bluuebunny/crossref_metadata_2025 huggingface dataset:
Valsalva maneuver techniques for supraventricular tachycardias: Which and how?
Authors: Ekinci Salih , Akgül Gökçe , Arş Eda , Aydin Alp , Musalar Ekrem , Aktaş Can
Published: November 2017

Study objective:

While some research has been done on Valsalva maneuvers in treating supraventricular tachycardia, there is no standardized algorithm on which technique has been the most effective for the termination of supraventricular tachycardias. In this study, we compare different Valsalva maneuver techniques in order to determine the exact technique needed for maximal vagal response.

Methods:

This was a repeated measures clinical study, which enlisted a sample of healthy adult volunteers. Participants performed four different Valsalva maneuver techniques (40 mm Hg—10 s, 40 mm Hg—15 s, 50 mm Hg—10 s, and 50 mm Hg—15 s) while lying in a supine position. The maneuvers were repeated three times. An electrocardiography printout was obtained during each trial, and heart rate differences between pre-maneuver and post-maneuver were measured.

Results:

Among the 97 volunteers who participated in the study, 7 were excluded because the target Valsalva maneuver pressures were not reached, and 1 volunteer was excluded due to T-wave inversion that developed after Valsalva maneuver. We enrolled 89 participants. There was no significant difference in the heart rate decrease among the four techniques. In addition, there was no difference between the vagal responses in terms of age, gender, and body mass index.

Conclusion:

This study shows that the four different Valsalva maneuver techniques were not superior to one another in terms of decreased heart rate.
Burnout syndrome in emergency medicine
Authors: Ivanić Dubravka , Adam Višnja Nesek , Srzić Ivana , Stepić Anika , Pintarić Hrvoje
Published: November 2017

Background:

Occupational burnout syndrome generally develops in individuals of helping professions and is considered to result from long-standing stress. Burnout syndrome is characterized by loss of interest, fatigue, or frustration, the negative consequences of which affect the individual’s performance, thus being a major factor that influences the quality of work.

Objectives:

The aim of the study was to assess the existence of burnout syndrome in medical staff working at hospital emergency department.

Methods:

The study included 120 subjects working at emergency departments. The following two questionnaires were used: Copenhagen Burnout Inventory and Copenhagen Psychosocial Questionnaire. Likert scale was employed on scoring the answers offered in the questionnaires. Statistical analysis was performed using the exploratory factor analysis, analysis of variance, Bonferroni test, and Pearson correlation coefficient. The level of statistical significance was set at p < 0.05.

Results:

Study results revealed that the subjects suffer mostly from the symptoms of fatigue due to occupational burnout and exhaustion at the end of the day. The prevalence of burnout syndrome was highest among subjects with 11–15 years work in emergency department, while lower risk was recorded in those nurses and physicians who reported a higher level of social support, sense of community, and feedback information.

Conclusion:

Results of the study confirmed the existence of burnout syndrome in medical staff working at hospital emergency department, with the highest prevalence recorded in those working at this department for more than 11 years. The main burnout symptoms reported by study subjects were fatigue, exhaustion at the end of the day, and feeling that they were giving more than they were receiving in return. Burnout syndrome was found to be less common among those nurses and physicians who reported a higher level of social support, sense of community, and feedback information.
Improving social dialogue: What employers expect from employee representatives
Authors: Pender Erica Romero , Elgoibar Patricia , Munduate Lourdes , García Ana Belén , Euwema Martin C
Published: November 2017

The model of social dialogue within organisations between management and employees is facing unprecedented challenges, and changing rapidly. In this new context of labour relations, experiences and expectations of each other are key drivers for the primary parties to this social dialogue. There has been little systematic research investigating the conditions for constructive social dialogue, particularly when it comes to ‘soft factors’, such as perceived competences, trust, influence and conflict behaviours. Addressing these issues based on theories of conflict, trust and influence, this article investigates experiences and expectations of employee representatives on the part of human resource managers, their counterparts in social dialogue. The results of surveys conducted in 11 European countries indicate that, overall, employers found a model of structured dialogue with elected employee representatives useful. Furthermore, competences of employee representatives, cooperative conflict behaviours, informal relations and trust promoted the influence of employee representatives on organisational decision-making and the quality of these decisions. We discuss implications for different systems of industrial relations.
Knowledge, Skills, and Attitudes Regarding the Use of Medical Cannabis in the Hospice Population: An Educational Intervention
Authors: Mendoza Kelly S. , McPherson Mary Lynn
Published: November 2017

Background:

Currently, 28 states and the District of Columbia have legalized cannabis for medical use despite its remaining Schedule I federally. Benefits of medical cannabis (MC) have been demonstrated in nausea/vomiting associated with chemotherapy, cachexia associated with HIV/AIDS, and certain types of neuropathic pain. However, it is unclear how comfortable hospice providers are with the concept of MC.

Objective:

The aim of this study is to determine changes in knowledge, self-perceived skills, and attitudes (KSA) of hospice providers regarding MC after an online educational intervention.

Methods:

The educational intervention consisted of 3 learning modules covering information from 6 learning domains. Participants took a pre- and postcourse survey to assess changes in KSA. Participant demographics were analyzed using descriptive statistics. To detect any differences between pre- and postsurvey answers, a paired t test was used to reduce intersubject variability.

Results:

Attitudes about the importance of cannabis knowledge were overall positive and did not change significantly after the intervention (N = 94). Both self-perceived skills and knowledge increased significantly, with providers reporting more positive skills, and >75% of respondents answering questions correctly after the intervention. There was a significant difference in attitudes in all domains in the postsurvey between participants who have practiced in hospice <3 years or ≥4 years, but no difference in perceived skills or knowledge.

Conclusion:

Providers’ attitudes regarding the importance of MC knowledge were strong and the same before and after. Both the self-perception of skills and direct knowledge were significantly increased after the educational intervention.
Unexpected Survivors: Children With Life-Limiting Conditions of Uncertain Prognosis
Authors: Nageswaran Savithri , Hurst Anna , Radulovic Andrea
Published: November 2017

Objective:

Prognostication of survival is difficult in children with life-limiting illnesses because of the rarity of these conditions and technological advances improving survival. The objective of this article is to describe the characteristics of children with life-limiting illnesses who survived longer than the expectations of health-care providers.

Study Design:

This is a retrospective cohort study conducted in a tertiary-care children’s hospital in North Carolina. “Unexpected survivors,” defined as children who survived despite a prognosis of imminent death or significantly longer than prognosticated by health-care providers, were identified from among 349 children enrolled in a pediatric palliative care program between March 2008 and October 2012. Children’s clinical courses were followed until September 2015 or their death.

Results:

Eighteen (5%) children were identified as unexpected survivors; 17 (10 girls and 7 boys) were included. Congenital anomalies were the most common diagnoses. Neonatal intensive care unit was the most frequent setting of prognostication. Thirteen children used some form of medical technology at the time of prognostication. Eleven children received hospice services. Eight died during the observation period but survived significantly longer than expected (median survival time 1.5 years), and 9 survived beyond the observation period (median survival time 5.9 years).

Conclusions:

Unexpected survivors are a small group of children with life-limiting conditions. Clinicians should be aware of the possibility of prognostic inaccuracy, able to communicate prognostic uncertainty to parents, and engage supportive services when prognosticating poor survival. Prospective studies are needed to understand outcomes of children with life-limiting illnesses of uncertain prognosis.
Can National Culture Affect the Implementation of Common Sustainable Policies? A European Response
Authors: Lahuerta-Otero Eva , González-Bravo M. Isabel
Published: November 2017

Businesses and researchers are increasingly seeking to understand the drivers of sustainability. Several recent studies have highlighted the effects of cultural factors when assessing environmental practices. While there is considerable research on the topic, we aim to provide additional evidence on the effects of cultural factors on environmental performance across countries. We propose that cultural factors affect sustainability strategies, although they depend on specific environmental issues. Little attention has been paid to the individual performance indicators forming the well-known global Environmental Performance Indicator (EPI) score when evaluating environmental performance. We use those individual indicators to identify specific environmental country-strategies depending on cultural and economic factors. The empirical analysis uses a sample of 31 European countries belonging to the European Environmental Agency, as they present common and aligned environmental strategies. The results show that despite common European objectives, country-specific environmental policies differ depending on Hofstede’s cultural dimensions. We also confirm that economic and innovation factors play an important role in the implementation of countries’ environmental policies in areas such as Ecosystem Vitality, Environmental Health, and water and sanitation.
Psychometric Investigation of the Raven’s Colored Progressive Matrices Test in a Sample of Preschool Children
Authors: Lúcio Patrícia Silva , Cogo-Moreira Hugo , Puglisi Marina , Polanczyk Guilherme Vanoni , Little Todd D.
Published: November 2017

The present study investigated the psychometric properties of the Raven’s Colored Progressive Matrices (CPM) test in a sample of preschoolers from Brazil ( n = 582; age: mean = 57 months, SD = 7 months; 46% female). We investigated the plausibility of unidimensionality of the items (confirmatory factor analysis) and differential item functioning (DIF) for sex and age (multiple indicators multiple causes method). We tested four unidimensional models and the one with the best-fit index was a reduced form of the Raven’s CPM. The DIF analysis was carried out with the reduced form of the test. A few items presented DIF (two for sex and one for age), confirming that the Raven’s CPM items are mostly measurement invariant. There was no effect of sex on the general factor, but increasing age was associated with higher values of the g factor. Future research should indicate if the reduced form is suitable for evaluating the general ability of preschoolers.
Customer Inconvenience and Price Compensation
Authors: Andreassen Tor W. , van Oest Rutger D. , Lervik-Olsen Line
Published: November 2017

Managers are faced with complex decisions when considering automating the front end of a service, where the firm interacts with its customers (e.g., check-in at airports). We develop an analytical model for the optimal decisions as to whether to automate the service and which price to charge. The model accounts for automation-induced customer inconvenience in the short run and differences in service quality and production costs in the long run. We show that it may be optimal not to automate, even if automated service reduces production costs for the firm and is ultimately desired by customers. In other situations, automated service is optimal, even though customer inconvenience may trigger financial losses in the short run. Automated service may also become optimal, as customers become more sensitive to service quality, but only if the quality of the automation technology is sufficiently high. We show that the firm should compensate customers for automation-induced inconvenience, but this price compensation can be reduced as customers become more comfortable with the service. Although automated service is cheaper to produce than labor-produced service, the firm should charge a price premium if the quality of the automated service is sufficiently superior.
Methotrexate and Cardiovascular Protection: Current Evidence and Future Directions
Authors: Mangoni Arduino A , Zinellu Angelo , Sotgia Salvatore , Carru Ciriaco , Erre Gian Luca
Published: November 2017

Patients with autoimmune rheumatic conditions, particularly rheumatoid arthritis, have an increased cardiovascular risk when compared with the general population. Methotrexate is a relatively old, yet effective, immunomodulatory drug for the management of autoimmune and chronic inflammatory disorders, such as rheumatoid arthritis, particularly in terms of symptom control, quality of life, and disease progression. Recent meta-analyses have also shown that methotrexate treatment is associated with a lower risk of cardiovascular events when compared with other disease-modifying antirheumatic drugs. This suggests that methotrexate might exert specific protective effects against atherosclerosis and thrombosis. This mini-review discusses the mechanisms associated with the increased cardiovascular risk in rheumatoid arthritis, the pharmacokinetics and pharmacodynamics of methotrexate, the available evidence on the in vitro and in vivo effects of methotrexate on modifiable cardiovascular risk factors, and suggestions for future research directions.
The loss of macular ganglion cells begins from the early stages of disease and correlates with brain atrophy in multiple sclerosis patients
Authors: Pietroboni Anna M , Dell’Arti Laura , Caprioli Michela , Scarioni Marta , Carandini Tiziana , Arighi Andrea , Ghezzi Laura , Fumagalli Giorgio G , De Riz Milena A , Basilico Paola , Colombi Annalisa , Benatti Eleonora , Triulzi Fabio , Scarpini Elio , Viola Francesco , Galimberti Daniela
Published: November 2017

Background:

The importance of neurodegeneration in multiple sclerosis (MS) is increasingly well recognized.

Objectives:

To evaluate retinal pathology using optical coherence tomography (OCT) and to investigate possible associations between retinal layers’ thickness and specific patterns of gray matter volume in patients with a new diagnosis of MS.

Methods:

A total of 31 patients underwent OCT scans and brain magnetic resonance imaging. In total, 30 controls underwent the same OCT procedure. The association between focal cortical volume and OCT measurements was investigated with voxel-based morphometry (VBM).

Results:

Compared to controls, patients’ macular retinal nerve fiber layer (mRNFL), macular ganglion cell layer (mGCL), macular inner plexiform layer (mIPL), and macular ganglion cell-inner plexiform layer (mGCIPL) thickness were significantly reduced ( p = 0.0009, p = 0.0003, p = 0.0049, and p = 0.0007, respectively). Peripapillary RNFL (pRNFL) and temporal sector pRNFL (T-pRNFL) did not show any significant changes, although there was a trend toward T-pRNFL thinning ( p = 0.0254). VBM analysis showed that mGCIPL and pRNFL were significantly correlated with the volume reduction of occipital-parietal cortex ( p < 0.005).

Conclusion:

mRNFL, mGCL, and mIPL are significantly reduced in MS patients without concomitant pRNFL thinning. These retinal changes show a significant association with cortical regions that are known to be important for visuospatial performance.
The effect of cooperative high-intensity interval training on creativity and emotional intelligence in secondary school: A randomised controlled trial
Authors: Ruiz-Ariza Alberto , Suárez-Manzano Sara , López-Serrano Sebastián , Martínez-López Emilio J
Published: November 2017

Evidence suggests that moderate physical activity (PA) positively relates to creativity and emotional intelligence (EI) in adolescents. However, it is unknown whether cooperative PA (physical exercises in pairs or small groups to enhance motivation, self-efficacy, and pro-social behaviours), performed over less time but at higher intensity, could have similar effects within a school setting. The aim was to analyse the effect of cooperative high-intensity interval training (C-HIIT) on creativity and EI in adolescents aged 12–16 years, and whether improvement effects are different according to weekly PA level. A randomised controlled trial was conducted with a control group (CG, n = 94), which did static stretching, and an experimental group (EG, n = 90), which performed C-HIIT. Both groups performed the activity during 16 minutes at the beginning of physical education (PE) classes. Creativity was assessed with one factor, and EI through four factors (well-being, self-control, emotionality, and sociability). Age and body mass index (BMI) were used as confounders. Both were measured twice (baseline and after 12 weeks). The EG increased well-being and sociability factors after the C-HIIT programme (both p < 0.001). More specifically, inactive adolescents in the EG showed significant improvements in comparison to the CG in creativity, well-being, and sociability ( p = 0.028, p < 0.001, and p < 0.003, respectively). However, we did not find changes among active adolescents. A programme of C-HIIT in PE is a novel strategy to improve creativity and EI, especially in physically inactive adolescents. Starting PE classes with 16 minutes of C-HIIT could be recommended, independently of other activities planned for the session.
‘Leaving masculinity at the car door’: Dogging, de-subjectification and the pursuit of pleasure
Authors: Haywood Chris
Published: November 2017

This article provides an insight into the sexual world of ‘dogging’; that of anonymous sex between men, and between men and women, usually carried out in car parks. Drawing upon interviews with 12 men who engage in dogging behaviours, this article provides insights into the micro-negotiations of the dogging encounter and men’s masculine subjectivities. It argues that masculinity may have limited analytical purchase in the dogging encounter. Instead, it suggests that dogging provides a space for desubjectification where men’s subjectivities are configured in gendered ways that are not dependent on conventional models of masculinity.
‘I am Lenni’: Boys, sexualisation, and the dangerous colour pink
Authors: Vänskä Annamari
Published: November 2017

On 31 May 2015, a self-identified mother, Mari Niinikoski published an open post on Facebook. It was about her son, Lenni, and how adults constantly ridiculed him in various social situations for cross-dressing and for his interest in girly stuff and the colour pink. This article asks why it is a problem that a little boy likes pink and wants to wear a dress? Why is liking ‘girly stuff’ considered detrimental for boys? What is at stake – especially when the history of men and fashion indicates that skirts, dresses and pink were long part of a masculine wardrobe? When did skirts, dresses and pink become feminised and signs of deviant sexuality? To answer these questions, the article will address the question of fashion and sexuality, the history of skirts and dresses, the changing meanings of the colour pink, the problem of heteronormative childhood, and, lastly, the problem of hegemonic masculinity.
Fundamental mechanics that govern the flexural behaviour of reinforced concrete beams with fibre-reinforced concrete
Authors: Visintin Phillip , Oehlers Deric J
Published: November 2017

Tests on steel reinforced concrete beams made with fibre-reinforced concrete have shown many benefits over reinforced concrete beams made with conventional concrete, such as increased strengths and ductilities and reduced deflections and crack widths. There has been much empirical research on quantifying the tensile and compressive fibre-reinforced concrete material properties in particular those subsequent to tensile flexural cracking or sliding of compression wedges. However, it is quite difficult to incorporate these material properties in strain-based approaches as they cannot cope with the rigid body movements of cracking or sliding directly. In this article, a segmental displacement–based approach is described that can both incorporate all the measured material test results directly and also explain the fundamental mechanics that governs the flexural behaviour of reinforced concrete beams made with fibre-reinforced concrete. The approach is generic in that it can cope with any type, geometry and strength of fibre-reinforced concrete and any shape or size of beam. The approach is described in a form suitable for the development of a numerical model and is illustrated via comparison to a published test result.
On the aerodynamic characteristics of stay cables attached with helical wires
Authors: Li Shouying , Deng Yangchen , Zhong Wei , Chen Zhengqing
Published: November 2017

To investigate the aerodynamic characteristics of stay cables attached with helical wires, a series of wind tunnel tests and computational fluid dynamics simulations were both carried out on the smooth and helical-wire cable models. The diameters of helical wires include 2, 3, and 4 mm, and the distances between adjacent helical wires include 200, 300, and 600 mm. Pressure taps were uniformly arranged on seven cross sections of the cable models. First, wind tunnel tests including 50 test cases were conducted to measure the wind forces and wind pressures on the cables using the forced vibration system in HD-2 wind tunnel. The effects of the helical wires on the mean and fluctuating aerodynamic forces and the correlation coefficients along the cable axis were investigated in detail based on the experimental data. Second, large Eddy simulation module incorporated in software FLUENT® was used to simulate the aerodynamic forces on the smooth and helical-wire cables. The parameters of the cable and the helical wire are similar to those used in the wind tunnel tests. The results show that helical wires can attenuate vortex shedding and reduce the wind pressure correlation along the cable axis. Within the Reynolds number range from 0.4 × 105 to 1.6 × 105, the mean drag force of the helical-wire cable is lower than the value of the smooth cable, and the correlation coefficient decreases with the increase in wind velocity. The results obtained from wind tunnel tests and computational fluid dynamics simulations agree well with each other. Furthermore, the wind velocity contour around the helical-wire cables obtained from computational fluid dynamics simulations visually indicates that the approaching flow is forced to separate at the surface of the helical wire in advance, which makes the vortex shedding disorder along the cable axis.
Short-term behaviour of reinforced and steel fibre–reinforced concrete composite slabs with steel decking under negative bending moment
Authors: Gholamhoseini Alireza , Khanlou Amir , MacRae Gregory , Hicks Stephen , Scott Allan , Clifton Charles
Published: November 2017

An experimental study was conducted on reinforced and steel fibre–reinforced concrete composite slabs with steel decking under negative bending moment to quantify the ultimate behaviour, loading capacity and crack width under short-term loading. Eight full-scale slab specimens were cast with different types and amounts of reinforcement in the concrete (e.g. mesh, steel fibre or normal reinforcing bars) but with the same type of steel decking. Each slab was simply supported and tested in four-point bending under increasing load until failure. The deflections at mid-span and under the applied point loads were monitored together with the end interface slip. The crack widths were obtained for each slab for different levels of applied load. It was found that the end slip was quite negligible and complete interaction on the steel decking–concrete slab interface existed at service loads and ultimate limit states. Compared to the slab with 20 kg/m3 steel fibre, the application of steel fibre in excess of 60 kg/m3 increased the rotational capacity and ultimate load by 60% and 80%, respectively. Moreover, the higher dosage of steel fibres resulted in improved crack control, as for the same level of applied load, the crack width was often reduced by 75%. However, the slabs with conventional high-strength ductile reinforcements had the greatest ultimate load and rotational capacity and exhibited the best degree of crack control with finer and more distributed cracks.
Functions of mHealth applications: A user’s perspective
Authors: Smahel David , Elavsky Steriani , Machackova Hana
Published: November 2017

The usage of mobile health (mHealth) applications is rapidly increasing. This research has been aimed mostly at reviewing existing mHealth apps and their functionality. However, studies from users’ perspectives are rather scarce. This exploratory study addresses that gap and, using cross-sectional survey data, seeks to reveal the socio-demographic and individual characteristics of users who utilize specific functions of mHealth apps. The data were collected via an online survey through websites oriented toward eating habits, exercising, dieting, and weight loss. From the original sample (1002 users; M = 24.8, standard deviation = 6.9; 81.6% females), the final sub-sample of 406 participants aged from 13 to 39 years (M = 23.8, standard deviation = 5.3, 86.9% females) who reported usage of mHealth apps was examined. The analyses revealed demographic and individual differences in predicting usage of various functions of mHealth apps. The drive for thinness was associated with functions for weight monitoring and planning functions. Excessive exercise was associated with weight monitoring, socializing functions, and functions for planning and monitoring goals. These findings imply that mHealth apps should be individually tailored to incorporate components such as risk-specific warnings or the provision of information related to seeking professional help for at-risk audiences.
Reducing the Undervote With Vote by Mail
Authors: Menger Andrew , Stein Robert M. , Vonnahme Greg
Published: November 2017

We study how ballot completion levels in Colorado responded to the adoption of universal vote by mail elections (VBM). VBM systems are among the most widespread and significant election reforms that states have adopted in modern elections. VBM elections provide voters more time to become informed about ballot choices and opportunities to research their choices at the same time as they fill out their ballots. By creating a more information-rich voting environment, VBM should increase ballot completion, especially among peripheral voters. The empirical results show that VBM elections lead to greater ballot completion, but that this effect is only substantial in presidential elections.
Patient and Aneurysm Characteristics Predicting Prolonged Length of Stay After Elective Open AAA Repair in the Endovascular Era
Authors: Casillas-Berumen Sergio , Rojas-Miguez Florencia A. , Farber Alik , Komshian Sevan , Kalish Jeffrey A. , Rybin Denis , Doros Gheorghe , Siracuse Jeffrey J.
Published: November 2017

Introduction:

Open aortic aneurysm repair (AAA) repair can be resource intensive and associated with a prolonged length of stay (LOS). We sought to examine patient and aneurysm predictors of prolonged LOS to better identify those at risk in the preoperative setting.

Methods:

Patient data were obtained from the targeted AAA American College of Surgery National Surgical Quality Improvement Program database from 2012 to 2014 of patients undergoing open AAA repair. Multivariable logistic regression was used to determine predictors of prolonged postoperative LOS defined as greater than 10 days (75th percentile).

Results:

There were 1172 open AAA repairs identified. The majority (54%) of patients were older than 70 years and male (74%). Surgical approach was transperitoneal (70.9%) and retroperitoneal (29.1%). Aneurysms were 51.4% infrarenal, 33% juxtarenal, 5.7% pararenal, 7.4% suprarenal, and 2.5% type IV thoracoabdominal. Mean and median LOS were 9.1 ± 7.4 and 7 (0-72) days, respectively. Independently associated with extended LOS factors were visceral revascularization (odds ratio [OR]: 5.32, 95% confidence interval [CI]: 2.77-10.22, P < .001), type IV thoracoabdominal extent (OR: 3.09, 95% CI: 1.01-9.46, P = .048), suprarenal extent (OR: 1.89, 95% CI: 1.07-3.34, P = .029) and juxtarenal (OR: 1.43, 95% CI: 1.01-2.02, P = .004), non-Caucasian race (OR: 2.80, 95% CI: 1.77-4.41, P < .001), chronic obstructive pulmonary disease (OR: 1.76, 95% CI: 1.20-2.59, P = .004), not-from-home admission (OR: 1.91, 95% CI: 1.13-3.24), and age greater than 70 (OR: 1.49, 95% CI: 1.08-2.05, P = .014).

Conclusion:

We identified patient and aneurysm characteristics independently associated with protracted LOS following open AAA repair. Prospective identification of high-risk patients may allow physicians and hospitals to engage in multidisciplinary collaborations preoperatively to try to improve LOS in this resource-intensive population.
The impact of staff training on special educational needs professionals’ attitudes toward and understanding of applied behavior analysis
Authors: Smyth Sinéad , Reading Benjamin E , McDowell Claire
Published: November 2017

Background:

Research-based evidence points to the efficacy and value of applied behavior analysis (ABA) in meeting the needs of individuals with learning disabilities and autism. Nonetheless, public, government, and professional perception of ABA can be negative. The current study was designed to measure the impact of a short intervention on professionals’ attitudes toward, and knowledge of, ABA.

Method:

Teachers and classroom assistants from two separate schools for children with severe learning difficulties completed a self-report survey on knowledge of and attitudes toward ABA. They were then presented with a 90-min training module designed to increase their knowledge of the history of ABA and their functional assessment skills. Following training, the self-report was readministered.

Results:

The mean scores for each group increased only after the training had been delivered. Discussion and conclusions: Further research is needed to address the impact of training on classroom practice.
Five Ways to Wellbeing: holistic narratives of public health programme participants
Authors: Farrier Alan , Dooris Mark , Froggett Lynn
Published: November 2017

This paper reports on a study which formed part of a qualitative process evaluation of a wellbeing programme in North West England. The study used the biographic narrative interpretive method (BNIM) to undertake and analyse data from interviews with six participants from diverse projects within the programme. This generated rich case studies and spotlighted cross-case commonalities, building understanding of how the programme achieved its effects. We present findings using the Five Ways to Wellbeing framework, presenting one abridged ‘case’ and summarising cross-cutting themes. We explore how BNIM gives insight into the psychosocial complexity of wellbeing, building understanding of its holistic and dynamic nature, and then highlight the flexibility, resonance and widespread appeal of Five Ways to Wellbeing. In concluding, we argue that by enabling participants to tell their own stories of participation in the different projects, we gain a more authentic understanding of the ‘whole’ story of how involvement has affected wellbeing. Such approaches are crucial as wellbeing becomes a central concept in global health policy and promotion.
Current management and treatment of patients with stable coronary artery diseases presenting to cardiologists in different clinical contexts: A prospective, observational, nationwide study
Authors: De Luca Leonardo , Temporelli Pier Luigi , Lucci Donata , Gonzini Lucio , Riccio Carmine , Colivicchi Furio , Geraci Giovanna , Formigli Dario , Maras Patrizia , Falcone Colomba , Di Lenarda Andrea , Gulizia Michele Massimo
Published: November 2017

Background

Stable coronary artery disease (CAD) is a leading cause of mortality worldwide. Few studies document the complete sequence of investigation of the overall stable CAD population during outpatient visits or hospitalisation.

Aim

To obtain accurate and up-to-date information on current management of patients with stable CAD.

Methods

START (STable coronary Artery diseases RegisTry) was a prospective, observational, nationwide study aimed at evaluating the presentation, management, treatment and quality of life of stable CAD patients presenting to cardiologists during outpatient visits or discharged from cardiology wards.

Results

Over a 3-month period, 5070 consecutive patients were enrolled in 183 participating centres: 72% managed by a cardiologist during outpatient or day hospital visits and 28% discharged from cardiology wards. The vast majority of patients (87%) received a coronary angiography (86% of patients managed during outpatient visits and 90% during hospitalisation; p < 0.0001). Outpatients more frequently received optimal medical therapy (OMT; i.e. aspirin or thienopyridine, β-blockers and statins) compared to hospitalised patients (70.2% vs 67.1%; p = 0.03). A personalised diet was prescribed in 58% (60.5% in outpatients and 52.9% in those admitted to hospitals; p < 0.0001), physical activity programmes were suggested in 65% (69.4% and 54.3%; p < 0.0001) and smoking cessation was recommended in 71% of currently smoking patients (73.2% and 65.2%; p = 0.02).

Conclusions

In this large, contemporary registry, patients with stable CAD discharged from cardiology wards more commonly underwent diagnostic imaging procedures and less frequently received OMT or lifestyle modification programmes compared to patients manged by cardiologists during outpatient visits.
Values Grounding the Informed Consent in Medical Practice: Theory and Practice
Authors: Frunză Ana , Sandu Antonio
Published: November 2017

This research aims to identify the significance of the informed consent (IC) in the medical staff’s daily practice. The research does not aim to validate a hypothesis, but it does aim to identify what meaning professionals give to the ethical tools they use. We wish to explore whether or not IC is understood by medical staff as a means of respecting patient’s autonomy, or whether it acts as a protective measure for health care staff. To identify the meanings attributed to IC by health professionals in health care institutions, we developed and conducted individual interviews and analyzed the acquired data using a grounded theory (GT) qualitative approach.
The Impact of Electronic Banking and Information Technology on the Employees of Banking Sector
Authors: Gupta Sweety , Yadav Anshu
Published: November 2017

In the last three decades, the banking sector has seen a profound transformation owing to the changes in the global financial environment. The major change witnessed in the banking sector has been great advances in financial innovations and technologies, which are a result of turmoil in the global financial environment. The improvement in financial innovations and technologies has made E-banking an intense part of the banking sector. E-banking has revolutionized the lives of all individuals of present times and is considered to be a wave of information revolution after the agricultural and industrial revolution. Earlier banking customers were required to personally visit a bank branch in order to transact through their saving accounts but with the arrival of Internet banking the manner in which financial transactions are carried out have changed. Although E-banking has been popular among computer literates for many years, its popularity is growing exponentially as Internet usage grows and people discover the numerous benefits that are provided by online banking. In today’s increasingly integrated financial systems facing higher volatilities, more competition and higher time constraints, E-banking has become an integral part of the global financial environment in order to meet different requirements of customers of banking sector, thereby meeting the increased expectations of the participants in Indian banking system. This study makes an attempt to analyse the impact of E-banking and information technology on the employees of banking sector.
The Neurobiology of Panic: A Chronic Stress Disorder
Authors: Goddard Andrew W.
Published: November 2017

Panic disorder is an often chronic and impairing human anxiety syndrome, which frequently results in serious psychiatric and medical comorbidities. Although, to date, there have been many advances in the diagnosis and treatment of panic disorder, its pathophysiology still remains to be elucidated. In this review, recent evidence for a neurobiological basis of panic disorder is reviewed with particular attention to risk factors such as genetic vulnerability, chronic stress, and temperament. In addition, neuroimaging data are reviewed which provides support for the concept of panic disorder as a fear network disorder. The potential impact of the National Institute of Mental Health Research Domain Criteria constructs of acute and chronic threats responses and their implications for the neurobiology of panic disorder are also discussed.
TGFβ3 recruits endogenous mesenchymal stem cells to initiate bone regeneration
Authors: Deng Moyuan , Mei Tieniu , Hou Tianyong , Luo Keyu , Luo Fei , Yang Aijun , Yu Bo , Pang Hao , Dong Shiwu , Xu Jianzhong
Published: November 2017

Background

The recruitment of a sufficient number of endogenous mesenchymal stem cells (MSCs) is the first stage of in-situ tissue regeneration. Transforming growth factor beta-3 (TGFβ3) could recruit stem or progenitor cells and endothelial cells to participate in tissue regeneration. However, the mechanism of TGFβ3 recruiting MSCs toward bone regeneration has remained obscure.

Methods

We estimated the promigratory property of TGFβ3 on human bone marrow MSCs (hBMSCs) cocultured with the vascular cells (human umbilical artery smooth muscle cells or human umbilical vein endothelial cells) or not by Transwell assay. After the addition of the inhibitor (SB431542) or Smad3 siRNA, the levels of MCP1 and SDF1 in coculture medium were tested by ELISA kit, and then the migratory signaling pathway of hBMSCs induced by TGFβ3 was investigated by western blot analysis. In vivo, a 2-mm FVB/N mouse femur defect model was used to evaluate chemokine secretion, endogenous cell homing, and bone regeneration induced by scaffolds loading 1 μg TGFβ3 through qPCR, immunofluorescent staining, immunohistochemical analysis, and Micro-CT, compared to the vehicle group.

Results

TGFβ3 (25 ng/ml) directly showed a nearly 40% increase in migrated hBMSCs via the TGFβ signaling pathway, compared to the vehicle treatment. Then, in the coculture system of hBMSCs and vascular cells, TGFβ3 further upregulated nearly 3-fold MCP1 secretion from vascular cells in a Smad3-dependent manner, to indirectly enhance nearly more than 50% of migrated hBMSCs. In vivo, TGFβ3 delivery improved MCP1 expression by nearly 7.9-fold, recruited approximately 2.0-fold CD31+ vascular cells and 2.0-fold Sca-1+ PDGFR-α+ MSCs, and achieved 2.5-fold bone volume fraction (BV/TV) and 2.0-fold bone mineral density, relative to TGFβ3-free delivery.

Conclusions

TGFβ3, as a MSC homing molecule, recruited MSCs to initiate bone formation in the direct-dependent and indirect-dependent mechanisms. This may shed light on the improvement of MSC homing in bone regeneration.
Effective hyperparameter optimization using Nelder-Mead method in deep learning
Authors: Ozaki Yoshihiko , Yano Masaki , Onishi Masaki
Published: November 2017

In deep learning, deep neural network (DNN) hyperparameters can severely affect network performance. Currently, such hyperparameters are frequently optimized by several methods, such as Bayesian optimization and the covariance matrix adaptation evolution strategy. However, it is difficult for non-experts to employ these methods. In this paper, we adapted the simpler coordinate-search and Nelder-Mead methods to optimize hyperparameters. Several hyperparameter optimization methods were compared by configuring DNNs for character recognition and age/gender classification. Numerical results demonstrated that the Nelder-Mead method outperforms the other methods and achieves state-of-the-art accuracy for age/gender classification.
Acute Coronary Artery Thrombus After Tranexamic Acid During Total Shoulder Arthroplasty in a Patient With Coronary Stents: A Case Report
Authors: Bridges Kathryn H. , Wilson Sylvia H.
Published: November 2017

Tranexamic acid (TXA), an antifibrinolytic, is routinely used to decrease transfusion rates in total joint replacement surgery. While recent publications have indicated a low risk of TXA-associated thromboembolic events in this orthopedic population, few studies specifically address the safety of TXA administration in high-risk patients. We present a case of acute coronary thrombus requiring emergent intervention in a patient with indwelling coronary stents who underwent shoulder arthroplasty with TXA administration.
Intrathecal Baclofen Injection to Avoid Withdrawal in a Multiple Sclerosis Patient Undergoing Lumbar Spine Surgery: A Case Report
Authors: Dupanovic Mirsad , Devine Robert P. , Jackson Sean R. , Lynch Sharon G.
Published: November 2017

Spasticity of spinal or cerebral origin is frequently treated with baclofen. Treatment interruption initially results in rebound spasticity; life-threatening withdrawal symptoms may follow. Severe rebound spasticity of leg muscles occurred in a multiple sclerosis patient after a 10-hour long perioperative pause of oral baclofen intake. In a subsequent spine surgery, recurrence was prevented by substituting a cumulative 12-hour oral baclofen dose with an intraoperative intrathecal injection. Administration of intrathecal baclofen during prolonged surgery in patients dependent on oral baclofen may improve patient comfort and prevent early withdrawal symptoms. The most optimal conversion ratio from oral to intrathecal baclofen is still undetermined.
Postoperative Harlequin Syndrome: Case Report of a Rare but Clinically Striking Condition
Authors: Kydes Ashley T. , Kelley Ashley M. , Pandya Samir R. , Barst Samuel M.
Published: November 2017

We present a case of a 2-year-old boy who underwent thoracoscopic resection of a left paraspinal mediastinal mass and developed Harlequin syndrome postoperatively. Harlequin syndrome is a rare neurological condition characterized by unilateral hyperhidrosis and erythema of the head and neck. Our discussion highlights this condition and other differential diagnoses that may present similarly in the postoperative period.
Water source most suitable for rearing a sensitive malaria vector, Anopheles funestus in the laboratory
Authors: Tchigossou Genevieve M. , Akoton Romaric , Yessoufou Akadiri , Djegbe Innocent , Zeukeng Francis , Atoyebi Seun M , Tossou Eric , Moutairou Kabirou , Djouaka Rousseau
Published: November 2017

Background:  The insecticide susceptibility status ofAnopheles funestus,one of the main malaria vectors in the Afrotropical regions, remains under-studied due to the difficulty of working with this mosquito species. Collecting their larvae in natural breeding sites, rearing and maintaining them in normal laboratory conditions have been a difficult task. Forced-egg laying technique has been a very good tool to generate eggs from adult mosquitoes collected from the wild but rearing these eggs to obtain satisfying portion as adults has always been the problem. In this study, we optimized the development of mosquito species larvae under standard laboratory conditions for desired production of adult mosquitoes that can be useful for insecticide susceptibility tests.

Methods: A forced-egg laying technique was used to obtain eggs from gravid femaleAnopheles funestuscollected from Kpome locality in Benin. Eggs were reared in three different water samples (water from the borehole,and two mineral water namely FIFA and Possotômè) and larvae were fed with TetraMin baby fish food. The physico-chemical parameters of the waters were investigated prior to use for egg incubation.

Results:In contrast to mineral water that had no contamination, the borehole water source was contaminated with lead (2.5mg/L) and nitrate (118.8mg/L). Egg hatching rates ranged as 91.9 ± 4.4%, 89.1 ± 2.5% and 87.9 ± 2.6% in FIFA, Possotômè and borehole water respectively. High emergence of larvae to adult mosquitoes was recorded as in FIFA (74.3%) and Possotômè(79.5%) water. No adult mosquito was obtained from larvae reared in borehole water.

Conclusions:This study gave insight on the water sources that could be good for rearing to mass produceAn. funestusin the laboratory. More analysis with other local mineral water sources in our environments could be considered in the future, hopefully giving better outputs.
Banning Foreign Pharmacies from Sponsored Search: The Online Consumer Response
Authors: Chesnes Matthew , Dai Weijia (Daisy) , Zhe Jin Ginger
Published: November 2017

Increased competition from the Internet has raised concerns about the quality of prescription drugs sold online. Given the pressure from the Department of Justice, Google agreed to ban pharmacies not certified by the National Association of Boards of Pharmacy (NABP) from sponsored search listings. Using comScore click-through data originated from health-related queries, we study how the ban affects consumer search and click behavior in a difference-in-differences framework using the synthetic control method. We find that non-NABP-certified pharmacies received fewer clicks after the ban, and this effect is heterogeneous. In particular, pharmacies not certified by the NABP but certified by other sources (other-certified websites), experienced an increase in organic clicks that partially offset the loss in paid clicks after the ban. By contrast, pharmacies not certified by any certification agency experience much lower rates of substitution in organic clicks. These results suggest that the ban has increased the search cost for other-certified websites, but at least some consumers overcome the search cost by switching from sponsored to organic links. The lower substitution for uncertified websites may be explained by the rising consumer concerns about the quality of drugs sold on uncertified websites after the ban.

Data and the online appendix are available at https://doi.org/10.1287/mksc.2017.1058 .
Improving care for patients with dementia in the recovery room
Authors: Edis Helena
Published: November 2017

Caring for patients with dementia emerging from general anaesthesia in the recovery room can be very challenging. Sedation is sometimes necessary in order to nurse patients effectively and avoid any negative consequences of poor post-anaesthetic care. No local or national guidelines could be found to suggest best nursing practice in this situation. Three small-scale innovations were introduced into the recovery room in one hospital as part of a quality improvement project to give alternatives to chemical restraint. These were: music and distraction therapy, maximising the use of the ‘About Me’ document and improved access to staff training. The simple innovations were well received by recovery room staff. Further research is needed to quantify the benefits of these innovations and further work is needed to develop use of the carer's passport in recovery.