim of this study was to investigate the correlation between the aberrant alterations of 8 driver genes and the primary resistance to EGFR‐TKIs in advanced NSCLC patients with activated EGFR mutations.

Methods

We retrospectively reviewed the clinical data from 416 patients with stage III/IV or recurrent NSCLC who received an initial EGFR‐TKI treatment, from April 2004 and March 2011, at the Sun Yat‐sen University Cancer Center. Several genetic alterations associated with the efficacy of EGFR‐TKIs, including the alterations in BIM, ALK, KRAS, PIK3CA, PTEN, MET, IGF1R, and ROS1, were detected by the routine clinical technologies. The progression‐free survival (PFS) and overall survival (OS) were compared between different groups using Kaplan–Meier survival analysis with the log‐rank test. A Cox regression model was used to estimate multivariable‐adjusted hazard ratios (HRs) and their 95% confidence intervals (95% CIs) associated with the PFS and OS.

Results

Among the investigated patients, 169 NSCLC patients harbored EGFR‐sensitive mutations. EGFR‐mutant patients having PTEN deletion had a shorter PFS and OS than those with intact PTEN (P = 0.003 for PFS, and P = 0.034 for OS). In the combined molecular analysis of EGFR signaling pathway and resistance genes, we found that EGFR‐mutant patients coexisted with aberrant alterations in EGFR signaling pathway and those having resistant genes had a statistically poorer PFS than those without such alterations (P < 0.001). A Cox proportional regression model determined that PTEN deletion (HR = 4.29,95% CI = 1.72–10.70) and low PTEN expression (HR = 1.96, 95% CI = 1.22–3.13), MET FISH + (HR = 2.83,95% CI = 1.37–5.86) were independent predictors for PFS in patients with EGFR‐TKI treatment after adjustment for multiple factor.

Conclusions

We determined that the coexistence of genetic alterations in cancer genes may explain primary resistance to EGFR‐TKIs.
Consensus Statement of the Malignant Hyperthermia Association of the United States on Unresolved Clinical Questions Concerning the Management of Patients With Malignant Hyperthermia
Authors: Litman Ronald S. , Smith Victoria I. , Larach Marilyn Green , Mayes Lena , Shukry Mohanad , Theroux Mary C. , Watt Stacey , Wong Cynthia A.
Published: March 2019

At a recent consensus conference, the Malignant Hyperthermia Association of the United States addressed 6 important and unresolved clinical questions concerning the optimal management of patients with malignant hyperthermia (MH) susceptibility or acute MH. They include: (1) How much dantrolene should be available in facilities where volatile agents are not available or administered, and succinylcholine is only stocked on site for emergency purposes? (2) What defines masseter muscle rigidity? What is its relationship to MH, and how should it be managed when it occurs? (3) What is the relationship between MH susceptibility and heat- or exercise-related rhabdomyolysis? (4) What evidence-based interventions should be recommended to alleviate hyperthermia associated with MH? (5) After treatment of acute MH, how much dantrolene should be administered and for how long? What criteria should be used to determine stopping treatment with dantrolene? (6) Can patients with a suspected personal or family history of MH be safely anesthetized before diagnostic testing? This report describes the consensus process and the outcomes for each of the foregoing unanswered clinical questions.
Long Intravascular Persistence of 20% Albumin in Postoperative Patients
Authors: Hasselgren Emma , Zdolsek Markus , Zdolsek Joachim H. , Björne Håkan , Krizhanovskii Camilla , Ntika Stelia , Hahn Robert G.
Published: March 2019

BACKGROUND:

Albumin may persist intravascularly for a shorter time in patients after major surgery than in healthy volunteers due to a surgery-induced breakdown (shedding) of the endothelial glycocalyx layer.

METHODS:

In this nonrandomized clinical trial, an IV infusion of 3 mL/kg of 20% albumin was given at a constant rate during 30 minutes to 15 patients on the first day after major open abdominal surgery (mean operating time 5.9 h) and to 15 conscious volunteers. Blood samples and urine were collected during 5 h and mass balance calculations used to estimate the half-lives of the administered albumin molecules and the induced plasma volume expansion, based on measurements of hemodilution and the plasma albumin concentration.

RESULTS:

At the end of the infusions, albumin had diluted the plasma volume by 13.3% ± 4.9% (mean ± SD) in the postoperative patients and by 14.2% ± 4.8% in the volunteers (mean difference −0.9, 95% CI, −4.7 to 2.9; 1-way ANOVA P = .61), which amounted to twice the infused volume. The intravascular half-life of the infused albumin molecules was 9.1 (5.7–11.2) h in the surgical patients and 6.0 (5.1–9.0) h in the volunteers (Mann-Whitney U test, P = .26; geometric mean difference 1.2, 95% CI, 0.8–2.0). The half-life of the plasma volume expansion was 10.3 (5.3–17.6; median and interquartile range) h in the surgical patients and 7.6 (3.5–9.0) h in the volunteers (P = .10; geometric mean difference 1.5, 95% CI, 0.8–2.8). All of these parameters correlated positively with the body mass index (correlation coefficients being 0.42–0.47) while age and sex did not affect the results.

CONCLUSIONS:

Twenty percent albumin caused a long-lasting plasma volume expansion of similar magnitude in postoperative patients and volunteers.
Transient Tachypnea of Newborns Is Associated With Maternal Spinal Hypotension During Elective Cesarean Delivery: A Retrospective Cohort Study
Authors: Singh Shubhangi , Lumbreras-Marquez Mario Isaac , Farber Michaela K. , Xu Xinling , Singh Prashant , Gorman Terri , Palanisamy Arvind
Published: March 2019

BACKGROUND:

The risk for transient tachypnea of newborns, a common cause of respiratory distress in the neonatal period, is 2- to 6-fold higher during elective cesarean delivery compared to vaginal delivery. Here, we evaluated the association between transient tachypnea of newborns and the degree and duration of predelivery maternal hypotension during spinal anesthesia for elective cesarean delivery.

METHODS:

Demographic data, details of anesthetic management, blood pressure measurements, and vasopressor requirement preceding delivery were compared between transient tachypnea newborns (n = 30) and healthy neonates (n = 151) with normal respiratory function born via elective cesarean delivery between July 2015 and February 2016. The degree and duration of hypotension were assessed using area under the curve for systolic blood pressure (SBP) ≤90 mm Hg and area under the curve for mean arterial pressure ≤65 mm Hg. After adjusting for confounders, multivariable logistic regression was used to evaluate the association between area under the curve for SBP and transient tachypnea of newborns.

RESULTS:

The median area under the curve for SBP was higher in cases of transient tachypnea of newborns (0.94; interquartile range, 0–28.7 mm Hg*min) compared to healthy controls (0; interquartile range, 0–3.30 mm Hg*min; P = .001). Similarly, median area under the curve for mean arterial pressure was also higher in cases of transient tachypnea of newborns (0; interquartile range, 0–18.6 mm Hg*min) compared to controls (0; interquartile range, 0–1.1 mm Hg*min; P = .01). Mothers of transient tachypnea newborns received significantly higher amounts of phenylephrine and ephedrine compared to controls (P = .001 and 0.01, respectively). Hence, the total vasopressor dose given to mothers in the transient tachypnea of newborn group was much higher than for the control group (P = .001). In the multivariable logistic regression, area under the curve for SBP was significantly associated with transient tachypnea of newborns (odds ratio, 1.02; 95% CI, 1.01–1.04, P = .005) after adjusting for gravidity and the type of anesthetic (spinal versus combined spinal epidural).

CONCLUSIONS:

Our results suggest that the degree and duration of maternal SBP <90 mm Hg after neuraxial anesthesia during elective cesarean delivery are associated with transient tachypnea of newborns. Future prospective studies should further explore the effects of maternal hypotension, its prevention, and treatment for transient tachypnea of newborns.