bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of the bispectral index and Observer’s Assessment of Alertness/Sedation Scale in monitoring sedation during spinal anesthesia: A randomized clinical trial
Authors: Lim Tae Wan , Choi Yi Hwa , Kim Jong Yeop , Choi Jong Bum , Lee Soo Kyung , Youn Eun Ji , Lee Jun Suck
Published: December 2019

Objective

The bispectral index (BIS) has been used to monitor sedation during spinal anesthesia. We evaluated the correlation between BIS and the Observer’s Assessment of Alertness/Sedation Scale (OAA/S) in patients sedated with dexmedetomidine, propofol, or midazolam.

Methods

This prospective, randomized study included 46 patients scheduled for knee arthroplasty under spinal anesthesia with sedation. The patients were randomized to receive sedation with dexmedetomidine (n = 15), propofol (n = 15), or midazolam (n = 16). Correlation between BIS and OAA/S was assessed during sedation in the three groups.

Results

A linear correlation was observed between BIS and OAA/S, and there was no significant difference in BIS score between the groups during mild to moderate sedation status (OAA/S 3–5). During deep sedation (OAA/S 1–2), the BIS score in the midazolam group was significantly higher than that in the propofol and dexmedetomidine groups (74.4 ± 11.9 vs 67.7 ±  9.5 vs 62.6 ± 12.2).

Conclusions

BIS values differed at the same level of sedation between different sedative agents. Objective sedation scores should therefore be used in combination with BIS values for the assessment of sedation levels during spinal anesthesia.
Treatment of serologically negative Sjögren’s syndrome with tacrolimus: A case report
Authors: Pan Xiaoli , Huang Fei , Pan Zhijun , Tian Mei
Published: December 2019

We herein report an unusual case of primary Sjögren’s syndrome in a 38-year-old woman with typical clinical symptoms (joint pain, dry mouth, and positive Schirmer test) and immunoglobulin G positivity but negativity for antinuclear antibody and all antinuclear antibody spectrum antibodies. Emission computed tomography demonstrated normal ingestion but impaired secretion by the submandibular and bilateral parotid glands. Labial gland biopsy revealed chronic tissue inflammatory changes and Chisholm grade 4 lymphocyte infiltration, confirming primary Sjögren’s syndrome. The patient’s condition was successfully controlled by nonsteroidal treatment with tacrolimus. Patients presenting with chronic dry mouth should be examined by a Schirmer test, lip gland biopsy, and salivary gland emission computed tomography for possible Sjögren’s syndrome, even if serological autoantibodies are negative, to facilitate early intervention. Tacrolimus is a potential treatment option in patients intolerant of steroidal drugs.
Foundational biogeography: Vegetation of the Great Smoky Mountains (Ecological Monographs, 26: 1–80, 1956), by Robert H. Whittaker
Authors: Malanson George P , Peet Robert K
Published: December 2019

A seminal paper in biogeography is reviewed. Whittaker’s 1956 paper in Ecological Monographs introduced gradient analysis as a conceptual framework. This approach replaced community classification as the preferred methodology among US ecologists and biogeographers. It later developed into the foundation for species distribution modeling. Although the paper underlies a continuing rift between US and European scientists, both groups recognize its importance for relating ecological processes to geographical patterns.
Spinopelvic Characteristics in Acetabular Retroversion: Does Pelvic Tilt Change After Periacetabular Osteotomy?
Authors: Grammatopoulos George , Salih Saif , Beaule Paul E. , Witt Johan
Published: December 2019

Background:

Acetabular retroversion may lead to impingement and pain, which can be treated with an anteverting periacetabular osteotomy (aPAO). Pelvic tilt influences acetabular orientation; as pelvic tilt angle reduces, acetabular version reduces. Thus, acetabular retroversion may be a deformity secondary to abnormal pelvic tilt (functional retroversion) or an anatomic deformity of the acetabulum and the innominate bone (pelvic ring).

Purpose:

To (1) measure the spinopelvic morphology in patients with acetabular retroversion and (2) assess whether pelvic tilt changes after successful anteverting PAO (aPAO), thus testing whether preoperative pelvic tilt was compensatory.

Study Design:

Case series; Level of evidence, 4.

Methods:

A consecutive cohort of 48 hips (42 patients; 30 ± 7 years [mean ± SD]) with acetabular retroversion that underwent successful aPAO was studied. Spinopelvic morphology (pelvic tilt, pelvic incidence, anterior pelvic plane, and sacral slope) was measured from computed tomography scans including the sacral end plate in 21 patients, with adequate images. In addition, the change in pelvic tilt with aPAO was measured via the sacrofemoral-pubic angle with supine pelvic radiographs at an interval of 2.5 ± 2 years.

Results:

The spinopelvic characteristics included a pelvic tilt of 4° ± 4°, a sacral slope of 39° ± 9°, an anterior pelvic plane angle of 11° ± 5°, and a pelvic incidence of 42° ± 10°. Preoperative pelvic tilt was 4° ± 4° and did not change postoperatively (4° ± 4°) ( P = .676).

Conclusion:

Pelvic tilt in acetabular retroversion was within normal parameters, illustrating “normal” sagittal pelvic balance and values similar to those reported in the literature in healthy subjects. In addition, it did not change after aPAO. Thus, acetabular retroversion was not secondary to a maladaptive pelvic tilt (functional retroversion). Further work is required to assess whether retroversion is a reflection of a pelvic morphological abnormality rather than an isolated acetabular abnormality. Treatment of acetabular retroversion should focus on correcting the deformity rather than attempting to change the functional pelvic position.
Employee Perceptions of Wellness Programs and Incentives
Authors: Fink Jennifer , Zabawa Barbara , Chopp Sara
Published: December 2019

Purpose:

To explore, by income level, employee perceptions of an employer offered wellness incentive program.

Design:

Qualitative and quantitative study that includes a survey with close-ended and open-ended questions.

Setting:

The study setting was a hospital in Wisconsin.

Participants:

Participants (n = 105).

Measures and Analysis:

Quantitative responses were analyzed using descriptive statistics in Qualtrics and logistic regression in Statistical Analysis System.

Results:

Sixty-three percent participated in the wellness incentivized program because their employer offers them a reward; 52% said they would participate without a reward; 48% feel like they must participate in this year’s program; and 34% feel like they would have to disclose information about their health at or below the current reward level.

Conclusion:

Income does not have a significant effect on whether employees feel they must participate or disclose health information. However, income has a significant effect on employee’s beliefs about whether or not employers should play an active role in improving the health of their employees.
Racial and Ethnic Differences in Response to Anticoagulation: A Review of the Literature
Authors: Gibson Caitlin M. , Yuet Wei C.
Published: December 2019

Introduction:

Anticoagulants are among the most frequently prescribed medications in the United States. Racial and ethnic disparities in incidence and outcomes of thrombotic disorders are well-documented, but differences in response to anticoagulation are incompletely understood.

Objective:

The objective of this review is to describe the impact of race and ethnicity on surrogate and clinical end points related to anticoagulation and discuss racial or ethnic considerations for prescribing anticoagulants.

Methods:

A PubMed and MEDLINE search of clinical trials published between 1950 and May 2018 was conducted using search terms related to anticoagulation, specific anticoagulant drugs, race, and ethnicity. References of identified studies were also reviewed. English-language human studies on safety or efficacy of anticoagulants reporting data for different races or ethnicities were eligible for inclusion.

Results:

Seventeen relevant studies were identified. The majority of major trials reviewed for inclusion either did not include representative populations or did not report on the racial breakdown of participants. Racial differences in pharmacokinetics, dosing requirements, drug response, and/or safety end points were identified for unfractionated heparin, enoxaparin, argatroban, warfarin, rivaroxaban, and edoxaban.

Conclusions:

Race appears to influence drug concentrations, dosing, or safety for some but not all direct oral anticoagulants. This information should be considered when selecting anticoagulant therapy for nonwhite individuals.
Phenytoin-Induced Paradoxical Seizures and Blood Dyscrasias in a Patient Receiving Rapid Intravenous Infusion: A Case Report
Authors: Sudarsan Pooja , Varghese Resia , Suresh Aneena , Radhakrishnan Arun
Published: December 2019

Paradoxical seizure is an unusual reaction of seizure aggravation or change in its pattern due to antiepileptics. Decrease in seizure threshold with phenytoin is bound to occur with an increase in serum levels. We herein report a 51-year-old female, who was brought to the intensive care unit with complaints of episodic seizures and frothing. She is a known case of tonic–clonic epilepsy on oral phenytoin 100 mg for past 6 months. Rapid intravenous infusion of 700 mg phenytoin in 100 mL normal saline over a rate of 15 minutes was initiated on admission. This was followed by a sudden abnormality of her baseline blood parameters and an occurrence of paradoxical seizure. The dose of phenytoin was tapered which reversed her condition. The patient was followed up regularly and monitored for fluctuations in her hematological parameters. The mainstay treatment for phenytoin-induced paradoxical seizure and blood dyscrasias is to monitor the patient and dose titration. Dosing of phenytoin remains a challenge for all clinicians which increase the need for such reports.
Integrating technology into the learning process of higher education: A creative inquiry
Authors: Wieser Desiree
Published: December 2019

Previous studies have attempted to examine and explain the integration of technology into the learning process. Most of these studies are related to the disciplines of pedagogy and informatics. The rest of the relevant literature cannot be definitively assigned to one discipline, but is often located at the intersection with the field of management. Taking a creative inquiry approach to analyzing this body of literature, the following key issues have been identified as of major relevance for future research. First, we must further explore what kind of influence the organizational culture of higher education institutions (HEIs) has on the strategy and implementation of integrating technology into the learning process. Second, we need to determine whether the integration of technology into the learning process at HEIs has the potential to support organizational development (mission, etc.) and/or adaptation, and whether an entrepreneurial culture could foster this potential.
Modernizing Conceptions of Valuation and Cognitive-Control Deployment in Adolescent Risk Taking
Authors: Do Kathy T. , Sharp Paul B. , Telzer Eva H.
Published: December 2019

Heightened risk taking in adolescence has long been attributed to valuation systems overwhelming the deployment of cognitive control. However, this explanation of why adolescents engage in risk taking is insufficient given increasing evidence that risk-taking behavior can be strategic and involve elevated cognitive control. We argue that applying the expected-value-of-control computational model to adolescent risk taking can clarify under what conditions control is elevated or diminished during risky decision-making. Through this lens, we review research examining when adolescent risk taking might be due to—rather than a failure of—effective cognitive control and suggest compelling ways to test such hypotheses. This effort can resolve when risk taking arises from an immaturity of the control system itself, as opposed to arising from differences in what adolescents value relative to adults. It can also identify promising avenues for channeling cognitive control toward adaptive outcomes in adolescence.
Influence of preanalytic and analytic variables in canine and feline urine specific gravity measurement by refractometer
Authors: Mösch Martina , Reese Sven , Weber Karin , Hartmann Katrin , Dorsch Roswitha
Published: December 2019

Urine specific gravity (USG), which is usually measured by refractometry, is an important indicator of renal concentrating ability. Few studies have evaluated refractometers with separate scales for canine and feline urine. Variables such as protein content or storage time may influence the USG. We compared the effects of measuring USG with a refractometer with single or separate scales for canine and feline urine, investigated inter- and intra-observer variability, and measured agreement between whole urine and supernatant. We evaluated the correlation between USG and osmolality, the influence of urinary protein on USG and osmolality, and the impact of storage time up to 6 mo. We examined 252 canine and 126 feline samples. Bland–Altman analysis revealed higher USG values of the single-scale refractometer than the dual-scale refractometer, with a mean difference (bias) of < 0.001 for canine and 0.003 for feline specimens. Inter- and intra-observer variability were acceptable. Good agreement was shown between USG of whole urine and supernatant. Correlations between USG and osmolality were excellent (0.98–0.99, p < 0.001). Proteinuria up to 1 g/L had no major impact on USG or osmolality. Storage time had no significant effect on USG. The difference between the refractometers is clinically irrelevant, and the use of a refractometer with separate feline and canine scales is unnecessary. Whole urine and supernatant stored up to 6 mo can both be used for USG measurement. The influence of proteinuria <1 g/L on USG and osmolality is negligible.
Psychological Distress and Social Support Availability in Different Family Caregivers of Latinas With Breast Cancer
Authors: Segrin Chris , Badger Terry , Sikorskii Alla
Published: December 2019

Introduction: Latinas with breast cancer draw on a diverse range of family members for informal care. Latin cultures typically prescribe high levels of support and care for an ill family member that leave caregivers vulnerable to compromised well-being. Method: In this cross-sectional survey study, 258 family caregivers of Latinas with breast cancer completed reports of psychological distress, availability of social support, and acculturation. Results: Mothers who provide care to a daughter with breast cancer experience higher levels of psychological distress and report lower availability of informational support than most other types of family caregivers. Mothers’ lower levels of acculturation may at least partially explain these reductions in well-being. Discussion: This study highlights the diverse range of family and fictive kin who participate in family caregiving for Latina breast cancer survivors. Spousal caregivers may not represent a unique population, whereas mothers as caregivers are indeed distinct for their higher distress levels.
Long-Term Management and Maxillofacial Growth in a Klippel-Trenaunay Syndrome Patient
Authors: Ogawa Takuya , Cheng Eric Shih-Wei , Muramoto Keiko , Moriyama Keiji
Published: December 2019

Klippel-Trenaunay syndrome (KTS) is a congenital disorder associated with capillary, venous, lymphatic vascular malformations, and unilateral hypertrophy of the soft tissue and bone. We report a case of a 5-year-old girl with KTS who was followed up until age 17. The asymmetry of her maxillary dentition became remarkable with growth, although no significant left-right difference in either the maxilla or mandible was recognized. Acceptable occlusion was achieved without fixed orthodontic appliances; however, it was necessary to develop treatment plans in accordance with the general symptoms of the disease.
Congenital Lateral Palatal Synechia Associated With Cleft Palate: A Case Report With Long-Term Follow-Up and Review of the Literature
Authors: Imai Yoshimichi , Tachi Masahiro
Published: December 2019

Lateral palatal synechiae are rare congenital adhesions running from the free borders of the cleft palate to the lateral parts of the tongue or the oral cavity floor, typically found in cleft palate lateral synechiae syndrome. We present a case of congenital lateral palatal synechia associated with a cleft palate that we treated and followed up for 10 years. We present the long-term prognosis. We also discuss variations in intraoral synechiae associated with cleft palate and the etiology of lateral palatal synechiae through a literature review.
Differences in Intensive Parenting Attitudes and Gender Norms Among U.S. Mothers
Authors: Forbes Lisa K. , Donovan Courtney , Lamar Margaret R.
Published: December 2019

Motherhood is a time of significant change for a woman. Once a woman enters motherhood, she must then navigate her mothering role within the societal expectation of intensive mothering. Intensive mothering prescribes the right way to be a mother which places unrealistic standards on mothers, which can lead to negative emotional reactions. A better understanding of intensive mothering may aid in mothers’ ability to navigate the unrealistic expectations. This study sampled 525 mothers within the United States and provided insight regarding differences in intensive parenting attitudes across various demographic characteristics. The findings demonstrate differences in intensive parenting attitudes across some mother characteristics; however, there were no differences found across many characteristics indicating the pervasiveness of intensive mothering beliefs among women regardless of their personal characteristics.
Osteopontin Levels in Patients With Chronic Kidney Disease Stage 5 on Hemodialysis Directly Correlate With Intact Parathyroid Hormone and Alkaline Phosphatase
Authors: Druck Aleksander , Patel Dimpi , Bansal Vinod , Hoppensteadt Debra , Fareed Jawed
Published: December 2019

Chronic kidney disease stage 5 (CKD5) marks the fifth stage of renal failure, frequently causing dysregulation of bone and mineral metabolism. Challenges exist in evaluating and managing chronic kidney disease–mineral bone disorder (CKD-MBD) with the standard panel of biomarkers. Our objective was to profile osteopontin (OPN) in patients with CKD5 on maintenance hemodialysis (CKD5-HD) and elucidate its relationship to phosphorus (P), calcium (Ca2+), alkaline phosphatase (AP), and intact parathyroid hormone (iPTH) to improve understanding of the present model of CKD-MBD. Elevation of plasma OPN was seen in the CKD5-HD cohort (n = 92; median: 240.25 ng/mL, interquartile range [IQR]: 169.85 ng/mL) compared to a normal group (n = 49; median: 63.30 ng/mL, IQR: 19.20 ng/mL; p < .0001). Spearman correlation tests revealed significant positive correlations of OPN with iPTH ( p < .0001; r = 0.561, 95% confidence interval = 0.397-0.690) and OPN with AP ( p < .0001; r = 0.444, 95% confidence interval = 0.245-0.590) in CKD5-HD patients. Ultimately, OPN may play an integral role in the MBD axis, suggesting that it may be important to actively monitor OPN when managing CKD5-HD.
Presence of toxigenic Clostridioides (Clostridium) difficile in edible bivalve mollusks in Spain
Authors: Candel-Pérez Carmen , Zapata-Galián Elvira , López-Nicolás Ruben , Ros-Berruezo Gaspar , Martínez-Graciá Carmen
Published: December 2019

Clostridioides difficile reservoirs other than humans are becoming increasingly recognized, and the occurrence of the pathogen in shellfish raises concern because spores can survive cooking temperature and edible bivalve mollusks are often consumed raw or poorly cooked. This study was conducted to determine the occurrence of pathogenic C. difficile in retail bivalve mollusks. The microbiological quality of samples was also checked through the isolation of Salmonella spp. and Escherichia coli. We analyzed 129 mollusk samples from different fishmongers and grocery stores in Murcia. C. difficile was isolated from 8.53% (11/129) of the mollusks investigated. Four C. difficile isolates harbored genes for the production of toxin A and B. Salmonella spp . were not isolated from any sample and E. coli was isolated from 1.55% (2/129) of the samples, in both cases in accordance with the current legal requirements for consumption. Our findings indicate that the intake of raw or poorly cooked contaminated bivalve mollusks could be a potential source of C. difficile, leading to a risk for human health.
Cannulation of the superficial femoral vein at mid-thigh when catheterization of the superior vena cava system is contraindicated
Authors: Zhao Linfang , Cao Xiuzhu , Wang Yapping
Published: December 2019

Purpose:

Patients needing medium- to long-term infusion therapy with limited catheterization via the superior vena cava system is a challenging condition. The conventional catheterization via the femoral vein in the groin has a high complication rate, discomfort, and short indwelling time. Since changing the insertion site can avoid the disadvantage of conventional catheterization via the femoral vein in the groin, the present study aimed to investigate the effects of femoral inserted central catheters insertion via the superficial femoral vein at the mid-thigh to resolve the issue of limited superior vena cava system catheterization.

Methods:

Based on the symptoms and signs, enhanced computed tomography findings, and insertion history, in 121 patients, limited catheterization via the superior vena cava system was identified. Subsequently, the femoral inserted central catheters were inserted via the superficial femoral vein at the mid-thigh under the guidance of ultrasound, and the tip of femoral inserted central catheters was in the inferior vena cava.

Results:

A total of 121 patients underwent femoral inserted central catheters insertion via a superficial femoral vein at the mid-thigh from August 2017 to December 2018. The success rate of insertion was 100%, and the indwelling time was 3–472 days. The complications of femoral inserted central catheters in the thigh were similar to that of peripherally inserted central catheters in the arm. The incidence of primary malposition was 1.65%, the incidence of catheter-related thrombosis was 0.83%, and the central line associated bloodstream infection rate was 0.83%. Subsequently, 116 lines (95.87%) were removed at the end of the treatment, one line (0.83%) was accidentally removed by the patient, and four lines (3.31%) were unplanned removed due to complications.

Conclusion:

The technique of femoral inserted central catheters insertion via the superficial femoral vein at the mid-thigh has a high success rate, low complication rate, and less impact on activities, and is easy to maintain. This phenomenon resolves the patient’s needs of medium- to long-term infusion therapy with limited catheterization of superior vena cava system.
Induction of tryptophan 2,3-dioxygenase expression in human monocytic leukemia/lymphoma cell lines THP-1 and U937
Authors: Hoffmann Delia , Pilotte Luc , Stroobant Vincent , Van den Eynde Benoit J
Published: December 2019

Tumor-associated macrophages are immune cells with diverse functions in tumor development. Among other functions, they downregulate immune-mediated tumor rejection by depriving lymphocytes of nutrients. The essential amino acid tryptophan is metabolized by the enzymes indoleamine 2,3-dioxygenase 1 and tryptophan 2,3-dioxygenase (TDO). Indoleamine 2,3-dioxygenase 1 is expressed in a large number of human tumors, and inhibitors are in development to improve immunotherapy. Tryptophan 2,3-dioxygenase was also found in human tumors and preclinical working models confirmed its immunosuppressive power. We explored a potential expression of TDO by macrophages. This enzyme could be induced in two human cell lines, THP-1 and U937, by incubation with phorbol myristate acetate, lipopolysaccharide, and interferon gamma. Phorbol-myristate-acetate-mediated induction was inhibited by rottlerin, a protein kinase C inhibitor. In contrast to these monocytic cell lines, other cell lines or fresh human monocytes isolated from peripheral blood mononuclear cells and differentiated into proinflammatory or anti-inflammatory macrophages could not be induced to express TDO. Our results suggest that TDO might play an immunosuppressive role in human monocytic leukemias but not in untransformed macrophages.
When ‘we’ are the alien forces: Misremembering the Conquest of America through the ‘Triumph over alien forces’ schematic narrative template
Authors: Lopez Cesar
Published: December 2019

National narratives about the past play a central role in the construction of collective memory and national identity. Drawing on Wertsch’s notion of a schematic narrative template, the purpose of this article is to explore how Spanish university students’ narratives of the Conquest of America and the Latin American independence processes are informed by the ‘triumph over alien forces’ general scheme. The author proposes that this particular scheme mediates the misremembering of these foundational events while supporting key features of national narratives, such as the naturalized nature of the nation and national identity and the nation’s bond with a natural territory. Using a qualitative analysis, students’ narratives were confronted with the ‘triumph over alien forces’ plot. The results indicate that most students’ narratives conformed to the ‘triumph over alien forces’ scheme, misleading their understanding of the past. The article concludes with a discussion of the implications of the powerful presence of this scheme for developing collective memory and its impact in hindering historical understanding.
Understanding Tradition: Marital Name Change in Britain and Norway
Authors: Duncan Simon , Ellingsæter Anne Lise , Carter Julia
Published: December 2019

Marital surname change is a striking example of the survival of tradition. A practice emerging from patriarchal history has become embedded in an age of detraditionalisation and women’s emancipation. Is the tradition of women’s marital name change just some sort of inertia or drag, which will slowly disappear as modernity progresses, or does this tradition fulfil more contemporary roles? Are women and men just dupes to tradition, or alternatively do they use tradition to further their aims? We examine how different approaches – individualisation theory, new institutionalism, and bricolage – might tackle these questions. This examination is set within a comparative analysis of marital surname change in Britain and Norway, using small qualitative samples. We find that while individualisation and new institutionalism offer partial explanations, bricolage offers a more adaptable viewpoint.
Police retention and storage of evidence in England and Wales
Authors: McCartney Carole , Shorter Louise
Published: December 2019

Central to the operation of the appellate system, is the ability of individuals who claim that their conviction is in error, to revisit and re-examine evidence gathered during the investigation, as well as that relied upon at their trial. High-profile miscarriages of justice have often only been remedied when there has been defence access to materials post conviction. There is also an imperative for forces to retain evidence in investigations in which no perpetrator has been detected or convicted, to facilitate cold case reviews. In order to give effect then to an appellate system and enable cold case reviews, evidence needs to be retained and properly stored. If materials are not retained and stored correctly, then re-investigations are rendered impossible. Retention is especially critical in respect of physical materials that could be subject to forensic examination. With the progress of science and technology, and the interpretation of results, it is essential that such physical (and now, often digital) materials are retained for future (re)evaluation. From analysis of responses to a Freedom of Information request to all police forces in England and Wales, and qualitative interviews with criminal justice stakeholders, this article examines the retention and storage of materials, and considers the operation and future of the Forensic Archive Ltd. It details a worrying picture of inconsistency, with confusion over what should be retained, and how. It concludes that justice demands that we accept that the proper retention and storage of materials is fundamental to the fair and effective operation of our criminal justice system, and ensures that the Court of Appeal can fulfil its remit in addressing wrongful convictions and forces can pursue justice in cold cases.
‘… This is my home and my neighbourhood with my very good and not so good memories’: The story of autobiographical place-making and a recent life with dementia
Authors: Calvert Lesley , Keady John , Khetani Beena , Riley Cathy ,   Open Doors Research Group, Swarbrick Caroline
Published: December 2019

As part of the wider Neighbourhoods and Dementia Study, co-researchers from the Open Doors Research Group (based in Salford, UK) produced a series of three films with the title ‘The Changing Face of our Neighbourhood’. These films were subsequently placed on ‘YouTube’ and document co-researchers’ storied experiences of Salford and the industrial, economic and social changes that have occurred over the inquiry group’s lifetime. Drawn directly from this autobiographical and socio-generational work, this article focuses on the experience of lead author Lesley Calvert, who was diagnosed with dementia in 2013 and has been a member of the Open Doors Research Group since 2014. Lesley grew up and worked as a district nurse for almost 40 years, remaining close to her place of birth in Salford all her life. In this article, Lesley draws upon her autobiographical narrative which she shares in the three films to describe the intersections between biography, place-making, belonging and dementia. The article concludes with the importance of democratising the research space and why academic researchers need to create opportunities for personal stories to be told, heard and acted upon.
Rubber–rubber blends: A critical review
Authors: Vayyaprontavida Kaliyathan Abitha , Varghese KM , Nair A Sreekumaran , Thomas Sabu
Published: December 2019

The blending of different rubbers is one of the effective methods to achieve required performance properties in their final products. This article reviews the thermodynamic considerations of rubber–rubber blends and their filled systems. Factors affecting the rubber blend morphology (i.e. distribution mechanism of fillers, curatives and other compounding ingredients) and preparation techniques for rubber–rubber blends emphasizing their advantages and disadvantages are well discussed in this review. Microscopy is the field of interest to all material scientists. In the case of rubber blends, microscopy is an essential tool in order to understand the morphology, that is, size, shape and distribution of phases and filler particles in the rubber–rubber blend. In this review, selected scientific reports based on optical microscopy, electron microscopy and atomic force microscopy in rubber–rubber blends are discussed. Rubber material is a complex macromolecule; it has significant proportion of fillers, processing aids and curing agents; therefore, only a very few studies have been reported on the microscopic aspects of filled rubber–rubber blends. In particular, influence of rubber blend composition, fillers (micro and nano length scales) and processing additives on the morphology of rubber blends systems has not been systematically reviewed and discussed in the scientific literature. Therefore, in the present scenario, this review was thought of, which deals with the essential background to rubber–rubber blends, miscibility and morphological characterization of various rubber blend systems by microscopy. It is very important to add that although there is scattered information on these aspects in the scientific literature, to date a comprehensive review has not been published. The pros, cons, artefacts and the new challenges on the use of microscopy for the characterization of rubber–rubber blends are also discussed here.
Health Disparities and the Heterogeneity of Blacks/African Americans in the United States: Why Should We Care?
Authors: Amuta-Jimenez Ann Oyare , Jacobs Wura , Smith Gabrielle
Published: December 2019

Each year, millions of dollars are spent on research and public health interventions targeted toward reducing health disparities primarily among the “Black/African Americans” community, yet the progress made lags far behind the amount of money and effort spent. We hypothesize that part of the problem is that sociocultural factors play a significant role in disease prevention. Most studies and programs aggregate “Black immigrants” (BIs) and “African Americans” (AAs) as “Black/African American.” This categorization assumes that the sociocultural determinants that influence BIs are the same as for AAs. BIs have health and mortality profiles that vary from AAs. This commentary aims to (1) introduce this idea in more depth and provide a brief scope of the problem, (2) provide scientific evidence of noteworthy differences between AAs and BIs in areas of sociodemographics, health behaviors, and health outcomes, (3) discuss implications of considering the Black/AA group as homogeneous and provide recommendations for disaggregation.
Memory Decline Following Epilepsy Surgery: Can We Predict Who Will Pay the Price?
Authors: Barr William B
Published: December 2019

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Minimally Invasive Aortic Valve Replacement with Sutureless Valves: Results From an International Prospective Registry
Authors: Glauber Mattia , Di Bacco Lorenzo , Cuenca Jose , Di Bartolomeo Roberto , Baghai Max , Zakova Daniela , Fischlein Theodor , Troise Giovanni , Viganò Giorgio , Solinas Marco
Published: December 2019

Objective

To report the early and mid-term results of patients who underwent minimally invasive aortic valve replacement (MI-AVR) with a sutureless prosthesis from an international prospective registry.

Methods

Between March 2011 and September 2018, among 957 patients included in the prospective observational SURE-AVR (Sorin Universal REgistry on Aortic Valve Replacement) registry, 480 patients underwent MI-AVR with self-expandable Perceval aortic bioprosthesis (LivaNova PLC, London, UK) in 29 international institutions through either minithoracotomy ( n = 266) or ministernotomy ( n = 214). Postoperative, follow-up, and echocardiographic outcomes were analyzed for all patients.

Results

Patient age was 76.1 ± 7.1 years; 64.4% were female. Median EuroSCORE I was 7.9% (interquartile range [IQR], 4.8 to 10.9). Median cardiopulmonary bypass and cross-clamp times were 81 minutes (IQR 64 to 100) and 51 minutes (IQR 40 to 63). First successful implantation was achieved in 97.9% of cases. Two in-hospital deaths occurred, 1 for noncardiovascular causes and 1 following a disabling stroke. In the early (≤30 days) period, stroke rate was 1.4%. Three early explants were reported: 2 due to nonstructural valve dysfunction (NSVD) and 1 for malpositioning. One mild and 1 moderate paravalvular leak were reported. In 16 patients (3.3%) pacemaker implantation was needed. Mean follow-up was 2.4 years (maximum = 7 years). During follow-up 5 explants were reported, 3 due to endocarditis and 2 due to NSVD. Follow-up stroke rate was 2.5%. Three structural valve deteriorations not requiring reintervention were reported. Five-year survival was 91.45%.

Conclusions

In this large prospective international registry, MI-AVR with Perceval valve confirmed to be safe, reproducible, and effective in an intermediate-risk population, providing excellent clinical recovery both in early and mid-term follow-up.
Acute Hepatitis A Outbreak Among Men Who Have Sex With Men in Krakow, Poland; February 2017–February 2018
Authors: Raczyńska Aleksandra , Wickramasuriya Nimmi Nimesha , Kalinowska-Nowak Anna , Garlicki Aleksander , Bociąga-Jasik Monika
Published: December 2019

Since February 2017 in Poland, an increasing number of acute hepatitis A (AHA) cases have been reported; a noteworthy increase to 3,072 cases of AHA in 2017 compared to 35 cases in 2016 was reported by the National Institute of Public Health (NIPH). The aim of this study was to evaluate the demographic features, clinical manifestations, laboratory results, and sexually transmitted coinfections. All cases of AHA diagnosed between February 2017 and February 2018 at the University Hospital in Krakow were analyzed. A total of 119 cases of hepatitis A virus (HAV) were reported; 105 (88%) were males and 14 (12%) were females, with a mean age 31 years (range 19–62). In 84 patients (71%), the HAV was transmitted by oral–anal sexual contact between men. Six women were infected by close house contact with men infected with HAV. The route of transmission was not identified for 29 cases, and 88 patients (74%) required hospitalization. Among the cases, the following coinfections were already diagnosed: HIV 36 patients (30%), chronic hepatitis C virus (HCV) 4 patients (3%), and chronic hepatitis B virus (HBV) 2 patients (1.5%). During AHA diagnosis, some new sexually transmitted infections (STIs) were detected; syphilis eight patients (6.7%), HIV/syphilis seven patients (6%), HIV//HCV/syphilis one patient, and acute retroviral syndrome/ Shigella flexneri one patient. Overall, AHA outbreak in Poland in 2017 affected primarily men who have sex with men (MSM) and was connected with oral–anal sexual contacts, and the majority of patients did not have HAV vaccination. These results show a clear need for routinely offering HAV vaccination to at-risk populations and that awareness among health-care workers about HAV sexual transmission may help introduce prevention methods.
Quantitative Evaluation of Hormesis in Breast Cancer Using Histoculture Drug Response Assay
Authors: Aoishi Yuka , Yoshimasu Tatsuya , Oura Shoji , Kawago Mitsumasa , Hirai Yoshimitsu , Miyasaka Miwako , Ohashi Takuya , Nishimura Yoshiharu
Published: December 2019

Purpose:

Hormesis is a phenomenon of growth stimulation at low doses and inhibition at higher doses. In cancer treatment, little is known about how hormesis affects cancer cell proliferation. We evaluated the hormetic dose–response relationship of paclitaxel using surgically resected breast cancer specimens on the basis of histoculture drug response assay (HDRA).

Methods:

We used surgically resected fresh tumor specimens from 22 patients with breast cancer: 17 invasive ductal, 3 mucinous, and 2 other “special-type” cancers. All patients were female, ranging in age between 40 and 86 (median 60) years. Small pieces of viable cancer tissue were placed on collagen gel and cultured for 7 days with paclitaxel. Inhibition rates of paclitaxel at several concentrations were measured and fitted to a sigmoid dose–response curve.

Results:

Hormesis was observed in 9 of the 22 cases; ED50 of cytotoxic effect was significantly higher ( P = .0036) in hormesis (H) group (44.6 ± 4.2 µg/mL) than in nonhormesis (N) group (26.7 ± 3.5 μg/mL).

Conclusion:

We evaluated hormesis in breast cancer tissue using HDRA for the first time although previously confirmed in cultured cells. Hormesis seems to occur in patients undergoing treatment with anticancer agents, especially in a metastatic setting. Meanwhile, tumor growth may be stimulated in patients who are resistant to paclitaxel.
Comparison of managerial competence of Indonesian first-line nurse managers: a two-generational analysis
Authors: Gunawan Joko , Aungsuroch Yupin , Fisher Mary L , McDaniel Anna M
Published: December 2019

Background

Much research provides evidence that four age groups or generations of nurse managers exist, and it is assumed that they work and act differently according to each generation’s characteristics and attitudes, which may influence their managerial competence.

Aims

To compare first-line nurse managers’ managerial competence according to generational analysis across public hospitals in Indonesia.

Methods

This study employed a cross-sectional survey in 18 public hospitals in Indonesia with 254 first-line nurse managers selected using simple random sampling. The Indonesian First-Line Nurse Managers Managerial Competence Scale (IFLNMMCS) was used to measure managerial competence. Data were analysed using descriptive analyses using means, standard deviations and independent t-test.

Results

There was no significant difference in the total score of managerial competence of Generation X and Millennial first-line nurse managers ( p = 0.077). Of five dimensions of managerial competence, only applying quality care improvement ( p = 0.028) and financial management ( p = 0.013) were significantly different, while leadership ( p = 0.142), facilitating spiritual nursing care ( p = 0.353), self-management ( p = 0.130), staffing and professional development ( p = 0.068) and utilizing informatics ( p = 0.304) were not significantly different.

Conclusion

This study serves as a foundation for better human resource management, education and professional development for first-line nurse managers among public hospitals in Indonesia.
Health Care Provider Knowledge and Perceptions of FDA-Approved and Do-It-Yourself Automated Insulin Delivery
Authors: Murray James A. , Clayton Margaret F. , Litchman Michelle L.
Published: December 2019

Background:

Automated insulin delivery (AID) technology may reduce variability in blood glucose, resulting in lower risk for hypoglycemia and associated complications, and by extension improve quality of life. While clinical trials, research, and patient experience have consistently demonstrated the value of AID, this technology is still inaccessible to many patients. Patient-driven innovation has resulted in alternative do-it-yourself (DIY) solutions to available off-the-shelf AID devices.

Method:

This two-phase cross-sectional observational study addressed health care provider (HCP) perceptions of AID as well as the perceived need for, development of, and evaluation of an AID fact sheet comparing the most commonly used Federal Drug Administration approved AID and DIY AID devices.

Results:

Negative attitudes toward the use of DIY AID were low. The majority of HCPs saw their lack of knowledge about how DIY AID work to be the greatest barrier to answering patient questions about what is available (74.4%). Additionally, the majority of HCPs (64.5%) indicated they were either “likely” or “very likely” to use the fact sheet when answering patient questions about AID options.

Conclusion:

Increased awareness and utilization of AID technology offer hope to further reduce the burden of diabetes, but there is a need to bridge the knowledge gap about DIY AID. A fact sheet provides a way to facilitate discussions of this emerging technology between HCPs and patients. Next steps could investigate additional ways to put needed information in the hands of HCPs.
Magnitude Matters: Art Image Size and Waiting Time Impact Perceived Quality of Care
Authors: Devlin Ann Sloan , Anderson Alaina , Hession-Kunz Sarah , Kelly Margaret , Noble Lilly , Zou Amy
Published: December 2019

Objective:

The study fills a gap in the literature by examining the size of the art displayed and waiting time in an exam office on patients’ judgments of the quality of care they are likely to receive.

Background:

A body of research shows that the content of art in healthcare settings has an impact on patients’ well-being, yet no work has empirically systematically examined the size of the art displayed on perceived healthcare outcomes.

Method:

A fully crossed 4 ×2 between-subjects experimental design examined the impact of exposure to images in an outpatient exam room that varied in the size of what was displayed (a landscape scene: small, medium, large, and control—blank wall) crossed by the time waiting for the physician (10 vs. 45 min). The Dependent Variables were the reported anxiety and various measures of satisfaction with the healthcare visit.

Results:

The size of the art had a significant effect on the majority of the dependent variables; specifically, the large image had a more positive impact than the other sizes; longer waits were also negatively evaluated by patients and affected anxiety and judgments of room spaciousness.

Conclusions:

Identifying the recommended content of art displayed is necessary but not sufficient; the size of the art in its context has the potential to impact a range of important perceptions related to healthcare. When the size does not match the available wall space (i.e., the canonical size was not utilized), a variety of ratings of the healthcare environment (including the practitioner) were negatively affected.
Immunotherapy-induced endocrinopathies: assessment, management and monitoring
Authors: Nogueira Edson , Newsom-Davis Tom , Morganstein Daniel L.
Published: December 2019

Immunotherapy with checkpoint inhibitors has transformed the treatment of cancer, but frequently results in immune-mediated adverse events affecting multiple organs, amongst which endocrine adverse events are frequent. The patterns of endocrine adverse events differ between inhibitors of the CTLA-4 and PD-1/PD-L1 pathways, but most frequently involve the thyroid and pituitary with insulin deficient diabetes also emerging as an important adverse event. These frequently result in long-lasting hormone deficiency requiring replacement. This review explores the mechanism of action of checkpoint inhibitors and details the expected endocrine adverse events and typical presentations. The effect of high-dose glucocorticoids therapy to treat nonendocrine adverse events is also discussed.
Outcome after treatment of osteoarthritis with open-wedge high-tibial osteotomy with a plate: 2-year results of a Japanese cohort study
Authors: Sawaguchi Takeshi , Takeuchi Ryohei , Nakamura Ryuichi , Yonekura Akihiko , Akiyama Takenori , Kerstan Marta , Goldhahn Sabine
Published: December 2019

Purpose:

This prospective multicenter study evaluated patient reported outcomes (PROs) in individuals undergoing medial open-wedge high-tibial osteotomy (OWHTO) with plate stabilization compared to conservative care or no treatment.

Methods:

One hundred eighteen of 148 patients older than 40 years were elected for OWHTO with plate treatment. Thirty patients declined surgery and were followed as a conservative group. The primary outcome measure was the Knee Injury and Osteoarthritis Outcome Score (KOOS) at 2 years. Secondary measures included Oxford knee score, Western Ontario and McMaster Universities osteoarthritis index, range of motion (ROM), joint space width (JSW), femorotibial angle (FTA), and weight-bearing line ratio (WBLR).

Results:

Patient enrollment and baseline characteristics were heterogeneously distributed and led to group characteristics that were not comparable. Therefore, the comparison of the KOOS between the groups showing no differences must be treated with caution. In the OWHTO plate group, all PROs and the ROM significantly improved between baseline and 2-year follow-up. JSW remained stable in the OWHTO group. The FTA and WBLR significantly changed from a mean of 179.3 (95% confidence interval (CI): 178.7, 179.9) to 169.8 (95% CI: 169.2, 170.5) and from 23.1 (95% CI: 20.7, 25.5) to 62.4 (95% CI 59.0, 65.8), respectively. Treatment failure with conversion to total knee arthroplasty occurred in 1% of the OWHTO group; and in the conservative group, 10% converted to HTO or knee arthroplasty.

Conclusions:

OWHTO with plate leads to significant improvement of PROs and function 2 years after intervention and demonstrates reliable mechanical axis correction with subsequent shift of weight-bearing.