bluuebunny/crossref_metadata_2025 huggingface dataset:
Regional competitiveness policy evaluation as a transformative process: From theory to practice
Authors: Aranguren Mari Jose , Magro Edurne , Wilson James R
Published: August 2016

Regional competitiveness policy evaluation is at an interesting juncture. Increasing demand for evaluation is emerging at a time when policy complexity is highlighting the limits of existing techniques. Moreover, widespread use of the concept of policy learning in conceptual analysis is not matched by experimentation and reflection that can articulate what policy learning means in practice. This paper explores the transformative role that evaluation can play in policy learning, in theory, and in practice. It analyses experience with three different competitiveness policy evaluations in the same regional and institutional setting. It finds that explicit demand for evaluation, decisions around the appropriate mode of knowledge generation, the existence of dialogue spaces where relevant policy–stakeholders (including researchers) frequently meet, and the development of trust and cognitive proximity within these meeting places, are all critical factors if evaluation is to be transformative.
Comparison of microbubble presence in the right heart during mechanochemical and radiofrequency ablation for varicose veins
Authors: Moon KH , Dharmarajah B , Bootun R , Lim CS , Lane TRA , Moore HM , Sritharan K , Davies AH
Published: August 2016

Objective

Mechanochemical ablation is a novel technique for ablation of varicose veins utilising a rotating catheter and liquid sclerosant. Mechanochemical ablation and radiofrequency ablation have no reported neurological side-effect but the rotating mechanism of mechanochemical ablation may produce microbubbles. Air emboli have been implicated as a cause of cerebrovascular events during ultrasound-guided foam sclerotherapy and microbubbles in the heart during ultrasound-guided foam sclerotherapy have been demonstrated. This study investigated the presence of microbubbles in the right heart during varicose vein ablation by mechanochemical abaltion and radiofrequency abaltion.

Methods

Patients undergoing great saphenous vein ablation by mechanochemical abaltion or radiofrequency ablation were recruited. During the ablative procedure, the presence of microbubbles was assessed using transthoracic echocardiogram. Offline blinded image quantification was performed using International Consensus Criteria grading guidelines.

Results

From 32 recruited patients, 28 data sets were analysed. Eleven underwent mechanochemical abaltion and 17 underwent radiofrequency abaltion. There were no neurological complications. In total, 39% (11/28) of patients had grade 1 or 2 microbubbles detected. Thirty-six percent (4/11) of mechanochemical abaltion patients and 29% (5/17) of radiofrequency ablation patients had microbubbles with no significant difference between the groups ( p=0.8065).

Conclusion

A comparable prevalence of microbubbles between mechanochemical abaltion and radiofrequency ablation both of which are lower than that previously reported for ultrasound-guided foam sclerotherapy suggests that mechanochemical abaltion may not confer the same risk of neurological events as ultrasound-guided foam sclerotherapy for treatment of varicose veins.
Parkes Weber syndrome—Diagnostic and management paradigms: A systematic review
Authors: Banzic Igor , Brankovic Milos , Maksimović Živan , Davidović Lazar , Marković Miroslav , Rančić Zoran
Published: August 2016

Objectives

Parkes Weber syndrome is a congenital vascular malformation which consists of capillary malformation, venous malformation, lymphatic malformation, and arteriovenous malformation. Although Parkes Weber syndrome is a clinically distinctive entity with serious complications, it is still frequently misdiagnosed as Klippel–Trenaunay syndrome that consists of the triad capillary malformation, venous malformation, and lymphatic malformation.

Methods

We performed a systematic review investigating clinical, diagnostic, and treatment modalities of Parkes Weber syndrome (PubMed/MEDLINE, Embase, and Cochrane databases). Thirty-six publications (48 patients) fulfilled the eligibility criteria.

Results

The median age of patients was 23 years (IQR, 8–32), and 24 (50.0%) were males. Lower extremity was affected in 42 (87.5%) and upper extremity in 6 (12.5%) patients; 15 (31.3%) patients developed high-output heart failure; 12 (25.0%) patients had chronic venous ulcerations, whereas 4 (8.3%) manifested distal arterial ischemia. The spinal arteriovenous malformations were reported in six (12.5%) patients and coexistence of aneurysmatic disease in five (10.4%) patients. The most frequently utilized invasive treatments were embotherapy followed by amputation and surgical arteriovenous malformation resection, and occasionally stent-graft implantation. All modalities showed clinical improvement. However, long follow-up and outcome remained unclear.

Conclusion

A diagnosis of Parkes Weber syndrome should be made on the presence of capillary malformation, venous malformation, lymphatic malformation, and arteriovenous malformation (as main defect) in overgrowth extremity. Arteriovenous malformation presents the criterion for distinguishing Parkes Weber syndrome from Klippel-Trenaunay syndrome, which is substantial for treatment strategy. The primary management goal should be patient's quality of life improvement and complication reduction. Embolization alone/combined with surgical resection targeting occlusion or removal of arteriovenous malformation “nidus” reliably leads to clinical improvement.
Effectiveness and safety of Chinese massage therapy (Tui Na) on post-stroke spasticity: a prospective multicenter randomized controlled trial
Authors: Yang Yu-jie , Zhang Jun , Hou Ying , Jiang Bao-yin , Pan Hua-fei , Wang Jian , Zhong Da-yong , Guo Hai-ying , Zhu Yi , Cheng Jie
Published: August 2016

Objective:

To evaluate the effectiveness and safety of Chinese massage therapy (Tui Na) for patients with post-stroke spasticity.

Design:

A prospective, multicenter, blinded, randomized, placebo-controlled intervention trial.

Subject:

A total of 90 patients with post-stroke spasticity were randomly assigned to the experimental (Tui Na therapy) group ( n = 45) or control (placebo Tui Na therapy) group ( n = 45).

Intervention:

Participants in the experimental group received Tui Na therapy, while those in the control group received placebo-Tai Na (gentle rubbing) for 20–25 minutes per limb, once per day, five days per week for a total of four weeks. All participants in both groups received conventional rehabilitation.

Main measure:

The Modified Ashworth Scale, the Fugl-Meyer Assessment and the Modified Barthel Index were used to assess the severity of spasticity, motor function of limbs and activities of daily living, respectively. Assessments were performed at baseline, at four weeks and at three months.

Results:

Tui Na group had a significantly greater reduction in Modified Ashworth Scale in only four muscle groups than the control did (elbow flexors, P = 0.026; wrist flexors, P = 0.005; knee flexors, P = 0.023; knee extensors, P = 0.017). Improvements were sustained at three months follow-up. There was no significant difference between the two groups in Fugl-Meyer Assessment ( P = 0.503) and Modified Barthel Index ( P = 0.544). No adverse reaction was recorded in any of the cases mentioned at all study sites.

Conclusions:

Tui Na might be a safe and effective treatment to reduce post-stroke spasticity of several muscle groups.
Water-based vs. non-water-based physiotherapy for rehabilitation of postural deformities in Parkinson’s disease: a randomized controlled pilot study
Authors: Volpe Daniele , Giantin Maria Giulia , Manuela Pilleri , Filippetto Consuelo , Pelosin Elisa , Abbruzzese Giovanni , Antonini Angelo
Published: August 2016

Objective:

To compare the efficacy of two physiotherapy protocols (water-based vs. non-water-based) on postural deformities of patients with Parkinson’s disease.

Design:

A single blind, randomized controlled pilot study.

Setting:

Inpatient (Rehabilitative Department).

Participants:

A total of 30 patients with idiopathic Parkinson’s disease.

Interventions:

Participants were randomly assigned to one of two eight-week treatment groups: Water-based ( n = 15) or non-water-based physiotherapy exercises ( n = 15).

Outcome measures:

Changes in the degree of cervical and dorsal flexion and in the angle of lateral inclination of the trunk (evaluated by means of a posturographic system) were used as primary outcomes. Unified Parkinson Disease Rating Scale section III, Time Up and Go Test, Berg Balance Scale, Activities-specific Balance Confidence, Falls Efficacy Scale and the Parkinson’s disease quality of life questionnaire (39 items) were the secondary outcomes. All outcomes were assessed at baseline, at the end of training and eight weeks after treatment. Patients were always tested at the time of their optimal antiparkinsonian medication (‘on’ phase).

Results:

After the treatment, only Parkinson’s disease subjects randomized to water-based treatment showed a significant improvement of trunk posture with a significant reduction of cervical flexion (water-based group: −65.2°; non-water-based group: +1.7°) and dorsal flexion (water-based group: −22.5°; non-water-based group: −6.5°) and lateral inclination of the trunk (water-based group: −2.3°; non-water-based group: +0.3°). Both groups presented significant improvements in the secondary clinical outcomes without between-group differences.

Conclusion:

Our results show that water-based physiotherapy was effective for improving postural deformities in patients with Parkinson’s disease.
A Randomized Trial of Expanding Choice Sets to Motivate Advance Directive Completion
Authors: Courtright Katherine R. , Madden Vanessa , Gabler Nicole B. , Cooney Elizabeth , Kim Jennifer , Herbst Nicole , Burgoon Lauren , Whealdon Jennifer , Dember Laura M. , Halpern Scott D.
Published: August 2016

Background. Evidence suggests that advance directives may improve end-of-life care among seriously ill patients, but improving completion rates remains a challenge. Objective. This study tested the influence of increasing the number of options for completing an advance directive among seriously ill patients. Methodology. Outpatients ( N = 316) receiving hemodialysis across 15 dialysis centers in the Philadelphia region between July 2014 and July 2015 were randomized to receive either the option to complete a brief advance directive form or expanded options including a brief, expanded, or comprehensive form. Patients in both groups could decline to complete an advance directive or take their selected version home. The primary outcome was a returned, completed advance directive. Secondary outcomes included whether patients wanted to complete an advance directive, decision satisfaction, quality of life at 3 months, and patient factors associated with advance directive completion. Results. Although offering more advance directive options was not significantly associated with increased rates of completion (13.1% in the standard group v. 12.2% in the expanded group, P = 0.80), it did significantly increase the proportion of patients who wanted to complete an advance directive and took one home (71.9% in standard v. 85.3% in expanded, P = 0.004). There was no difference in satisfaction ( P = 0.65) or change in quality of life between groups ( P = 0.63). A higher baseline quality of life was independently associated with advance directive completion ( P = 0.006). Conclusions and Relevance. These results suggest that although an expanded choice set may initially nudge patients toward completing advance directives without restricting choice, increasing actual completion requires additional interventions that overcome downstream barriers.
Syncytial Hepatitis of Tilapia (Oreochromis niloticus L.) is Associated With Orthomyxovirus-Like Virions in Hepatocytes
Authors: del-Pozo J. , Mishra N. , Kabuusu R. , Cheetham S. , Eldar A. , Bacharach E. , Lipkin W. I. , Ferguson H. W.
Published: August 2016

Using transmission electron microscopy (TEM), the presented work expands on the ultrastructural findings of an earlier report on “syncytial hepatitis,” a novel disease of tilapia (SHT). Briefly, TEM confirmed the presence of an orthomyxovirus-like virus within the diseased hepatocytes but not within the endothelium. This was supported by observing extracellular and intracellular (mostly intraendosomal), 60–100 nm round virions with a trilaminar capsid containing up to 7 electron-dense aggregates. Other patterns noted included enveloped or filamentous virions and virion-containing cytoplasmic membrane folds, suggestive of endocytosis. Patterns atypical for orthymyxovirus included the formation of syncytia and the presence of virions within the perinuclear cisternae (suspected to be the Golgi apparatus). The ultrastructural morphology of SHT-associated virions is similar to that previously reported for tilapia lake virus (TiLV). A genetic homology was investigated using the available reverse transcriptase polymerase chain reaction (RT-PCR) probes for TiLV and comparing clinically sick with clinically normal fish and negative controls. By RT-PCR analysis, viral nucleic acid was detected only in diseased fish. Taken together, these findings strongly suggest that a virus is causally associated with SHT, that this virus shares ultrastructural features with orthomyxoviruses, and it presents with partial genetic homology with TiLV (190 nucleotides).
Amyloid-Producing Odontogenic Tumors of the Facial Skin in Three Cats
Authors: Hirayama K. , Endoh C. , Kagawa Y. , Ohmachi T. , Yamagami T. , Nomura K. , Matsuda K. , Okamoto M. , Taniyama H.
Published: August 2016

Amyloid-producing odontogenic tumors (APOTs) of the facial skin were diagnosed in 3 domestic cats. The neoplasms had the histopathological characteristics of the odontogenic tumor. The neoplastic cells were present in irregular islands, strands, and sheets. The peripheral neoplastic cells of the islands and strands were arranged in a palisading fashion, while the central cells were polyhedral to stellate and randomly arranged. Multiple spherules of homogeneous eosinophilic material were closely apposed to the neoplastic epithelial cells. The spherules stained with Congo red and produced an apple green birefringence under polarization microscopy, indicative of amyloid. Immunohistochemically, amyloid materials of the neoplasms reacted with polyclonal antibodies for ameloblastin, amelogenin, and sheathlin antibodies. Neoplastic epithelial cells also reacted with antiameloblastin, amelogenin, and sheathlin antibodies, with varied intensity. The histopathological and immunohistochemical characteristics of dermal neoplasms of the 3 cats were analogous to those of APOTs reported in the dog and the cat.
Increasing Lower Extremity Injury Rates Across the 2009-2010 to 2014-2015 Seasons of National Collegiate Athletic Association Football
Authors: Westermann Robert W. , Kerr Zachary Y. , Wehr Peter , Amendola Annuziato
Published: August 2016

Background:

Sports-related concussions (SRCs) have gained increased societal interest in the past decade. The National Collegiate Athletic Association (NCAA) has implemented legislation and rule changes to decrease the incidence and risk of head injury impacts. The “targeting” rule forbids initiating contact with the crown of a helmet and targeting defenseless players in the head and neck area; however, there are concerns that this rule change has unintentionally led to an increased incidence of lower extremity injuries.

Purpose/Hypothesis:

The purpose of this study was to evaluate the change in lower extremity injury rates in NCAA football during the 2009-2010 to 2014-2015 seasons. We hypothesized that the lower extremity injury rate has increased across the time period.

Study Design:

Descriptive epidemiology study.

Methods:

Sixty-eight NCAA football programs provided 153 team-seasons of data to the NCAA Injury Surveillance Program. Lower extremity injuries (ie, hip/groin, upper leg/thigh, knee, lower leg/Achilles, foot/toes) and SRCs sustained during NCAA football games were examined. We calculated injury rates per 1000 athlete-exposures (AEs) for lower extremity injuries and SRCs. Rate ratios (RRs) compared injury rates between the 2009-2010 to 2011-2012 and 2012-2013 to 2014-2015 seasons.

Results:

Overall, 2400 lower extremity injuries were reported during the 2009-2010 to 2014-2015 seasons; most were to the knee (33.6%) and ankle (28.5%) and caused by player contact (59.2%). The lower extremity injury rate increased in 2012-2013 to 2014-2015 compared with 2009-2010 to 2011-2012 (23.55 vs 20.45/1000 AEs, respectively; RR, 1.15; 95% CI, 1.06-1.25). This finding was retained when restricted to injuries due to player contact (RR, 1.19; 95% CI, 1.07-1.32) but not for injuries due to noncontact/overuse (RR, 0.96; 95% CI, 0.80-1.14). When examining player contact injury rates by anatomic site, only ankle injuries had an increase (RR, 1.36; 95% CI, 1.13-1.64). The SRC rate also increased in 2012-2013 to 2014-2015 compared with 2009-2010 to 2011-2012 (3.52 vs 2.63/1000 AEs, respectively; RR, 1.34; 95% CI, 1.08-1.66).

Conclusion:

The lower extremity injury rate has increased in NCAA football athletes. Similarly, SRC rates have increased, although this may be caused by concurrent policies related to better education, identification, and management. Targeting rule changes may be contributing to increased rates of player contact–related ankle injuries. Alongside continued surveillance research to examine longitudinal time trends, more in-depth individual-level examinations of how targeting rule changes influence coaching and player behaviors are warranted.
Safety and efficacy of rush allergen-specific immunotherapy in Chinese allergic rhinitis patients
Authors: Qiu Qianhui , Xu Mimi , Lu Chuan , Chen Jianjun , Chen Shaohua , Kong Weijia , Han Hong
Published: August 2016

The purpose of this prospective, open-IV clinical trial was to assess the safety and efficacy differences between Rush immunotherapy (RIT) and conventional immunotherapy in Chinese allergic rhinitis (AR) patients. The trial involved 174 patients with AR. They were divided into two groups according to their preference of therapy: RIT or conventional immunotherapy. A total of 162 patients completed a 1-year treatment course. For safety and effectiveness evaluation, the local and systemic adverse reactions were recorded throughout the initial phase of both groups. Weeks 0, 2, 5, and 17 were set as observation time points for immunoglobulin G (IgG) and IgG4. Besides that, another observation time point (Week 11) was added in for a visual analog scale (VAS) and a weekly drug dosage scale. In the RIT group, systemic adverse events of AR were similar to those of the conventional therapy group. LTB4 was descended. The VAS of the RIT group did not show a downward trend clearly, instead Week 5 was higher compared with Week 0. The weekly drug dosage scale did not indicate a significant decline, but there was a clear rise in IgG4 in the RIT group. The safety and efficacy of RIT for AR is positive, but further study is needed for improvement.
Measuring the Multicultural Dispositions of Preservice Teachers
Authors: Jensen Bryant , Whiting Erin Feinauer , Chapman Sara
Published: August 2016

Claims abound in the research literature regarding multicultural teacher dispositions, including how to foster them in teacher preparation programs. However, measures of multicultural dispositions of teachers that (a) capture the range of conceptually rich constructs and (b) demonstrate strong psychometric properties are not represented in the literature. In this article, we discuss the iterative development and psychometric properties of the Multicultural Teacher Dispositions Scale (MTDS), a survey of 15 items designed to assess three dispositions/factors: Meekness, Social Awareness, and Advocacy. We analyze responses from 372 preservice teachers in three samples and analytic phases, and discuss factor and item analytic results from the final phase. Results demonstrate strong support for Meekness, though moderate support for Social Awareness and Advocacy. We discuss limitations, implications for measure refinement, and eventual use for research and practice improvement.
A Personal Approach for Abdominoplasty
Authors: El-Sabbagh Ahmed Hassan
Published: August 2016

Abdominoplasty is a common cosmetic procedure. It addresses skin excess, excess fat, and muscular weakness. Complications of abdominoplasty may include hematoma, seroma, wound dehiscence, abscess, severe cellulitis, and venous thromboembolism. The aim was to perform abdominoplasty with minimal complications and accepted aesthetic results. Twenty-nine women aged between 38 and 59 years underwent full abdominoplasty with umbilical transposition at a single hospital from April 2012 to April 2015. Of the 29 patients, 26 cases showed acceptable results. The average amount of liposuction was 800 cc, the least amount was 400 cc, and the most was 1200 cc. The excised segment weighed between 900 and 2500 g. Umbilicus was viable in all cases. Three of the 29 patients showed partial flap necrosis and wound dehiscence. Complicated cases were treated conservatively. Hypertrophic scar was developed in 1 case. Two patients developed minor seroma that required a single aspiration in the office every week for 2 weeks. Abdominoplasty is a safe and an easy operation to execute by adopting some techniques in carefully selected patients.
Carbon Dioxide–Assisted Pneumodissection in Fat Grafting
Authors: Blugerman Guillermo , Schavelzon Diego , Wexler Gabriel , Valente Pedro Miguel
Published: August 2016

Fat grafting has become a popular procedure due to its wide range of clinical applications. Several fat grafting techniques have been described to increase the survival rate of the grafted fat. This article presents carbon dioxide (CO2) pneumodissection to improve the biological microenvironment of the recipient site. A total of 40 patients were treated with CO2 pneumodissection for aesthetic and reconstructive indications. The known effects of carboxitherapy such as vasodilation, enhanced Bohr effect, and neoangiogenesis are applied to facilitate the grafting procedure and in the search for higher rate of graft uptake. Tissue pneumodissection has demonstrated reduced pain due to the fat injection process, and reduces the sedation requirements and local anesthesia infiltration requirements.
Vision Loss in a Young, Healthy Woman Following Liposuction
Authors: Ahmad Mariam , Pelak Victoria
Published: August 2016

A previously healthy 38-year-old female developed vision loss after abdominoplasty and liposuction of the back, flanks, infragluteal region, and thighs. Ophthalmic exam revealed bilateral optic nerve edema consistent with postoperative ischemic optic neuropathy. Laboratory workup revealed severe anemia. Despite correction of anemia, the patient suffered permanent visual loss in the left eye. Here, we review the previous reports on ischemic optic neuropathy after liposuction and the 2012 American Society of Anesthesiology Practice Advisory for perioperative vision loss.
Maximal Pharmacologic Reduction of Postoperative Nausea and Vomiting in Patients Undergoing Aesthetic Breast Surgery Under General Anesthesia
Authors: Beard Mauree NaShea , De Arup
Published: August 2016

Postoperative nausea and vomiting (PONV) is a major patient dissatisfier in aesthetic ambulatory surgical patients. Limited data exist demonstrating single surgeon reduction in PONV after utilizing modern pharmacologic techniques for analgesia and PONV chemoprophylaxis for patients who receive general anesthesia. In our study, multimodal analgesia included pregabalin, oxycontin, ketamine, and opioids; PONV chemoprophylaxis included transdermal scopolamine, diphenhydramine, dexamethasone, and ondansetron. A treatment arm of 36 patients undergoing aesthetic breast surgery was evaluated prospectively and compared with a retrospective control group of 47 patients who underwent similar procedures in the prior year. The aggressive screening for PONV risk factors preoperatively and preemptive treatment resulted in an overall reduction in PONV rate from 31.9% to 5.6%.
Improved Efficiency of Muller’s Muscle Resection Through the Use of Locking Forceps In Lieu of Traction Sutures
Authors: Russell David J. , Silkiss Rona Z.
Published: August 2016

Muller’s muscle resection (MMR) surgery is effective for repair of eyelid ptosis. We describe an efficient modification to the MMR surgery, as described by Putterman, which uses locking 0.5-mm forceps, in place of retraction sutures, to retract the conjunctiva and Muller’s muscle while the ptosis clamp is applied. A chart review was performed to identify 100 consecutive patients starting from January 2015 who underwent the described technique of MMR. Primary end points were need for reoperation or complications. Pathologic specimens were reviewed for similarity between the standard approach using retraction sutures and the modified technique using locking forceps. All 100 patients had satisfactory surgical outcomes. There were no complications or reoperations needed. Pathologic analysis on tissue from the standard technique and modified technique was similar. The described technique is a technically easy, cost-effective, and logistically feasible modification that ptosis surgeons could adopt immediately.
Pratiques collaboratives et habitus consumériste : une analyse des mécanismes transformatifs de la consommation collaborative
Authors: Herbert Maud , Collin-Lachaud Isabelle
Published: August 2016

En 2010, la consommation collaborative a été intronisée en tant que mode de consommation disruptif, voire révolutionnaire. En adoptant un cadre théorique et méthodologique inspiré de la praxéologie de Pierre Bourdieu, ce travail interroge cette prophétie transformative. Des données qualitatives ont été collectées selon différentes méthodes et de manière incrémentale. Leur analyse révèle que les consommateurs distinguent et adoptent ces activités d’abord en exerçant un sens pratique façonné par des dispositions marchandes. Bien qu’influencées par cet habitus consumériste, certaines pratiques collaboratives relèvent également d’une logique de marché alternatif. Les consommateurs identifient en outre un espace de pratiques entre lesquelles ils naviguent de manière dynamique. Ces mécanismes et le degré de socialisation perçue des activités collaboratives permettent de discuter de l’ habitus consumériste, du potentiel transformatif des pratiques et des enjeux pour la recherche en marketing.
La Psychologie Scolaire au Québec Français-School Psychology in French Quebec
Authors: Goguen Suzette , Montreuil Tina C.
Published: August 2016

Psychology and more importantly, school psychology has undergone many changes in French Quebec since the last special issue was published on the subject matter, close to two decades ago. Quebec is a “breeding ground” for psychologists as more than two thirds of Canada’s psychology professionals practice in this province alone. Since the mid 2000’s, a doctoral degree is now required for licensing and registration to the professional order, the Order of Psychologists of Quebec (OPQ). Although this field has since evolved, other aspects of the profession remain unchanged. For one, professional shortages and recruitment challenges (i.e. unrealistic student to psychologist ratios) represent a major obstacle to service provision. Hence, the primary duty of psychologists working in schools remains to perform psychoeducational assessments for coding purposes. Much work and advocacy is still needed to further the practice of school psychology in Quebec. Professional practice, training and, future perspectives of school psychology are further discussed in the current paper.
Analysis of Gait Disturbance in Glut 1 Deficiency Syndrome
Authors: Blumenschine Michelle , Montes Jacqueline , Rao Ashwini K. , Engelstad Kristin , De Vivo Darryl C.
Published: August 2016

Anticipating potential therapies for Glut 1 deficiency syndrome (Glut1DS) emphasizes the need for effective clinical outcome measures. The 6-minute walk test is a well-established outcome measure that evaluates walking ability in neurological diseases. Twenty-one children with Glut 1 deficiency syndrome and 21 controls performed the 6-minute walk test. Fatigue was determined by comparing distance walked in the first and sixth minutes. Gait was analyzed by stride length, velocity, cadence, base of support, and percentage time in double support. Independent sample t-tests examined differences between group. Repeated-measures analysis of variance evaluated gait parameters over time. Glut 1 deficiency syndrome patients walked less ( P < .05), had slower velocities ( P < .0001), had shorter stride lengths ( P < .0001), spent more time in double support ( P < .001), and had increasing variability in base of support ( P = .009). Glut 1 deficiency syndrome patients have impaired motor performance, walk more slowly, and have poor balance. The 6-minute walk test with gait analysis may serve as a useful outcome measure in clinical trials in Glut 1 deficiency syndrome.
Effect of Transition From a Unit-Based Team to External Transport Team for a Pediatric Critical Care Unit
Authors: Cummings Brian M. , Kaliannan Kanakaraju , Yager Phoebe H. , Noviski Natan
Published: August 2016

Objective:

Pediatric hospitals must consider staff, training, and direct costs required to maintain a pediatric specialized transport team, balanced with indirect potential benefits of marketing and referral volume. The effect of transitioning a unit-based transport team to an external service on the pediatric intensive care unit (PICU) is unknown, but information is needed as hospital systems focus on population management. We examined the impact on PICU transports after transition to an external transport vendor.

Methods:

Single-center retrospective review performed of PICU admissions, referrals, and transfers during baseline, post-, and maintenance period with a total of 9-year follow-up. Transfer volume was analyzed during pre-, post-, and maintenance phase with descriptive statistics and statistical process control charts from 1999 to 2012.

Results:

Total PICU admissions increased with an annual growth rate of 3.7%, with mean annual 626 admissions prior to implementation to the mean of 890 admissions at the end of period, P < .001. The proportion of transport to total admissions decreased from 27% to 21%, but mean annual transports were unchanged, 175 to 183, P = .6, and mean referrals were similar, 186 to 203, P = .8. Seasonal changes in transport volume remained as a predominant source of variability. Annual transport refusals increased initially in the postimplementation phase, mean 11 versus 33, P < .03, but similar to baseline in the maintenance phase, mean 20/year, P = .07. Patient refusals were due to bed and staffing constraints, with 7% due to the lack of transport vendor availability.

Conclusion:

In a transition to a regional transport service, PICU transport volume was maintained in the long-term follow-up and total PICU admissions increased. Further research on the direct and indirect impact of transport regionalization is needed to determine the optimal cost–benefit and quality of care as health-care systems focus on population management.
Withdrawing and Withholding Life Support in Patients With Cancer in an ICU Setting: A 5-Year Experience at a European Cancer Center
Authors: Tavares Márcio , Neves Inês , Chacim Sérgio , Coelho Fernando , Afonso Ofélia , Martins Anabela , Mariz J. Mário , Faria Filomena
Published: August 2016

Objective:

This was an observational retrospective study aimed to examine the frequency and associated factors of withdrawing or withholding life support (WWLS) in the intensive care unit (ICU) of a comprehensive cancer center.

Methods:

Medical records of adult patients with cancer admitted to the ICU between January 2010 and December 2014 were reviewed. Patients who died during that period were classified into 2 groups: full life support and withdrawing and withholding life support. The relative impact of demographic and clinical factors was assessed using logistic regression.

Results:

A total of 247 patients died in our unit (mortality rate of 16.3%). Their median age was 62 (interquartile range [IQR] 51-73) years, there were 142 (57.5%) male patients, and they had predominantly solid malignancies (62.3%). The median Simplified Acute Physiology Score II and Acute Physiology and Chronic Health Evaluation scores were 67 (IQR 54-80) and 29 (IQR 23-55), respectively. Ninety-six (38.9%) patients died after WWLS with no statistically significant differences in decisions to limit therapy during the study period. Patients with advanced age, solid malignancies, nonneutropenic, and longer duration of mechanical ventilation were more likely to die after WWLS. In multivariate analysis, presenting with neutropenia was independently associated with a lower likelihood of dying after WWLS (odds ratio: 0.34, 95% confidence interval: 0.15-0.80).

Conclusion:

Limitation of therapy has been a common practice in oncologic ICUs over recent years. Neutropenia is an independent predictor of limitation of therapy.
Factors That Influence Self-Reported Health Changes With Caregiving
Authors: Danilovich Margaret , Xiang Xiaoling , Pinto Daniel
Published: August 2016

Objective: This study examined factors associated with the self-reported change in health status as a result of caregiving. Method: Multinomial logistic regression were performed to examine the sociodemographic characteristics, care recipients’ characteristics, and caregiving experiences that affect caregivers’ perceptions of health affected by caregiving using data from 1,087 caregiver respondents in the Caregiving in the U.S. 2015 data set. Data were collected through an online or telephone survey of randomly selected adults in 50 states. Results: Worsened self-reported health with caregiving occurred for caregivers aged 50 to 64, racial/ethnic minorities, those who lived within 20 min of the care recipient’s home, the presence of cognitive deficits, prolonged caregiving, and limited availability of accessible and affordable care services. Importantly, the feeling of choice in taking on care responsibilities was associated with an over fourfold increase in the odds ratio (OR) of better health in response to caregiving (OR = 4.21; confidence interval [CI] = [1.95, 9.08]; p < .001). Discussion: Results suggest that improving accessibility of social service resources to assist caregivers in being better supported and having more choice in caregiving responsibilities may foster a positive change in health status with caregiving.
Real contact total length of linear motion roller guide without preload based on Greenwood–Williamson rough contact model
Authors: Ke Nan , Feng Hu-Tian , Chen Zeng-Tao , Ou Yi , Zhou Chang-Guang
Published: August 2016

In traditional studies of linear motion roller guide, the static stiffness is a main indicator to evaluate the mechanical behavior. However, the local contact profile between the roller and raceway surface, although very important to the precision maintenance, cannot be reflected in the measured value of static stiffness. In this article, a new indicator, named the real contact total length (RCTL), is proposed based on the Greenwood–Williamson model and the Hertz contact theory. In particular, an electric contact model is presented where the RCTL of linear motion roller guide without preload is expressed in terms of the measured electric resistances. To verify the model, an experiment is conducted to measure the electric resistances under different vertical loads by a designed load test bench and a digital, direct-current, high-resolution electric resistance meter (DRRM). The test results show good agreement with the model. Based on the electric contact model, the main parameters that affect the RCTL value are roughness Ra and the length of roller, which are directly related to the mechanical behavior of linear motion roller guide in the design and manufacture stages.
An improved footprint generation method for entry vehicles
Authors: Wang Tao , Zhang Hongbo , Li Yongyuan , Tang Guojian
Published: August 2016

Entry landing footprint is an important index of the flight capability of an entry vehicle. Footprint generation methods can be classified into three categories, namely, methods based on the interpolation of the drag profile, methods based on the maximum cross-range, and methods based on virtual targets. This paper proposes a procedure for improving the methods based on virtual targets method by avoiding the problem of setting virtual targets. Taking the cross-range of the vehicle as the performance index, the optimal control law is used to develop the bank angle control law. Through coordinate transformation, the optimal control problem is transformed into a univariate root-finding problem that is similar to the result of the methods based on virtual targets method. But the method in the paper is more convenient for engineering application. At last, the footprint of the EG13 mission of X-33 is generated.
Active fault-tolerant satellite attitude control based on fault effect classification
Authors: Zhou Jun , Li Xin , Liu Rui , Liu Yingying
Published: August 2016

An active fault-tolerant satellite attitude control scheme based on fault effect classification is presented at the occurrence of faults associated with torques. In this paper, the flexibility and practicability of the fault-tolerant scheme are top priorities. Faults are modeled and divided into additive and multiplicative ones in order to estimate and deal with them specifically and exactly. The additive faults, including additive part of flywheel faults and other uncertain fault torques, are estimated by additive fault estimator and compensated on the basis of nominal controller, whereas the multiplicative faults, denoting torque gain parameter faults of flywheels, are estimated by multiplicative fault estimator and the estimated fault parameters are used for dynamic torque command distribution of flywheels. The final simulation examples and performance comparison of three fault-tolerant schemes show that the proposed scheme based on fault effect classification is an effective, flexible and saving-energy fault-tolerant satellite attitude control scheme. It possesses an engineering value for improving reliability and prolonging on-orbit working lifetime of satellites.
A war psychiatry approach to warfare in the Middle Byzantine period
Authors: Ntafoulis Pavlos
Published: August 2016

Combat stress cases were traced in historical texts and military manuals on warfare from the Middle Byzantine period; they were mainly labelled as cowardice. Soldiers suffered from nostalgia or exhaustion; officers looked stunned, or could not speak during the battle. Cruel punishments were often enforced. Suicide and alcohol abuse were rarely mentioned. The Byzantines’ evacuation system for battle casualties was well organized. Psychological operations were conducted and prisoners-of-war were usually part of them. The Byzantine army had ‘ parakletores’, officers assigned to encourage soldiers before combat. The leaders dealt with combat stress by using their rhetoric skills and emphasizing religious faith in eternal life. The treatment of the ‘cowards’ was rather similar to modern war psychiatry principles of treatment. No description of PTSD was found.
Computational aero-acoustic modelling of external rear-view mirrors on a mid-sized Sedan
Authors: Mukkamala Yagnavalkya , Devabhaktuni Sandeep , Rajkumar Vishnu Ganesh
Published: August 2016

Ever-rising fuel costs necessitate design of fuel-efficient vehicles. Consequently, modern vehicle manufacturers are focused on designing low aerodynamic drag vehicles which would in-turn reduce the fuel consumption. This study analyses the contribution of external rear-view mirrors to the total drag force and the overall sound pressure level at the A, B and C pillars, while optimising the external rear-view mirror design accordingly. Solid Works renditions of external rear-view mirror models mounted on a reference luxury sedan were analysed using a commercially available computational fluid dynamic package ANSYS FLUENT. A different approach was followed to carry out the empirical flow visualisation and predict sound pressure levels. The aerodynamic characterisation of the vehicle was done utilising the widely used shear stress transport turbulence model, while the analysis of wind noise and the contributing vortices employed a large eddy simulation. This approach significantly reduced computational time without compromising on accuracy.
Adoption and use of information and communication technologies by Pentecostal churches in Ibadan, Nigeria
Authors: Omotayo Funmilola Olubunmi
Published: August 2016

Information and communication technologies have been accepted as one of the most significant forces of modernization. Studies have looked at the role information and communication technologies play in religion and their application in religious environments. However, the majority of these studies focused on the developed world. Few empirical studies focused on Nigeria. This study investigated the adoption and use of information and communication technologies by Pentecostal churches in Ibadan, Nigeria. The results revealed that the majority of Pentecostal churches in Ibadan have adopted and are using information and communication technologies, the main reason being to propagate the gospel. This research has been able to contribute to knowledge by bringing out their role and impact on church growth, spiritual upliftment of members and its concomitant effect on society as a whole.
Association between antiphospholipid antibodies and arterial thrombosis in patients with rheumatoid arthritis
Authors: Kim K-J , Baek I-W , Park K-S , Kim W-U , Cho C-S
Published: August 2016

Objectives

Antiphospholipid antibodies (aPL) are present in a proportion of patients with rheumatoid arthritis but their clinical significance remains unclear. We investigated the association between aPL and thrombotic events in rheumatoid arthritis patients.

Methods

In this cross-sectional study, aPL profiles were evaluated in 376 rheumatoid arthritis patients in accordance with the standard guidelines. Clinical and radiographic data were retrospectively collected.

Results

aPL were identified in 39 patients (10.4%). Lupus anticoagulant was the most common subtype ( n = 25, 6.6%); anti-cardiolipin antibodies and anti-β2 glycoprotein I antibodies were detected in six and 12 patients (1.6% and 3.2%), respectively. Compared to the aPL-negative group, aPL-positive patients included more male patients (41.0% vs. 15.4%, P < 0.001) and more smokers (41.0% vs. 16.0%, P = 0.001). There was no difference between the two groups in age, disease duration and body mass index, or the frequency of diabetes, hypertension or dyslipidaemia. Of note, arterial thromboses were more common in the aPL-positive than the aPL-negative group (12.8% vs. 2.1%, P = 0.004), whereas the frequency of venous thrombosis did not differ between the two groups (0.0% vs. 0.9%, P = 1.000). On multivariate regression analysis, aPL, age, hypertension, dyslipidaemia and baseline C-reactive protein level were independently associated with arterial thrombotic events (all P values < 0.05).

Conclusion

aPL was found in a subset of rheumatoid arthritis patients, who were more often smokers, and aPL was independently associated with development of arterial thrombosis. This result suggests that aPL may contribute to an increased risk of arterial thrombosis in rheumatoid arthritis patients.
Clinical characteristics of children with membranous lupus nephritis: the Childhood Arthritis and Rheumatology Research Alliance Legacy Registry
Authors: Boneparth A , Wenderfer S E , Moorthy L Nandini , Radhakrishna S M , Sagcal-Gironella A C P , von Scheven E ,   for the CARRA Registry investigators
Published: August 2016

Objective

The objective of this article is to describe and compare clinical features, treatment, and renal outcomes of children with membranous lupus nephritis (MLN), through analysis of a national multicenter registry.

Methods

Patients with pediatric systemic lupus erythematosus (SLE) and MLN from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Legacy Registry were included. Demographic, disease and medication-related data were collected between 2010 and 2014 from 59 CARRA Legacy Registry sites.

Results

A total of 132 individuals had MLN, either in isolation or in combination with proliferative LN. Seventy-four patients had pure MLN. The proportion of patients with daily corticosteroid treatment was similar among groups (96%, 91%, and 96%, for class III+V, IV+V, and V, respectively, p = 0.67). Proportion of individuals exposed to any disease-modifying antirheumatic drug (DMARD) or biologic was similar among the three groups (83%, 91%, 95% for class III+V, IV+V, and V, respectively, p = 0.189). Proportion of patients with decreased glomerular filtration rate (less than 90 ml/min/1.73 m2) was significantly different among groups (4%, 38%, and 4%, for class III+V, IV+V, and V, respectively, p < 0.0001).

Conclusion

This is the largest reported cohort of children with MLN. More research is needed to understand treatment practices for pediatric MLN, particularly decisions related to pharmacologic treatment of pure MLN. More work is also needed to identify prognostic factors and predictors of outcome for pediatric MLN. Future observational studies will be a first step toward understanding and formulating a standardized approach to treatment of pediatric membranous LN and allowing for the initiation of prospective comparative effectiveness studies and interventional trials.
Inferential tools in penalized logistic regression for small and sparse data: A comparative study
Authors: Siino Marianna , Fasola Salvatore , Muggeo Vito MR
Published: August 2016

This paper focuses on inferential tools in the logistic regression model fitted by the Firth penalized likelihood. In this context, the Likelihood Ratio statistic is often reported to be the preferred choice as compared to the ‘traditional’ Wald statistic. In this work, we consider and discuss a wider range of test statistics, including the robust Wald, the Score, and the recently proposed Gradient statistic. We compare all these asymptotically equivalent statistics in terms of interval estimation and hypothesis testing via simulation experiments and analyses of two real datasets. We find out that the Likelihood Ratio statistic does not appear the best inferential device in the Firth penalized logistic regression.
New Testament Prophecy and Its Implications for the Ministry of Women
Authors: Cox Jennifer Anne
Published: August 2016

Instead of considering the question of the role of Christian women in ministry by providing a new exegesis of contested passages it is helpful to provide a new approach to the matter. This new approach is to explore the nature of New Testament prophecy. The line drawn between prophecy and teaching is not as clear as some conservatives contend, since both make use of Scripture. Women are named as prophets in the Bible and some female prophets have had their words recorded as Scripture. Paul ranks prophets more highly than teachers in 1 Cor. 12.28. Therefore, if women can prophesy they can also teach. This approach provides a way of biblically affirming the full ministry of women within the Christian Church.
Relational Demography in John 4: Jesus Crossing Cultural Boundaries as Praxis for Christian Leadership
Authors: Jones-Carmack Joy
Published: August 2016

Utilizing social rhetorical criticism and social cultural texture, this exegetical analysis of John 4 examines the transformational interaction of Jesus and a Samaritan woman. Previous research focuses on the woman’s demographic profile without fully investigating the significance of relational demography in the context of first century Mediterranean culture. This analysis of the social cultural texture of John 4 presents a model for Christian leadership that crosses gender, race, and geographic barriers and capitalizes on the benefits of relational demography for organizational success.