bluuebunny/crossref_metadata_2025 huggingface dataset:
Spiritually Sensitive Intervention to Mitigate Depressive Symptoms Among Hospitalized Children Affected With Congenital Heart Diseases: Insights for Holistic Pediatric Nursing
Authors: Pandya Samta P.
Published: January 2019

This article reports on an experiment in 28 pediatric hospitals across 14 African and Asian cities. The aim was to examine the effect of a customized spiritually sensitive intervention (SSI) on mitigating depressive symptoms among hospitalized children with congenital heart diseases (CHD). Results showed that post-SSI, 1,139 treatment group children were less depressed vis-à-vis the control group. The SSI was more effective for children from African cities, boys, middle class, Christians and Buddhists, those undergoing medical care for ventricular septal defects, children who stayed in the hospital for 2 to 3 weeks and who regularly self-practiced the lessons after hospital discharge. The SSI could be effectively used for holistic pediatric nursing and health care across contexts with CHD affected children, with some culture-specific variations for greater impact.
Gender Quotas or Girls’ Networks? Evidence from an Italian Research Selection
Authors: Checchi Daniele , Cicognani Simona , Kulic Nevena
Published: January 2019

This article investigates the role of the gender composition of selection committees and connections in promoting women in research. Exploiting a newly collected data set on research recruitment processes to entry-level positions in a leading Italian research centre operating mainly in the hard sciences, the study finds that bias against women manifests itself at non-tenured entry level and is attenuated by the presence of a woman on the selection committee. However, the most important predictor for recruitment in the study is previous connections with the research centre, a mechanism which, due to the lower density of network links with the institute among female candidates, operates as a selection device discriminating against women. The results suggest that the gender of the committee members, network structure and type of recruitment must all be considered in approaching recruitment policy.
A multi-locus predictiveness curve and its summary assessment for genetic risk prediction
Authors: Wei Changshuai , Li Ming , Wen Yalu , Ye Chengyin , Lu Qing
Published: January 2019

Genetic association studies using high-throughput genotyping and sequencing technologies have identified a large number of genetic variants associated with complex human diseases. These findings have provided an unprecedented opportunity to identify individuals in the population at high risk for disease who carry causal genetic mutations and hold great promise for early intervention and individualized medicine. While interest is high in building risk prediction models based on recent genetic findings, it is crucial to have appropriate statistical measurements to assess the performance of a genetic risk prediction model. Predictiveness curves were recently proposed as a graphic tool for evaluating a risk prediction model on the basis of a single continuous biomarker. The curve evaluates a risk prediction model for classification performance as well as its usefulness when applied to a population. In this article, we extend the predictiveness curve to measure the collective contribution of multiple genetic variants. We further propose a nonparametric, U-statistics-based measurement, referred to as the U-Index, to quantify the performance of a multi-locus predictiveness curve. In particular, a global U-Index and a partial U-Index can be used in the general population and a subpopulation of particular clinical interest, respectively. Through simulation studies, we demonstrate that the proposed U-Index has advantages over several existing summary statistics under various disease models. We also show that the partial U-Index can have its own uniqueness when rare variants have a substantial contribution to disease risk. Finally, we use the proposed predictiveness curve and its corresponding U-Index to evaluate the performance of a genetic risk prediction model for nicotine dependence.
Something Old and Something New: Future Directions in Vocational Research With People of Color in the United States
Authors: Flores Lisa Y. , Martinez Leticia D. , McGillen Gloria G. , Milord Johanna
Published: January 2019

Vocational psychology scholarship has largely overlooked the work experiences of people of color. In this article, we present evidence that vocational research that addresses the work issues of people of color has been neglected in the key outlets for vocational research among vocational psychologists. We outline seven directions for research inquiry with people of color, namely using culturally sensitive research methods, increasing research on the effectiveness of career interventions, integrating interdisciplinary perspectives, merging psychological and educational science with vocational development, using intersectional approaches, examining collective mobility strategies and structural reforms, and assessing the impact of environmental disasters on long-term educational and work outcomes.
The “Quantifying Construct Validity” Procedure: Its Role, Value, Interpretations, and Computation
Authors: Furr R. Michael , Heuckeroth Sarah
Published: January 2019

The current article enhances the test validation process by addressing important issues with the quantifying construct validity (QCV) procedure. The QCV procedure is intended to help researchers systematically and objectively evaluate the degree to which a pattern of convergent and discriminant validity correlations correspond to a priori hypotheses. Although the QCV procedure holds promise as a psychometric tool and has enjoyed some use, at least three factors have likely limited the frequency and accuracy of its use—questions regarding its role and utility in test validation, a lack of clarity about its key concepts, and a lack of integration with widely available statistical software. We address these important issues and provide psychometrically grounded recommendations for applying the QCV procedure. This work facilitates the understanding, computation, and useful application of the QCV procedure, and ultimately it is intended to enhance work in test validation.
“She Wanted to Know the Full Story”: Children’s Perceptions of Open Versus Closed Questions
Authors: Brubacher Sonja P. , Timms Lydia , Powell Martine , Bearman Madeleine
Published: January 2019

The current study explored children’s perceptions of open and closed questions in an interview setting. Children aged 7–12 ( n = 83) years watched a short film and were questioned about it by an interviewer who asked only open questions and an interviewer who asked only closed questions (counterbalanced). A third interviewer subsequently invited perceptions of each interview by asking children to compare the interviews on 10 attributes (e.g., length, perceived interviewer interest). Children’s comparisons on each of the 10 attributes were analyzed quantitatively and their responses to the follow-up questions underwent thematic analysis. Overall, children tended to find closed questions easier than open questions because they required less thought to answer but felt more listened to and better able to give their stories in response to open questions. Their perceptions frequently matched findings in the literature about the utility of open versus closed questions. The research has implications for interviews with child victims.
Neurodiverse Be the Policymakers! A Study Exploring News Text Informed Potential for Anxiety-Enhanced Policymaking and Guiding the Progressive Reporting of Mental Diversity
Authors: Mellifont Damian
Published: January 2019

The Australian government is challenged to address significant mental health policy issues. These problems include those of unemployment, incarceration, homelessness and suicide. It is therefore timely to consider inclusive and innovative approaches in which these issues might be better addressed. This is the first study to critically explore the potential of neurodiverse persons to co-produce a mental health policy as informed by the contemporary news reporting on the concept of high-functioning anxiety. Enabling such investigation, this research has applied the framework analysis technique to a purposive sample of nine news texts obtained from an Internet search enquiry. Exploratory findings reveal themes relating to prospective anxiety-related capabilities and constraints across the policy development dimensions of analysis, timeline management and stakeholder consultation. The study, while concluding that journalists within the Asia-Pacific region and elsewhere should be encouraged to report on mental diversity in ethical, balanced and progressive ways, offers a practical guide to support this.
Five Challenges Facing Journalism Education in the UK
Authors: Frost Chris
Published: January 2019

Journalism and journalism education has been through a time of massive change over the past 20 years as the media has got to grips with the technology revolution, learning how to deal with the benefits and problems that the move from analog to digital has brought. Now education needs to look to the future to predict what’s coming and to prepare teachers and students for even more change as the interface between humans and the digital world becomes ever closer. Journalism education also needs to take more seriously the need to not just train journalism students but to give them the tools to deal with a fast-moving world where things can change almost month by month.

Students can now expect a career of up to 60 years duration and learning how to predict the future, deal with the latest innovations, manage change and identify what is important and what is merely transitory; a glossy distraction rather than a change in basic truths will be key skills for success. Training simply for today’s world is no longer good enough and lets our students down – students need skills for a future that will be more different than any sci-fi artefact film can imagine.
Stakeholder Participation and Strategy in Rulemaking: A Comparative Analysis
Authors: Crow Deserai A. , Albright Elizabeth A. , Koebele Elizabeth A.
Published: January 2019

Integrating a diversity of stakeholder voices in policymaking processes can lead to more legitimate and widely supported laws and rules. While most attention to stakeholder participation in public decision processes has focused on legislative policymaking or the role of industry stakeholders in regulatory processes, strategic choices about participation by non-industry stakeholders in rulemaking remains largely overlooked, particularly at the state level. Previous research shows that agency rulemaking processes often provide greater procedural access to industry actors, who may significantly influence final rule content by bringing greater technical knowledge to bear on rulemaking processes. Less is understood about the strategies used by non-industry stakeholders, such as environmental advocacy groups, to influence regulatory decisions. This study, which compares environmental rulemaking processes across three issues in five states, finds that industry actors and environmental advocacy groups both use a variety of participation strategies classically thought to be “insider” and “outsider” strategies, and that these choices are motivated by reasons other than the perceived effectiveness of the strategy within the formal rulemaking process.
The Disparity of Impairment of Neurogenesis and Cognition After Acute or Fractionated Radiation Exposure in Adolescent BALB/c Mice
Authors: Peng Shuang , Yang Bo , Duan Meng Yun , Liu Zi Wei , Wang Wei Feng , Zhang Xiang Zhi , Ren Bo Xu , Tang Feng Ru
Published: January 2019

The effect of acute X-ray irradiation with 2 Gy or fractionated exposure with 0.2 Gy continuously for 10 days (0.2 Gy × 10 = 2 Gy) was evaluated in the postnatal day 21 (P21) BALB/c mouse model. Both acute and fractionated irradiation induced impairment of cell proliferation and neurogenesis in the subgranular zone of the dentate gyrus labeled by Ki67 and doublecortin, respectively. Parvalbumin immunopositive interneurons in the subgranular zone were also reduced significantly. However, the 2 patterns of irradiation did not affect animal weight gain when measured at ages of P90 and P180 or 69 and 159 days after irradiation. Behavioral tests indicated that neither acute nor fractionated irradiation with a total dose of 2 Gy induced deficits in the contextual fear or spatial memory and memory for novel object recognition. Animal motor activity was also not affected in the open-field test. The disparity of the impairment of neurogenesis and unaffected cognition suggests that the severity of impairment of neurogenesis induced by acute or fractionated irradiation with a total dose of 2 Gy at P21 may not be worse enough to induce the deficit of cognition.
Multimodal grasp data set: A novel visual–tactile data set for robotic manipulation
Authors: Wang Tao , Yang Chao , Kirchner Frank , Du Peng , Sun Fuchun , Fang Bin
Published: January 2019

This article introduces a visual–tactile multimodal grasp data set, aiming to further the research on robotic manipulation. The data set was built by the novel designed dexterous robot hand, the Intel’s Eagle Shoal robot hand (Intel Labs China, Beijing, China). The data set contains 2550 sets data, including tactile, joint, time label, image, and RGB and depth video. With the integration of visual and tactile data, researchers could be able to better understand the grasping process and analyze the deeper grasping issues. In this article, the building process of the data set was introduced, as well as the data set composition. In order to evaluate the quality of data set, the tactile data were analyzed by short-time Fourier transform. The tactile data–based slip detection was realized by long short-term memory and contrasted with visual data. The experiments compared the long short-term memory with the traditional classifiers, and generalization ability on different grasp directions and different objects is implemented. The results have proved that the data set’s value in promoting research on robotic manipulation area showed the effective slip detection and generalization ability of long short-term memory. Further work on visual and tactile data will be devoted to in the future.
New Paradigm of Personalized Glycemic Control Using Glucose Temporal Density Histograms
Authors: Trahtemberg Uriel , Hallas Tova , Segman Yehonatan , Sheiman Ella , Shasha Michal , Nissim Kobi , Segman Yosef (Joseph)
Published: January 2019

Background:

Current methods used to assess glycemic control use averaged measures and provide little information on the glycemic pathology of the patients. In this article we propose visual tools and their related mathematical formulas that allow for improved characterization of the glycemic behavior and achieve better glycemic control.

Methods:

We present a reanalysis of published data, based on SMBG measurements from clinical trials of both men and women older than 18 years who were either healthy volunteers, prediabetes, or type 1 or type 2 diabetes. New graphic visualizations of glycemia as well as mathematical formulas that describe the glycemic behavior are presented and described, as well as suggested methods for their use to improve glycemic control.

Results:

Patients with different problems in their glycemic control had different histogram shapes. In addition, patients who had the same HbA1c level at the time of the trial revealed significantly different glucose histograms with different shapes, variability and glycemic burden. The derived graphic visualizations provided information about the temporal evolution of the glycemic control.

Conclusions:

A paradigm change of the existing model of diabetes control is proposed, shifting from standardized treatment algorithms based on HbA1c follow-up to a new controlling approach that is based on the personal glucose density histogram. The histogram is an informative, detailed tool for the current patient glycemic behavior, and a future histogram can be targeted for a successful treatment. In addition, the glucose burden and the glucose severity index are proposed as informative markers for successful treatment. This is applicable to any glycemic data, by means of invasive and noninvasive glucometers.
Urticaria pigmentosa-like skin disease in a domestic shorthair cat
Authors: Tomich Lara M , Pieper Jason B
Published: January 2019

Case summary

A 14-month-old castrated male domestic shorthair cat presented with an 8 month history of severe pruritus, alopecia, papules and excoriations. Initial evaluation and treatment prior to referral included skin scrape, cytology, two strict food trials, dermatophyte culture, and bacterial culture and sensitivity, as well as antibiotic therapy, empiric treatment for mites, steroids and ciclosporin A (Atopica; Elanco). The cat was referred to the Dermatology and Otology Clinic at the University of Illinois Veterinary Teaching Hospital for further diagnostics and treatment. Skin scrapes were unremarkable. Cytology showed rare bacteria and moderate neutrophils. The cat was given an injection of triamcinolone acetonide, which was ineffective. Oclacitinib (Apoquel; Zoetis) was given for 4 weeks with no improvement. A skin biopsy was performed, and histopathology showed large numbers of well-differentiated monomorphic mast cells with fewer eosinophils that diffusely infiltrated the superficial dermis, supportive of urticaria pigmentosa. Oral dexamethasone and cetirizine hydrochloride were initiated, and the cat responded favorably. At the time of writing, the cat continues to do well on cetirizine hydrochloride with only intermittent tapering courses of dexamethasone.

Relevance and novel information

To the best of our knowledge, this is the first reported case of urticaria pigmentosa in a domestic shorthair cat. This case also highlights the importance of biopsy after a thorough, systematic work-up in a cat with severe, intractable pruritus to reveal an uncommon disease pattern, as well as the efficacy of oral dexamethasone and cetirizine hydrochloride as a potential management option.
Effects of 12-months treatment with zoledronate or teriparatide on intima-media thickness of carotid artery in women with postmenopausal osteoporosis: A pilot study
Authors: Passeri Elena , Mazzaccaro Daniela , Sansoni Veronica , Perego Silvia , Nano Giovanni , Verdelli Chiara , Lombardi Giovanni , Corbetta Sabrina
Published: January 2019

Atherosclerosis and osteoporosis are interrelated entities and share similar pathogenic mechanisms. Recent studies showed that key proteins of bone metabolism, such as osteoprotegerin (OPG) and osteopontin (OPN), are also involved in vascular atherosclerosis and calcifications. The carotid intima-media thickness (CA-IMT) is an early quantitative marker of generalized atherosclerosis. Aim of study was to investigate whether 12-months treatment with zoledronate (ZLN) or teriparatide (TPT) affects CA-IMT and circulating OPG and OPN levels. In this study, 11 postmenopausal osteoporotic women (aged 73, 70.5–74.5 years; median, range interquartile) treated with 5 mg/year iv ZLN; 9 postmenopausal osteoporotic women (aged 70, 62.5–73.5 years) treated with 20 µg/day sc TPT; and 10 aged-, body mass index (BMI)-, glycemic, and lipid profiles-matched, free from anti-osteoporotic and hypocholesterolemic drugs, controls were prospectively investigated at baseline and after 12 months. At baseline, median CA-IMT was similar in the three groups and increased after 12 months. CA-IMT increased significantly in TPT-treated patients (1.0, 0.8–1.2 vs 1.1, 0.9–15 mm, P = 0.04), though the change was minimal. After 12 months of treatment, CA-IMT positively correlated with alkaline phosphatase (ALP) levels (r = 0.767, P = 0.008) and negatively with high-density lipoprotein (HDL) cholesterol levels (r = −0.65, P = 0.03), suggesting interplay between active bone remodeling and lipid profile. At baseline and after 12 months, median serum OPG and OPN levels did not differ among the groups and did not correlate with changes in CA-IMT. In conclusion, ZLN and TPT treatments are safe on carotid walls in osteoporotic women with subclinical atherosclerosis; circulating OPG and OPN are not affected by long-term anti-osteoporotic treatments and do not correlate with CA-IMT.
Use of Dipstick Assay and Rapid PCR-DNA Analysis of Nasal Secretions for Diagnosis of Bacterial Sinusitis in Children With Chronic Cough
Authors: Song Charles , Chorath Jeena , Pak Youngju , Redjal Nasser
Published: January 2019

Background

Chronic cough in children is a diagnostic challenge.

Objective

To discover the utility of nasal dipsticks and polymerase chain reaction (PCR)-DNA analysis in differentiating bacterial sinusitis from other causes of chronic cough and identifying pathogens from the nasal cavity.

Method

We recruited 22 patients under 15 years of age with cough lasting longer than 4 weeks (group 1), 7 controls with allergic rhinitis (group 2), and 10 controls without respiratory symptoms (group 3). Based on symptoms, the results of nasal secretion assays, and nasal endoscopy, a diagnosis of clinical bacterial sinusitis was made. We identified potential pathogens by quantitative PCR of nasal secretions.

Results

Group 1A (cough with clinical bacterial sinusitis n = 10): Eight (80%) patients had bacterial sinusitis associated with dominant potential pathogenic bacteria (PPB): Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Group 1B (cough without clinical bacterial sinusitis n = 12): None had dominant PPB. Group 2 (allergic rhinitis n = 7): None had dominant PPB. Group 3 (asymptomatic n = 10): None had dominant PPB. Twenty to 57% of all groups were colonized with Staphylococcus aureus. Fifty to 70% were colonized with Staphylococcus epidermidis, Corynebacterium pseudodiphtheriticum, and Dolosigranulum pigrum.

Conclusion

In children with chronic cough, clinicians can utilize a simple and inexpensive nasal secretion dipstick assay for rapid diagnosis of sinusitis and identify PPB by DNA-PCR test for specific antibiotic treatment.
Neuronavigated Versus Non-navigated Repetitive Transcranial Magnetic Stimulation for Chronic Tinnitus: A Randomized Study
Authors: Sahlsten Hanna , Holm Anu , Rauhala Esa , Takala Mari , Löyttyniemi Eliisa , Karukivi Max , Nikkilä Johanna , Ylitalo Kirsi , Paavola Janika , Johansson Reijo , Taiminen Tero , Jääskeläinen Satu K.
Published: January 2019

Repetitive transcranial magnetic stimulation (rTMS) has shown variable effect on tinnitus. A prospective, randomized 6-month follow-up study on parallel groups was conducted to compare the effects of neuronavigated rTMS to non-navigated rTMS in chronic tinnitus. Forty patients (20 men, 20 women), mean age of 52.9 years (standard deviation [ SD] = 11.7), with a mean tinnitus duration of 5.8 years ( SD = 3.2) and a mean tinnitus intensity of 62.2/100 ( SD = 12.8) on Visual Analog Scale (VAS 0–100) participated. Patients received 10 sessions of 1-Hz rTMS to the left temporal area overlying auditory cortex with or without neuronavigation. The main outcome measures were VAS scores for tinnitus intensity, annoyance, and distress, and Tinnitus Handicap Inventory (THI) immediately and at 1, 3, and 6 months after treatment. The mean tinnitus intensity (hierarchical linear mixed model: F3 = 7.34, p = .0006), annoyance ( F3 = 4.45, p = .0093), distress ( F3 = 5.04, p = .0051), and THI scores ( F4 = 17.30, p < .0001) decreased in both groups with non-significant differences between the groups, except for tinnitus intensity ( F3 = 2.96, p = .0451) favoring the non-navigated rTMS. Reduction in THI scores persisted for up to 6 months in both groups. Cohen’s d for tinnitus intensity ranged between 0.33 and 0.47 in navigated rTMS and between 0.55 and 1.07 in non-navigated rTMS. The responder rates for VAS or THI ranged between 35% and 85% with no differences between groups ( p = .054–1.0). In conclusion, rTMS was effective for chronic tinnitus, but the method of coil localization was not a critical factor for the treatment outcome.
Differences and mechanisms underpinning a change in the knee flexion moment while running in stability and neutral footwear among young females
Authors: Sayer Timothy A. , Hinman Rana S. , Paterson Kade L. , Bennell Kim L. , Fortin Karine , Kasza J. , Bryant Adam L.
Published: January 2019

Background

Higher peak external knee flexion moments (KFM) during running has been observed in healthy people wearing athletic footwear compared to barefoot, which may increase risk of knee pathologies such as patellofemoral pain. Currently, no studies have examined whether stability and neutral style athletic shoes influence the peak KFM differently, or explored the underlying biomechanical mechanisms by which footwear alters peak KFM in young females.

Methods

Lower limb biomechanics of sixty girls aged between 10 and 25 years old were collected while running in footwear (both stability and neutral) and barefoot. The external peak KFM, sagittal plane kinematics, sagittal plane knee ground reaction force (GRF) lever arm and sagittal plane resultant GRF magnitude were analysed by repeated measures Analysis of Variance. Linear mixed models were fit to identify predictors of a change in peak KFM, and to determine if the effects of these predictors differed between footwear conditions.

Results

The peak KFM was higher wearing both shoe styles compared to barefoot (p < 0.001), while no between‐shoe differences were found (p > 0.05). Both shoes also increased kinematic variables at the hip, knee, and ankle (p < 0.05). When all these variables were entered into the mixed model, only a change in the knee‐GRF lever arm was predictive of a change in peak KFM wearing shoes compared to barefoot (p < 0.001).

Conclusion

These findings provide evidence that stability and neutral shoes increase peak KFM compared to barefoot, which is associated with a change in the knee‐GRF lever arm rather than a change in lower limb kinematics. Future studies may consider manipulating footwear characteristics to reduce the knee‐GRF lever arm in an effort to reduce peak KFM and the potential risk of patellofemoral pain.
New analytical expression of the magnetic gradient tensor for homogeneous polyhedrons
Authors: Ren Zhengyong , Chen Huang , Chen Chaojian , Zhong Yiyuan , Tang Jingtian
Published: January 2019

We have developed a new analytical expression for the magnetic-gradient tensor for polyhedrons with homogeneous magnetization vectors. Instead of performing the direct derivative on the closed-form solutions of the magnetic field, it is obtained by first transforming the volume integrals of the magnetic-field tensor into surface integrals over polyhedral facets, in terms of the gradient theorem. Second, the surface divergence theorem transforms the surface integrals over polyhedral facets into edge integrals and structure-simplified surface integrals. Third, we develop analytical expressions for these edge integrals and simplified surface integrals. We use a synthetic prismatic target to verify the accuracies of the new analytical expression. Excellent agreements are obtained between our results and those calculated by other published formulas. The new analytical expression of the magnetic-gradient tensor can play a fundamental role in advancing magnetic mineral explorations, environmental surveys, unexploded ordnance and submarine detection, aeromagnetic and marine magnetic surveys because more and more magnetic tensor data have been collected by magnetic-tensor gradiometry instruments.
Impact of Accuracy of Survival Predictions on Quality of End-of-Life Care Among Patients With Metastatic Cancer Who Receive Radiation Therapy
Authors: Sborov Katherine , Giaretta Stephanie , Koong Amanda , Aggarwal Sonya , Aslakson Rebecca , Gensheimer Michael F. , Chang Daniel T. , Pollom Erqi L.
Published: January 2019

PURPOSE:

For patients treated with palliative radiation, we examined the association between life expectancy predictions by radiation oncologists and aggressive end-of-life care.

MATERIALS AND METHODS:

We included decedents from a study that assessed the ability of oncologists to predict survival of patients with metastatic cancer who received radiation. We identified patients who died within 12 months of study enrollment to assess accuracy of predictions. Aggressive end-of-life care was defined by the National Quality Forum, ASCO Quality Oncology Practice Initiative metrics, and advanced radiation modalities in the last month of life. Survival predictions were categorized as follows: correct (< 12 months), 12 to 18 months, 18 to 24 months, and more than 24 months. We assessed association between prediction and aggressive end-of-life care using a generalized estimation equation.

RESULTS:

Of 489 decedents, we identified 467 encounters with survival estimates. Overall, 156 decedents (32%) met at least one metric of aggressive end-of-life care. Factors associated with aggressive end-of-life care included younger age, female sex, primary cancer diagnosis, no brain metastases, and private insurance. In each encounter when an oncologist predicted survival, 363 predictions (78%) were correct (< 12 months), 54 (11%) incorrectly predicted 12 to 18 months, 27 (6%) predicted 18 to 24 months, and 23 (5%) predicted more than 24 months. Compared with patients who had encounters that had correct survival predictions, patients predicted to live more than 24 months were more likely to meet at least one metric of aggressive end-of-life care (odds ratio, 2.55; 95% CI, 1.09 to 5.99; P = .03).

CONCLUSION:

Inaccurate survival predictions by oncologists are associated with more aggressive end-of-life care for patients with advanced cancer.
Value of CT iterative metal artifact reduction in PET/CT—clinical evaluation in 100 patients
Authors: Reinert Christian Philipp , la Fougère Christian , Nikolaou Konstantin , Pfannenberg Christina , Gatidis Sergios
Published: January 2019

Objective:

To assess the technical feasibility and diagnostic benefit of CT iterative metal artifact reduction (iMAR) in patients with metal implants undergoing positron emission tomography (PET/CT.

Methods:

PET/CTs of 100 patients with metal implants in different anatomical localization were retrospectively analyzed. CT data were reconstructed with iMAR and without iMAR (noMAR) and used in comparison for PET attenuation correction, generating iMAR-corrected and noMAR PET data. The effect of iMAR on quantitative CT and PET analysis was assessed by measurements of Hounsfield units (HUs) and standard uptake values (SUV) in predefined anatomical structures and pathological lesions in the vicinity of metal implants. Diagnostic confidence for lesion delineation was assessed using a 3-point scale.

Results:

For artifact-affected structures, mean HU of iMAR corrected CT significantly differed compared to noMAR CT and standard deviations were significantly lower [e.g. M. masseter: 71.01 ± 22.34 HU (iMAR) vs 98.89 ± 92.18 HU (noMAR), p < .01]. SUVs did not significantly differ in artifact-affected structures [e.g. M. masseter: SUVmean 0.96 ± 0.54 (iMAR) vs 0.97 ± 0.55 (noMAR); p > .89] and pathological findings [SUVmean 10.78 (iMAR) vs 10.81 (noMAR); p > .98] between iMAR and noMAR PET. Qualitatively, delineation was significantly improved in iMAR corrected CT for the interpretation of anatomical and pathological structures [e.g. score of pathologic lesions: 2.80 (iMAR) vs 2.31 (noMAR); p < .01].

Conclusion:

The use of iMAR in PET/CT significantly improves delineation of anatomical and pathological structures in the vicinity of metal implants in CT. PET quantification and PET image quality are not significantly affected by the use of iMAR-based attenuation correction independent of the presence of metal implants.

Advances in knowledge: 

IMAR is a feasible algorithm in PET/CT improving CT image quality in the vicinity of metal implants without affecting PET quantification and can therefore be implemented in the clinical routine.
Clinical characteristics and long-term prognosis of spontaneous coronary artery dissection: A single-center Chinese experience
Authors: Liu Xintian , Xu Chengyi , Liu Chengwei , Su Xi
Published: January 2019

Background and Objective: Spontaneous coronary artery dissection (SCD) remains a rare and important cause of coronary artery disease (CAD). The purpose of this study was to describe the clinical and angiographic features in SCD and to evaluate the treatment and long-term prognosis of this condition in China.

Methods: This retrospective cohort study included 118 Chinese patients with SCD confirmed by coronary angiography. Clinical and angiographic features, treatment modalities and outcomes of SCD were estimated.

Results: The overall prevalence of SCD was 0.15%. Age was 57 ± 10 years; 86% patients were men; 75% presented with acute coronary syndrome (ACS); 72% had concomitant atherosclerotic CAD. SCD often affected right coronary artery (RCA) and caused a short dissection (< 20mm). A conservative therapy was used in 28% of patients and revascularization in 72% (percutaneous coronary intervention [PCI] 57%; coronary artery bypass grafting [CABG] 15%). Only one patient died during hospitalization due to multiple organ failure after CABG. During a median follow-up of 43 months (range, 1 - 158 months), 32 patients had a new-onset ACS, 9 received revascularization (7 PCI and 2 CABG), and 8 died. The Kaplan-Meier estimated 12-year rates of freedom from cardiac death and ACS were both higher in revascularization versus conservative therapy (78% versus 57%; P = 0.023; 48% versus 25%, P = 0.014). No significant difference was found in freedom from revascularization between the two therapies.

Conclusions: In China, SCD was usually associated with atherosclerosis and predominantly affected male population. SCD often affected RCA and caused a short dissection. In-hospital mortality rate was low regardless of therapeutic strategy. However, a significantly better long-term prognosis was observed in the revascularization compared with conservative therapy.

How to cite this:Liu X, Xu C, Liu C, Su X. Clinical characteristics and long-term prognosis of spontaneous coronary artery dissection: A single-center Chinese experience. Pak J Med Sci. 2019;35(1):106-112. doi: https://doi.org/10.12669/pjms.35.1.321

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Meeting and Working with H.T. Engelhardt Jr.: An Inspiring Experience for a (once young) European Scholar
Authors: Schotsmans Paul
Published: January 2019

The author – a European “companion” of H. T. Engelhardt during the two last decades of the 20th century – describes his meetings with and impressions of Tris Engelhardt. He clarifies how open mindedness was the main concern in their common activities.
Fair Equality of Opportunity in Healthcare
Authors: Nunes Rui
Published: January 2019

The allocation of resources for health, as well as the distribution of other social goods, being a political problem, can also be observed as belonging to the universe of distributive justice, considering that all citizens must have the necessary means for an acceptable physical, psychological and social performance. Individual autonomy, paradigm of a full citizenship in a modern society, cannot otherwise be achieved. Human dignity seems to imply that no citizen can be excluded from the basic health system due to the lack of financial resources. Indeed, equal access of all citizens to basic social goods and therefore to key places in society – principle of fair equality of opportunities – is one of the core aspects of Rawls's difference principle. It is, in essence, about ensuring the exercise of the right to individual self-determination in the relationship between the individual and society, as well as the right to play a social role according to skills and merit. But, it is not only the theory of the social contract that provides for a fair equality of opportunities. Different perspectives of justice contemplate this ideal. As suggested by Tristram Engelhardt Jr individual autonomy must be interpreted as a value in itself and a determining factor for the exercise of a full citizenship. But, justice is an ideal that must be progressively built. Whether in a specific society or on a global scale. And, the great challenge of humanity is precisely to recognize the existing intercultural differences and propose sufficiently flexible ideological systems that can be applied in different countries with very different levels of social and economic development. Without detracting from the ethical principles that should underpin the construction of the 21st century global society.
Association between CD4 T cell counts and the immune status among adult critically ill HIV-negative patients in intensive care units in Uganda
Authors: Kavuma Mwanje Arthur , Ejoku Joseph , Ssemogerere Lameck , Lubulwa Clare , Namata Christine , Kwizera Arthur , Wabule Agnes , Okello Erasmus , Kizito Samuel , Lubikire Aggrey , Sendagire Cornelius , Andia Biraro Irene
Published: January 2019

Background: Cluster of differentiation 4 (CD4) T cells play a central role in regulation of adaptive T cell-mediated immune responses. Low CD4 T cell counts are not routinely reported as a marker of immune deficiency among HIV-negative individuals, as is the norm among their HIV positive counterparts. Despite evidence of mortality rates as high as 40% among Ugandan critically ill HIV-negative patients, the use of CD4 T cell counts as a measure of the immune status has never been explored among this population. This study assessed the immune status of adult critically ill HIV-negative patients admitted to Ugandan intensive care units (ICUs) using CD4 T cell count as a surrogate marker.

Methods: A multicentre prospective cohort was conducted between 1st August 2017 and 1st March 2018 at four Ugandan ICUs. A total of 130 critically ill HIV negative patients were consecutively enrolled into the study. Data on sociodemographics, clinical characteristics, critical illness scores, CD4 T cell counts were obtained at baseline and mortality at day 28.

Results: The mean age of patients was 45± 18 years (mean±SD) and majority (60.8%) were male. After a 28-day follow up, 71 [54.6%, 95% CI (45.9-63.3)] were found to have CD4 counts less than 500 cells/mm³, which were not found to be significantly associated with mortality at day 28, OR (95%) 1 (0.4–2.4), p = 0.093. CD4 cell count receiver operator characteristic curve (ROC) area was 0.5195, comparable to APACHE II ROC area 0.5426 for predicting 24-hour mortality.

Conclusions: CD4 T cell counts were generally low among HIV-negative critically ill patients. Low CD4 T cells did not predict ICU mortality at day 28. CD4 T cell counts were not found to be inferior to APACHE II score in predicting 24 hour ICU mortality.
Diagnosis, treatment and prevention of shingles: the role of the healthcare assistant
Authors: Nazarko Linda
Published: January 2019

Herpes zoster (shingles) infection causes a painful, blistering rash; it is more common in older people. It affects 3.5 per 1000 person-years among 50–54-year-olds to 7.1 per 1000 person-years among 75–79-year-olds ( Gauthier et al, 2009 ). Around 40% of people infected experience ongoing nerve pain lasting three months or longer and one person in 1000 over the age of 70 dies as a result of infection ( NHS UK, 2018 ).

People who are at greatest risk of infection can now be immunised. Immunisation can reduce the risks of shingles by 75% ( Green Book, 2018 ).

Shingles is caused by a virus: early identification and prompt treatment with antiviral drugs reduces symptoms and leads to reduced risk of ongoing nerve pain.

This article explains how older people are at an increased risk of shingles and its complications. It aims to enable readers to recognise the clinical features of shingles, be aware of treatments, infection control procedures and how vaccination can protect older people from this distressing condition.
Wandering behaviour and elopement in the nursing home
Authors: Duffy Anita , Hallahan Patricia
Published: January 2019

People living with dementia are at risk of harm due to a decline in their cognition. This decline can cause wandering or persistent walking, which is stressful for both the person with dementia and their carer. Wandering can lead to falls and other injuries, elopement, getting lost and even death. People with dementia who wander are often admitted to long-term care facilities for safety reasons and because their carers cannot cope. Specific strategies, policies, risk assessment and management procedures are needed for these residents.

This article explores the challenges encountered and provides solutions for care staff to better manage wandering behaviour in residents in long-term care settings.
Exploring therapeutic interventions to reduce the experience of guilt in carers of people living with dementia
Authors: Owen Louise Gillard , Dening Karen Harrison
Published: January 2019

Family carers of people with dementia often describe feelings of guilt, grief and low mood, and are also at increased risk of clinical depression. Through a skilled assessment of a carer's feelings of guilt, an Admiral Nurse identified specific psychological approaches helpful in relieving this potentially damaging and paralysing phenomenon. Person- and family-centred approaches throughout the assessment process, and addressing the needs of individual family members in expressing their individual emotions and experience to the changes in needs of the person with dementia as they become more complex, are essential to family wellbeing. Identifying and differentiating between guilt, anticipatory grief and depression are essential when planning interventions to support family carers.
Legal and ethical considerations for midwives performing the neonatal infant physical examination
Authors: Price Cheri
Published: January 2019

The newborn and infant physical examination (NIPE) is part of a national screening programme in the UK that involves the first full physical assessment of the newborn. The examination aims to identify conditions and diseases early in order for prompt intervention and treatment to be arranged. Historically, the examination has lain solely in the paediatrician's remit; however, the more recent shift in midwifery care provision has led to a focus on midwifery-led care, continuity of carer and seamless care, which has brought the NIPE into the midwife's sphere of practice. There has been increasing evidence demonstrating that the midwife is the most suitable practitioner to conduct the NIPE following appropriate training; however, this has not been evaluated in recent years. Midwives are supported professionally, legally and ethically to conduct this examination, provided that they work within their sphere of practice and professional guidelines.
Out of Africa: Students' reflections on the personal and professional impact of volunteering
Authors: Power Alison , Boughen Adelle , Ames Charlotte
Published: January 2019

The Nursing and Midwifery Council (2009) states that student midwives should seek opportunities to develop their skills and knowledge base.

In the summer of 2018, two student midwives from the University of Northampton independently researched and signed up to a 2-week overseas mission trip to Kenya, with the aim of immersing themselves in a different culture to gain new knowledge and develop transferable skills to embed into their practice in the UK. Charlotte Ames and Adelle Boughen also visited a number of projects around the region supporting girls and young women who have fled their homes to escape injustices such as underage marriage, female genital mutilation (FGM) and domestic abuse. Hearing the young women's stories of bravery, resilience and optimism have had a profound effect on both Charlotte and Adelle, providing them with a new understanding of the term ‘with woman’ and influencing their future practice.
800 words to revolutionise midwifery
Authors: Brammer Molly
Published: January 2019

Every midwife is unique, and brings forward a mosaic of past experiences and innovative ideas. How can we take responsibility to maintain this in a pressurised and conforming work environment?
Managerial competencies of head nurses: a model and assessment tool
Authors: Moghaddam Nader Markazi , Jame Sanaz Zargar Balaye , Rafiei Sima , Sarem Ali Asghari , Ghamchili Ashraf , Shafii Milad
Published: January 2019

Head nurses' performance plays an important role in the successful operation of hospitals. Identification and prioritisation of managerial competencies required for these supervisors and evaluation of their performance on this basis are necessary. This study aimed to provide a valid tool for assessing managerial competencies of hospital department head nurses. First, through literature review, Delphi technique and expert panel, a competency model was developed. Then using the analytic hierarchy process, competencies were weighted and prioritised. Finally, based on the model, an instrument was designed to measure the competencies of head nurses. Validity and reliability of the instrument was also checked. The proposed framework included 27 competencies categorised by four main managerial tasks: planning, organising, leadership and control. Findings revealed that the highest priority was given to strategic thinking (0.1221) and the lowest priority was given to evidence-based decision making (0.007). Based on impact score and content validity ratio results, the content validity of all questions has been proved. Furthermore through the use of a content validity index, 11 questions were omitted or modified. The study presents a valid and comprehensive model for assessing managerial competencies of hospital department head nurses in order to take an important step towards improving their performance.
Acute upper gastrointestinal bleeding: a guide for nurses
Authors: Chapman Warren , Siau Keith , Thomas Fiona , Ernest Selvajothi , Begum Shriya , Iqbal Tariq , Bhala Neeraj
Published: January 2019

This article outlines latest evidence-based care for patients with acute upper gastrointestinal (GI) bleeding. It aims to help gastroenterology and general medical ward nurses plan nursing interventions and understand the diagnostic treatment options available. Acute upper GI bleeding can present as variceal or non-variceal bleeding and has a high death rate. Endoscopy is used for diagnosis and to provide therapy, prior to which the patient should be adequately resuscitated and assessed. Various therapies can be initiated at endoscopy, depending on the source of bleeding. If bleeding continues in spite of these therapies, further interventions such as the Sengstaken tube, oesophageal stents, radiological or surgical treatments may be required. After endoscopy, it is important to have a plan for ongoing treatment. Patients may require acid suppression treatment or eradication of Helicobacter pylori as part of their treatment plan. They may in additional require correction of their haemoglobin levels and follow-up endoscopy. It is essential that nurses caring for such patients are aware of the current UK guidance and help patients to adhere to agreed treatment plans.
Taking the temperature of patient safety in the NHS
Authors: Tingle John
Published: January 2019

John Tingle reflects on the Care Quality Commission's assessment of the state of services in England, and the issues around regulating compliance with the duty of candour