bluuebunny/crossref_metadata_2025 huggingface dataset:
Making healthcare decisions in a person’s best interests when they lack capacity: clinical guidance based on a review of evidence
Authors: Wade Derick T , Kitzinger Celia
Published: June 2019

Objective:

To clarify the concept of best interests, setting out how they should be ascertained and used to make healthcare decisions for patients who lack the mental capacity to make decisions.

Context:

The legal framework is the Mental Capacity Act (MCA) 2005, which applies to England and Wales.

Theory:

Unless there is a valid and applicable Advance Decision, an appointed decision-maker needs to decide for those without capacity. This may be someone appointed by the patient through a Lasting Power of Attorney, or a Deputy appointed by the court. Otherwise the decision-maker is usually the responsible clinician. Different approaches exist to surrogate decision-making cross-nationally. In England and Wales, decision-making is governed by the MCA 2005, which uses a person-centred, flexible best interests (substituted interests) approach.

Observations:

The MCA is often not followed in healthcare settings, despite widespread mandatory training. The possible reasons include its focus on single decisions, when multiple decisions are made daily, the potential time involved and lack of clarity about who is the responsible decision-maker.

Solution:

One solution is to decide a strategic policy to cover more significant (usually health-related) decisions and to separate these from day-to-day relational decisions covering care and activities. Once persistent lack of capacity is confirmed, an early meeting should be arranged with family and friends, to start a process of sharing information about the patient’s medical condition and their values, wishes, feelings and beliefs with a view to making timely treatment decisions in the patient’s best interests.
Cognitive function in aging cocaine smokers
Authors: Chao Thomas , Haney Margaret , Cooper Ziva D , Vadhan Nehal P , Van Dam Nicholas T , Van Snellenberg Jared , Bedi Gillinder
Published: June 2019

Background:

Little is known about the functional status of older drug users, who may pose challenges to public health systems in coming years. Here, we assessed cognitive function in aging cocaine smokers compared to demographically matched controls.

Methods:

A total of 22 non-treatment-seeking aging (50–60 years old) cocaine smokers (⩾twice/week; ⩾15 years of weekly use) and 19 controls completed a comprehensive cognitive battery. Controls with cannabis, tobacco, and alcohol use were included to better match the cocaine users. All cocaine users, and current cannabis- or alcohol-using controls, completed testing after 4 drug-free inpatient days to better control for acute and residual drug effects.

Results:

Cocaine users (52.9 ± 2.5 years old, four female; cocaine use 3.9 ± 1.4 days/week) and controls (52.7 ± 2.6 years old, four female) were well matched demographically, but cocaine users reported a more extensive substance use profile. Cocaine users showed marginally worse verbal learning than controls, recalling on average one word fewer across immediate and delayed word recall trials. Their performance was intact relative to controls across all other measures of cognitive function. Bayesian analysis indicated the absence of group differences was not due to power limitations.

Conclusion:

These data suggest that aging, long-term cocaine users have similar cognitive functioning to appropriately matched controls when tested under drug-free conditions, with only marginal decreases in verbal learning. Findings, although reassuring with regard to broad cognitive capacities in aging cocaine smokers, suggest that future investigations of cognitive function in aging drug users are warranted.
Rheumatoid cervical pannus: feasibility of volume and perfusion quantification using dynamic contrast enhanced time resolved MRI
Authors: Fasler David A , Ingrisch Michael , Nanz Daniel , Weckbach Sabine , Kyburz Diego , Fischer Dorothee R , Guggenberger Roman , Andreisek Gustav
Published: June 2019

Background

Dynamic contrast-enhanced magnetic resonance imaging has the potential to show disease activity of rheumatoid arthritis even in complex anatomic areas as the atlantodental region.

Purpose

To demonstrate the technical feasibility of measuring synovial volume and perfusion characteristics with dynamic contrast-enhanced magnetic resonance imaging of the atlantodental region in patients with rheumatoid arthritis.

Material and Methods

Ten patients with rheumatoid arthritis and cervical spine involvement underwent dynamic contrast-enhanced magnetic resonance imaging of the cervical spine at 1.5 T. For each patient, 80 3D datasets were acquired using the commercialized Time Resolved Imaging of Contrast KineticS (TRICKS) sequence. Volumes of synovia with active synovitis on anatomical and parametric images were segmented. Synovial tissue perfusion parameters, namely plasma flow (Fp), relative plasma volume (vp), and the permeability-surface area product (PS), were calculated using a two-compartment uptake model. Statistical analysis included calculation of intra- and inter-reader agreement and a correlation of perfusion parameters with Outcome Measures in Rheumatology Clinical Trials (OMERACT) criteria.

Results

Dynamic contrast-enhanced magnetic resonance imaging as well as quantification of volume and perfusion characteristics of synovia was successful in most patients (80%). Intra- and inter-reader agreement was excellent (0.89–0.99). There was a positive correlation between OMERACT score and the permeability-surface product.

Conclusion

Dynamic contrast-enhanced magnetic resonance imaging using a 4D angiography sequence for the atlantodental region in patients with rheumatoid arthritis for quantitative and qualitative assessment of synovial volume and perfusion characteristics is technically feasible.
Resilience in Fukushima: Contribution to a Political Economy of Consent
Authors: Ribault Thierry
Published: June 2019

This article is a contribution to the political economy of consent based on the analysis of speeches, declarations, initiatives, and policies implemented in the name of resilience in the context of the Fukushima nuclear disaster. It argues that, in practice as much as in theory, resilience fuels peoples’ submission to an existing reality—in the case of Fukushima, the submission to radioactive contamination—in an attempt to deny this reality as well as its consequences. The political economy of consent to the nuclear, of which resilience is one of the technologies, can be grasped at four interrelated analytical levels adapted to understanding how resilience is encoded in key texts and programs in the wake of the Fukushima Daiichi accident. The first level is technological: consent through and to the nuclear technology. The second level is sociometabolic: consent to nuisance. The third level is political: consent to participation. The fourth level is epistemological: consent to ignorance. A fifth cognitivo-experimental transversal level can also be identified: consent to experimentation, learning and training. We first analyze two key symptoms of the despotism of resilience: its incantatory feature and the way it supports mutilated life within a contaminated area and turns disaster into a cure. Then, we show how, in the reenchanted world of resilience, loss opens doors, that is, it paves the way to new “forms of life”: first through ignorance-based disempowerment; second through submission to protection. Finally, we examine the ideological mechanisms of resilience and how it fosters a government through the fear of fear. We approach resilience as a technology of consent mobilizing emotionalism and conditioning on one side, contingency and equivalence on the other.
Development of a parameterized reduced-order vertical-axis wind turbine wake model
Authors: Tingey Eric B , Ning Andrew
Published: June 2019

Analyzing or optimizing wind farm layouts often requires reduced-order wake models to estimate turbine wake interactions and wind velocity. We propose a wake model for vertical-axis wind turbines in streamwise and crosswind directions. Using vorticity data from computational fluid dynamic simulations and cross-validated Gaussian distribution fitting, we produced a wake model that can estimate normalized wake velocity deficits of an isolated vertical-axis wind turbine using normalized downstream and lateral positions, tip-speed ratio, and solidity. Compared with computational fluid dynamics, taking over a day to run one simulation, our wake model predicts a velocity deficit in under a second with an appropriate accuracy and computational cost necessary for wind farm optimization. The model agreed with two experimental studies producing percent differences of the maximum wake deficit of 6.3% and 14.6%. The wake model includes multiple wake interactions and blade aerodynamics to calculate power, allowing its use in wind farm layout analysis and optimization.
Intravenous versus inhalational anaesthesia and lung ventilation–perfusion matching
Authors: Peyton Philip J , Marsh Harry , Thompson Bruce R
Published: June 2019

Lung gas exchange efficiency deteriorates during general anaesthesia due to ventilation–perfusion ( V/Q) scatter. Propofol total intravenous anaesthesia (TIVA) may preserve V/Q matching better than inhalational agents. We compared V/Q matching in patients randomized to either TIVA or sevoflurane anaesthesia, using deadspace and shunt measurements and the MIGET (Multiple Inert Gas Elimination Technique). Baseline arterial blood and mixed expired gas sampling was done before induction and repeated after one to two hours of relaxant general anaesthesia in 20 patients, supine with controlled ventilation at an FiO2of 0.3 and a target end-tidal PCO2of 30–35 mmHg. Blood samples for MIGET were processed after headspace equilibration by gas chromatography. The primary endpoint was a comparison of the two groups in the change from baseline of absolute difference between log standard deviation of ventilation and blood flow distributions (∂(σV−σQ)). Deadspace fraction increased and PaO2/FiO2ratio decreased across both groups overall with anaesthesia, but change in deadspace was not different between groups (mean (standard deviation, SD) sevoflurane 21.8% (11.7%) versus TIVA 20.5% (10.6%), P = 0.601). Change in PaO2/FiO2ratio was also similar between groups (mean (SD) sevoflurane −51.9 (69.1) mmHg versus TIVA −78.3 (76.9) mmHg, P = 0.43), as was change in shunt fraction (δQs/Qt mean (SD) sevoflurane −5.1% (12.6%) versus TIVA 0.4% (7.7%), P = 0.174). The primary endpoint ∂(σV−σQ) was not different between sevoflurane and propofol TIVA groups (mean (SD) 0.17 (0.81) versus 0.17 (0.29), P = 0.94). TIVA did not better preserve V/Q matching in patients undergoing anaesthesia with controlled ventilation compared with sevoflurane.
Enhanced Methodology for the Identification of Locations with High Risk of Wet Crashes
Authors: Vélez Rodríguez Kenneth X. , Katicha Samer W. , Flintsch Gerardo W.
Published: June 2019

About 18% of crashes on Virginia’s interstates from 2014 to 2016 were reported to be wet crashes. Although extensive research on crashes has been conducted, limited attention has been devoted to the prediction of wet crashes. The ratio of wet over dry crashes (wet over dry ratio [WDR]) has traditionally been the parameter of interest. In this paper, negative binomial regression is used to quantify the relationship between WDR and traffic and road parameters. One issue with the WDR is the handling of sites with zero dry crash counts. This was addressed by numerically replacing the zeros with 0.5 or by using an empirical Bayes estimate of the expected number of dry crashes instead of the dry crash counts. The empirical Bayes approach resulted in a better model fit as measured using Akaike’s Information Criterion. The negative binomial model developed for wet crashes was used to identify parameters that affect the pavement water film thickness and the expected number of wet crashes. The approach identified the longitudinal grade difference as an important parameter.
Relationship between Online Shopping and Store Shopping in the Shopping Process: Empirical Study for Search Goods and Experience Goods in Nanjing, China
Authors: Zhai Qing , Cao Xinyu (Jason) , Zhen Feng
Published: June 2019

As online shopping proliferates, many studies have investigated its impact on travel. Most studies, however, treat online shopping as a transaction channel and overlook its interaction with physical shopping at various stages of the shopping process. Using adult internet users in Nanjing, China, this study explores the interactions between online shopping and traditional shopping for search goods (books) and experience goods (clothing) during the shopping process. The results show that experience goods have a stronger stickiness combination between pre-purchase channels and transaction channels than search goods. As a pre-purchase channel for experience goods, stores are more likely to promote cross-channel than internet shopping; the relationship is the opposite for search goods.
Disability Segregation in Volunteer Work
Authors: Shandra Carrie L.
Published: June 2019

People with disabilities in the United States experience different types of paid work than people without disabilities; however, less is known about patterns in voluntary work—another form of productive labor that takes place within organizations. This study uses the Volunteer Supplement of the Current Population Survey to evaluate disability segregation in volunteer organizations and activities. Net of sociodemographic characteristics, volunteers with disabilities have lower odds than volunteers without disabilities of participating in educational/youth organizations and sport/hobby/cultural organizations, and higher odds of participating in social/community organizations. Furthermore, volunteers with disabilities have lower odds of participating in professional or coaching/teaching/mentoring activities and higher odds of participating in distribution activities—suggesting less access to leadership roles and opportunities for skill development. Finally, indices of dissimilarity indicate higher levels of segregation by disability status than by gender, race, or ethnicity. Volunteer work—like paid work—is stratified by disability, mirroring broader patterns of inequality.
Lost in Translation: Obstacles to Converting Global Cultural Capital to Local Occupational Success
Authors: Jarvis Jonathan A.
Published: June 2019

International students studying at foreign universities believe this experience will translate to occupational opportunities in their home countries. Although the motives for global education have been considered, we know less about the conversion process upon return. Using 66 in-depth interviews (20 evaluators, 20 locally-educated Koreans, 26 foreign-educated Koreans), I examine how global cultural capital can be both deeply meaningful and an obstacle to organizational fit and reintegration. When Koreans leave Korea before attending a local university, the acquisition of global institutional, embodied, and objectified cultural capital may come at the expense of how they activate or portray embodied local cultural capital. Koreans with more balanced global and local cultural capital—those leaving after graduating from a Korean university—were able to navigate the work context with greater ease, choosing when and how to signal both their global knowledge and understanding of the rules of the Korean work world.
Influence of Cognition on Length of Stay and Rehospitalization in Older Veterans Admitted for Post-Acute Care
Authors: Stelmokas Julija , Rochette Amber D. , Hogikyan Robert , Kitchen Andren Katherine A. , Reckow Jaclyn , Sciaky Alexandra , Bieliauskas Linas , Alexander Neil B.
Published: June 2019

Objectives:

Evaluate the relative contribution of cognitive test performance to post-acute care (PAC) length of stay (LOS) and rehospitalization while controlling for key demographic, medical, and functional outcomes.

Methods:

Retrospective medical record review of 160 older Veterans, including cognitive test performance (Addenbrooke’s Cognitive Examination–Revised [ACE-R]), on admission to a Veterans Administration Hospital Community Living Center (CLC) PAC.

Results:

Individuals with impaired scores on the ACE-R had a longer LOS (10 median days longer; U = 2,547.00, p = .028). Of those rehospitalized, 71.4% ( n = 20) screened positive for cognitive impairment. Key medical factors explained the largest amount of variance in CLC-PAC LOS (29.8%), followed by admission ADL (activities of daily living) dependency (4.6%) and ACE-R total score (3.30%).

Discussion:

Cognitive screening should be considered on PAC admission, with impairment on ACE-R predicting geriatric rehabilitation outcomes such as risk of increased LOS and rehospitalization.
Association of Daytime Napping and Diagnosed Diabetes in Middle-Aged Premenopausal, Middle-Aged Postmenopausal, and Older Postmenopausal Chinese Women
Authors: Fang Shu , Zhou Junmin
Published: June 2019

Purpose:

To examine associations of daytime napping and diagnosed diabetes in middle-aged premenopausal, middle-aged postmenopausal, and older postmenopausal Chinese women.

Design:

Quantitative, cross-sectional.

Setting:

2015 cross-sectional data from China Health and Retirement Longitudinal Study. Participants were recruited from 150 counties/districts and 450 villages/resident committees.

Participants:

Six thousand nine hundred and forty women aged 45 years and older (mean age = 61 years) stratified by age and menopausal status.

Measures:

The outcome was self-reported diagnosed diabetes. The exposure was self-reported daytime napping (0, >0-≤60, or >60 min/d). Participants were stratified to middle-aged premenopausal, middle-aged postmenopausal, and older postmenopausal women according to their age (≤60 or >60 years) and menopausal status.

Analysis:

One-way analysis of variance and χ2 tests were conducted to explore differences on characteristics of middle-aged premenopausal, middle-aged postmenopausal, and older postmenopausal women. Multiple logistic regressions were used to estimate adjusted odds ratios (ORs) for diagnosed diabetes according to daytime napping in the total sample, middle-aged premenopausal, middle-aged postmenopausal, and older postmenopausal Chinese women.

Results:

Participants’ mean self-reported daytime napping duration was 34 minutes. Women who napped more than 60 minutes were more likely to report diagnosed diabetes (OR = 1.39, 95% confidence interval (CI), 1.09-1.76) comparing to those who did not nap, after adjusting for potential confounders. No statistical significance of interaction term between daytime napping and age/menopausal status was detected ( P = .602 and P = .558) among total women. The stratified analysis revealed the significant association among middle-aged postmenopausal women napping more than 60 minutes (OR = 1.81, 95% CI, 1.18-2.77). The association, however, was found to be insignificant in middle-aged premenopausal women and older postmenopausal women.

Conclusions:

Long daytime nap (>60 min/d) was associated with diagnosed diabetes in middle-aged postmenopausal women in China.
The Impact of Cognitive Impairment on Poststroke Outcomes: A 5-Year Follow-Up
Authors: Rohde Daniela , Gaynor Eva , Large Margaret , Mellon Lisa , Hall Patricia , Brewer Linda , Bennett Kathleen , Williams David , Dolan Eamon , Callaly Elizabeth , Hickey Anne
Published: June 2019

Aim:

To explore the impact of cognitive impairment poststroke on outcomes at 5 years.

Methods:

Five-year follow-up of the Action on Secondary Prevention Interventions and Rehabilitation in Stroke (ASPIRE-S) prospective cohort. Two hundred twenty-six ischemic stroke survivors completed Montreal Cognitive Assessments at 6 months poststroke. Outcomes at 5 years included independence in activities of daily living, receipt of informal care, quality of life, and depressive symptoms. Data were analyzed using logistic and linear regression models. Adjusted odds ratios (ORs; 95% confidence interval [CI]) and β coefficients (95% CI) are reported.

Results:

One hundred one stroke survivors were followed up at 5 years. Cognitive impairment at 6 months was independently associated with worse quality of life (B [95% CI]: −0.595 [−0.943 to −0.248]), lower levels of independence (B [95% CI]: −3.605 [−5.705 to −1.505]), increased likelihood of receiving informal care (OR [95% CI]: 6.41 [1.50-27.32]), and increased likelihood of depressive symptoms (OR [95% CI]: 4.60 [1.22-17.40]). Conclusion: Cognitive impairment poststroke is associated with a range of worse outcomes. More effective interventions are needed to improve outcomes for this vulnerable group of patients.
Influence of thread count of carbon twill textile-reinforced polyamide 66 laminates on the inductive heating behavior
Authors: Becker Stephan , Mitschang Peter
Published: June 2019

This study addresses the experimental investigation of the influence of the thread count of carbon fiber (CF) twill textile-reinforced polyamide 66 laminates on their inductive heating behavior. By means of stationary heating experiments of laminates, different twill 2/2 fabrics have been investigated. The used twill 2/2 fabrics differ only in thread count and consequently in their area weight. Due to the different area weight, the manufactured laminates differ in the number of plies to guarantee an equal fiber volume content in each plate. In order to evaluate the heating behavior of the different specimens, the heating rates of both surfaces of the specimens were measured and compared. Thus, it was found that a lower thread count promotes a faster inductive heating of CF twill 2/2-reinforced polymer composites. Further investigations based on microsection analysis and measurements of rovings cross-section shape revealed that the increase of heating rates at lower thread counts relies more on the number of fabric layers. Through a higher number of fabric layers, the total contact area will be higher due to more interply and intraply contact interfaces which occur in the laminate.
Are You Out There? Internet Presence of Nonprofit Human Service Organizations
Authors: Campbell David A. , Lambright Kristina T.
Published: June 2019

Using a sample of nonprofit human service organizations in South Central New York, this article analyzes the nature and extent of their Internet presence by examining their adoption of various Internet-based tools as well as their activity and visibility on the Internet. Nearly all organizations had websites but few provided interactive features, beyond the opportunity to donate. Many organizations also used at least one form of social media, although level of adoption, activity, and visibility varied. High capacity organizations and those with members had higher levels of Internet presence while those reliant on program service fees and government funding had lower levels. In addition, our results suggest distinct aspects of Internet presence are related and organizations can increase their visibility on the Internet by being more active.
The effect of endwall boundary layer and incoming wakes on secondary flow in a high-lift low-pressure turbine cascade at low Reynolds number
Authors: Qu Xiao , Zhang Yanfeng , Lu Xingen , Lei Zhijun , Zhu Junqiang
Published: June 2019

The endwall flow features are heavily dependent on the incoming boundary layer. It was particularly important to increase understanding the effect of inlet boundary layer thickness on endwall secondary flow under unsteady conditions. In present study, the influences of incoming wakes and various boundary layer thickness on endwall secondary flow were studied in a typical high-lift low-pressure turbine cascade, numerical calculation and experiment measurement of seven-hole probe were adopted at Re = 25,000 (based on the inlet velocity and the axial chord). Upstream wakes were simulated through moving rods upstream of the cascade. Detailed analysis was focused on the mechanisms of periodic wake influencing on the endwall vortex structures under thick endwall boundary layer condition. Influences of two different endwall boundary layer thickness on endwall secondary vortices structures were also comparatively analyzed. Under steady condition without wake, although thick incoming boundary layer reduces the cross-passage pressure gradient near endwall, more low momentum fluid inside thick endwall boundary layer is drawn into secondary vortices, finally resulting in stronger the pressure side leg of the leading edge horseshoe vortex and passage vortex, compared to the results of thin boundary layer condition. Under unsteady condition with thick inlet boundary layer, the “negative jet” effect of incoming wakes delays intersection of pressure side leg and suction side leg of leading edge horseshoe vortex on blade suction surface. The time-averaged strength of passage vortex and counter vortex core decreases by about 32%, and the underturning and overturning of endwall secondary flow is suppressed. The instantaneous results also indicate the endwall secondary vortices are reduced periodically at the position of wakes passing.
Genetic algorithm optimized finite frequency H∞ time-delay control with the objective to maximize the allowable external disturbance energy
Authors: Wang Xingye , Zhang Jinqiu , Li Guoqiang , Zhang Jian , Peng Zhizhao
Published: June 2019

In order to alleviate the deterioration on control effect caused by the inertia mass and the time-delay of a rack and pinion electromagnetic actuator, a finite frequency dynamic output feedback H∞ time-delay control strategy is proposed in this article. Currently, a H∞ controller is generally designed with the objective to minimize the infinite norm of the transfer function from the external disturbance to the control output, and the values of the slack coefficients are obtained according to the experience. But when used in practical, problems are found that only small external disturbance energy and narrow scope of driving conditions are allowed and it is difficult to find the optimal solution just according to the experience. In allusion to these problems, a H∞ controller design method with the objective to maximize the allowable external disturbance energy is proposed, and genetic algorithm is used to optimize the values of the slack coefficients. Finally, bench tests are carried forward to verify the control effects of the two controllers. The tests results show that, the controller designed with the objective to maximize the allowable external disturbance energy can adapt to more severe driving conditions, and it is more significant in actual application on vehicles.
Knowledge and Distrust May Go a Long Way in the Battle With Disinformation: Mental Processes of Spontaneous Disbelief
Authors: Mayo Ruth
Published: June 2019

A common claim is that people have an easier time accepting information than rejecting it, resulting in gullibility. In this article, I review empirical research demonstrating how the human mind is equipped with successful and spontaneous rejection processes that may protect us from disinformation.
Source of Finance Resorted to, Cost Involved in Financing and Financing Decisions Taken by MSMEs: An Insight into Sports Goods Industry of Punjab
Authors: Mahajan Divya , Sidhu Amarjit
Published: June 2019

The research paper presents research done on access to finance by micro-, small- and medium-sized enterprises (MSMEs). There is a substantial evidence that small firms face larger growth constraints and have less access to formal sources of external finance. The study offers an insight into the sources of finance used by the enterprises of Sports Goods Industry of Punjab. In this article, the relationship or association between age of the MSMEs is studied with source of finance chosen by them, that is, whether there is any pattern witnessed in choosing the source of finance by young and old organisations. The findings were based on interviews conducted with 107 organisations.
Theoretical analysis on the adaptive vibration attenuation of a fixed-fixed beam realized by a piezo-shape memory alloy ferrule
Authors: Wang Longfei , Wu Ying , Liu Zishun
Published: June 2019

In this article, the vibration attenuation of a fixed-fixed beam with a piezo-shape memory alloy ferrule is theoretically investigated. First, a dynamic model of the beam with a piezo-shape memory alloy ferrule is established, and the nonlinear dynamic response of the model is numerically analysed. The results show that the stability of the beam structure can be improved adaptively through self-regulation of the stiffness of the piezo-shape memory alloy ferrule undergoing external excitations. The effects of some internal system characteristics, such as the ferrule dimensions as well as the initial ferrule temperatures and boundary conditions, on the vibration attenuation of the beam are discussed. The stability of the proposed model under different external factors, including damping and external excitations, is also investigated. Compared with an aluminium ferrule, the present ferrule is better at the suppressing vibrations of the beam, and its adaptive property avoids the structural resonances for bigger ferrule sizes, making it more intelligent, efficient and convenient.
Dissensus, Resistance, and Ideology: Design Thinking as a Rhetorical Methodology
Authors: Greenwood April , Lauren Benjamin , Knott Jessica , DeVoss Dànielle Nicole
Published: June 2019

Design thinking—at times described as a mind-set, practice, process, method, methodology, tool, heuristic, and more—is a productive, iterative approach used to engage divergent thinking. Often made up of stages incorporating empathy, definition, ideation, prototyping, and testing, design thinking provides a framework for identifying and approaching problems. Design thinking, however, generally lacks a critical–rhetorical–methodological structure that makes room for what Rebecca Burnett called “substantive conflict,” or “conflict that deals with critical issues of content and rhetorical elements.” This article situates design thinking across the professional and academic spaces in which it is heralded and implemented in order to explore how it can be used in collaborative contexts to support substantive, productive dissensus. The authors lean on the ways in which they engage in design thinking in their different roles to situate the good, the bad, and the ugly of design thinking. They conclude by suggesting a rhetorical methodology for cultivating design thinking that facilitates dissensus, addresses resistance, and considers ideological variables.
Teacher Trust in District Administration: An Overlooked Relational Support for Teachers
Authors: Adams Curt M.
Published: June 2019

Trust effects between internal school actors (e.g., teachers, students, administrators, parents) are well established in the literature, but less evidence exists about trust in district administration, leading to the question addressed in this study: Does teacher trust in district administration operate in a similar way as other trust forms? The study begins by situating trust within district leadership literature. A definition of trust in district administration is then advanced and its nature explained. From here, evidence on trust effects and self-determination theory are used to advance a hypothesized model that is tested in the empirical analysis. Results support the theory that trust in district administration may function as a relational support for teachers.
Stiripentol: A Novel Antiseizure Medication for the Management of Dravet Syndrome
Authors: Buck Marcia L. , Goodkin Howard P.
Published: June 2019

Objective: To describe the pharmacology, efficacy, and safety of stiripentol in the treatment of refractory seizures in patients with Dravet syndrome. Data Sources: A search of the English language literature was conducted using PubMed and MEDLINE (1978 to April 2019) with the search terms stiripentol, Dravet syndrome, and refractory epilepsy. Other resources included article bibliographies, prescribing information, and relevant trials at https://clinicaltrials.gov/ . Study Selection and Data Extraction: All phase 1, 2, or 3 trials; observational studies; and retrospective studies were analyzed. Data Synthesis: In controlled studies, stiripentol has been shown to reduce seizure frequency by 50% or more in 40% to 70% of patients with Dravet syndrome. Reductions in seizure duration and episodes of status epilepticus have also been documented. Common adverse effects include somnolence and anorexia. Stiripentol inhibits the metabolism of clobazam and valproate, often requiring dose adjustment. Relevance to Patient Care and Clinical Practice: Stiripentol, a direct allosteric modulator of GABAA receptors, offers a novel approach to treatment in patients with Dravet syndrome, both with and without pathogenic variants of the sodium channel α-1 subunit gene, and potentially other refractory seizures. Although available outside the United States for a decade, it was only recently approved by the Food and Drug Administration for patients 2 years of age and older with Dravet syndrome taking clobazam. Conclusions: Stiripentol is an effective adjunctive therapy for reducing the frequency and duration of refractory seizures in patients with Dravet syndrome. Its role in the treatment of other refractory epilepsies requires further study.
Abnormal wave propagation behaviors in two-dimensional mass–spring structures with nonlocal effect
Authors: Wang Jiao , Huang Yang , Chen Weiqiu , Zhu Weiqiu
Published: June 2019

This paper considers the propagation of elastic waves in periodic two-dimensional mass–spring structures with diagonal springs. The second-neighbor interactions in non-diagonal directions are included to account for the nonlocal effect. The influences of the spring stiffness in the diagonal directions and the nonlocal effect on the propagation characteristics of elastic waves are then scrutinized. Through the dispersion relation curve and the equi-frequency contours, it is seen that when the diagonal spring stiffness increases, the slope of the second curve in the [Formula: see text]–M direction will not always be positive, meaning that the negative group velocity occurs. Therefore, an incident wavevector with a chosen angle to the negative group velocity can lead to the negative refraction phenomenon in the two-dimensional mass–spring structure. Another interesting phenomenon called directional radiation of elastic waves can also be achieved by adjusting the nonlocal effect. Within a certain range, the stronger the nonlocal effect in a specific direction is, the more obviously the elastic waves propagate along this direction. In this paper, we theoretically analyze and numerically simulate the phenomena of negative refraction and directional wave propagation by choosing a proper set of parameters of the two-dimensional mass–spring structure.
Identification of separated lenticular planes using optical coherence tomography
Authors: Zheng Ke , Han Tian , Zhao Feng , Han Yinan , Zhou Xingtao
Published: June 2019

Purpose:

To discuss how optical coherence tomography can be used to identify separated lenticular planes during small incision lenticule extraction (SMILE).

Methods:

SMILE procedures were performed on 26 eyes of 13 patients. An anterior segment optical coherence tomography examination was performed after laser scan. Anterior segment optical coherence tomography examinations were conducted again both after separation of the anterior lenticular plane in the right eye and after separation of the posterior lenticular plane in the left eye. Lenticule extraction was then completed, followed by another anterior segment optical coherence tomography examination. Anterior segment optical coherence tomography was also conducted on both eyes on the first day after surgery. Each measurement consisted of four line scans along the 45°, 90°, 135°, and 180° meridians. The brightness scores were compared between the two planes after the separation of one plane.

Results:

Anterior segment optical coherence tomography showed two bright lines after laser scan. Along with all meridians, the brightness of the anterior plane was less in the right eye, for which only the anterior plane was separated, and the brightness of the posterior plane was less in the left eye, for which only the posterior plane was separated (all P < 0.001). After lenticule extraction in both eyes, anterior segment optical coherence tomography revealed that a smooth hyperreflective line existed between the cap and the residual stromal bed, and this line remained throughout the first day after surgery.

Conclusion:

The bubbles produced by the creation of the lenticule in SMILE mostly disappear by manual separation, and anterior segment optical coherence tomography can help the surgeon identify the separated lenticular planes.
Vision-related quality of life in patients treated for myopic choroidal neovascularization: A post hoc analysis of the OLIMPIC study
Authors: Virgili Gianni , Parravano Mariacristina , Viola Francesco , Varano Monica
Published: June 2019

Purpose:

To investigate vision-related quality of life in patients referred to the Italian Retina Services for intravitreal ranibizumab treatment for choroidal neovascularization due to pathologic myopia.

Design:

Post hoc analysis of a multicenter, interventional phase IIIb study (OLIMPIC).

Methods:

Patients with either previously untreated (naïve) or treated choroidal neovascularization due to pathologic myopia were enrolled. Vision-related quality of life was measured using the Italian version of the Impact of Vision Impairment Questionnaire with scores from 0 (no impact) to 5 (severe impact). Burden of illness data were collected regarding income, and personal and public resource use.

Results:

In the 200 included subjects, mean best-corrected visual acuity in the better eye was 68.3 Early Treatment Diabetic Retinopathy Study letters (standard deviation: 15.2) compared with 42.5 Early Treatment Diabetic Retinopathy Study letters (standard deviation: 23.3) in the worse eye. The proportion of better eyes affected by choroidal neovascularization was 147/200 (73.5%). In multivariable analyses, lower better eye, but not worse eye, best-corrected visual acuity was associated with lower vision-related quality of life (per 10 fewer letters, beta: + 0.17, p < 0.001). An annual income below 20,000 euros was also associated with lower vision-related quality of life (beta: + 0.38; standard error: 0.13, p = 0.004). Moreover, in univariate analyses, increasing income level was linearly associated with better presenting best-corrected visual acuity in the better eye (p < 0.003), with a difference of 15 Early Treatment Diabetic Retinopathy Study letters for patient income <20,000 euros compared with >70,000 euros.

Conclusion:

Italian patients with myopic choroidal neovascularization and a low income presented with lower better-eye best-corrected visual acuity and lower vision-related quality of life compared with those with a higher income. Future research should investigate disease awareness and candidacy issues that may influence the quality of life of patients.
Initial 3-year results of first human use of an in-body tissue-engineered autologous “Biotube” vascular graft for hemodialysis
Authors: Nakayama Yasuhide , Kaneko Yoshiyuki , Okumura Noriko , Terazawa Takeshi
Published: June 2019

This study presents the initial 3-year results of the first in-human study of internal shunt restoration using completely autologous vascular grafts, “Biotubes,” based on in-body tissue architecture. Biotubes (diameter, 6 mm; length, 7 cm) were prepared as autologous collagenous tubular tissues with approximately 0.5 mm wall thickness by embedding molds (two per patient), assembled with a silicone rod and a stainless steel pipe with many slits, into the patients’ abdominal subcutaneous tissue for 2 months. Two female patients with end-stage renal disease were undergoing hemodialysis with a high probability of failure due to repeated stenosis every few months at the venous outflow regions over 1.5 years. Biotubes formed in both patients and were bypassed over the venous stenosis region of the arteriovenous shunt. After bypass with Biotubes without living cells, palpable thrill and typical turbulent flow pattern were observed by pulsed-wave Doppler. Follow-up angiography showed no signs of dilation or stenosis after implantation, and puncture could be performed easily without graft damage. In both cases, stenosis of Biotubes occurred after 3–4 months. In the first case, percutaneous transluminal angioplasty was not required for over 2 years after implantation even after the development of Biotube stenosis. In the second case, stenosis at the proximal anastomotic site of the Biotube became prominent, and percutaneous transluminal angioplasty was needed 7 months after implantation and then repeated at up to 2 years. This was the first human study successfully supporting the concept of internal shunt restoration for hemodialysis using an autologous Biotube.
Doing Dis/ordered Mappings: Shapes of Inclusive Spaces in Museums
Authors: Rieger Janice , Kessler Charlotte , Strickfaden Megan
Published: June 2019

Since knowledge is the commodity museums produce, then understanding how this knowledge is produced, shaped, borrowed, and translated, and through what forces, is critical to creating inclusive museums. Through studies of three national Canadian museums, we came to an understanding of how the shaping of space, physical access, and access to knowledge is used and produced to create inclusive museums, not as a product but as an ongoing process. Doing dis/ordered mappings, as an alternate approach to understanding inclusion, allowed for an exploration of the material relations among people, spaces, and things, creating new trajectories and cartographic methods to explore inclusion within museums. This article introduces the benefits of the doing of mappings to explore differing embodiments of people, with and without disabilities, to create an alternative way to approach/encounter/create inclusion for all people and things in our public spaces.
Videoconference clinics improve efficiency of inflammatory bowel disease care in a remote and rural setting
Authors: Ruf Benjamin , Jenkinson Phillip , Armour David , Fraser Mhairi , Watson Angus JM
Published: June 2019

Introduction

Patients with inflammatory bowel disease (IBD) require long-term secondary care with periodic specialist follow-up. This can be especially challenging for patients living in remote areas. One possible solution is the implementation of videoconference (VC) clinics as a distance-management tool. Here we assessed the use of VC clinics for IBD in terms of patient safety and economic benefit for patients with IBD living in rural areas in the Scottish Highlands and Islands.

Methods

Eighty-eight patients participating in the IBD specialist nurses VC clinic administered via Raigmore Hospital, Inverness, Scotland, UK, between January 2016 and June 2017 were included in this study. A total of 229 appointments were assessed.

Results

We found the use of a VC clinic to be safe and effective as only 0.9% of appointments required urgent medical assessment and 92% of the VC clinic appointments resulted in further VC clinic follow-up. A total travelling distance of 72,245.3 km and a total travelling time of 71,688 minutes were saved in this patient cohort. It was shown that an average of US$36.61 of potential travelling cost could be saved per appointment.

Discussion

VC clinics represent a patient-centred participatory model of care for IBD patients living in remote areas with enormous time- and cost-saving potential while being safe and effective. Further investigations into patient satisfaction and the combination with other telemedicine tools such as telephone conferencing and mobile phone applications are needed to evaluate the full potential of the concept.
Culturally sensitive assessment of anxious-depressive distress in the Cambodian population: Avoiding category truncation
Authors: Hinton Devon E. , Seponski Desiree M. , Khann Sareth , Armes Stephanie E. , Lahar Cindy J. , Kao Sovandara , Schunert Tanja
Published: June 2019

In a large national survey in Cambodia (N = 2689), the present study investigated the prominence of certain culturally salient symptoms and syndromes in the general population and among those with anxious-depressive distress (as determined by the Hopkins Symptom Checklist-25, or HSCL). Using an abbreviated Cambodian Symptom and Syndrome Addendum (CSSA), we found that the CSSA complaints were particularly elevated among those with anxious-depressive distress. Those with anxious-depressive distress had statistically greater mean scores on all the CSSA items as well as severity of endorsement analyzed by percentage: among those with HSCL caseness, 75.3% were bothered “quite a bit” or “extremely” by “thinking a lot” (vs. 27.5% without caseness); 53.8% were bothered by “standing up and feeling dizzy” (vs. 13.8%); and 45.6% by blurry vision (vs. 16.8%). In a logistic regression analysis to predict anxious-depressive distress, 51% of the variance was accounted for by five predictors: “weak heart,” “thinking a lot,” dizziness, “ khyâl hitting up from the stomach,” and sleep paralysis. Using ROC analysis, a cut-off score of 1.81 on the CSSA was optimal as a screener to indicate anxious-depressive distress, giving a sensitivity of 0.86. The study results suggest that to avoid category truncation (i.e., the omission of key complaints that are part of an assessed distress domain) when profiling anxious-depressive distress among Cambodia population that items other than those in standard psychopathology measures should be assessed such as “thinking a lot,” “weak heart,” “blurry vision,” and “dizziness upon standing up.”
Contextual research for educational improvement: A collaborative process in Northern California
Authors: Baharav Hadar , Newman Elizabeth
Published: June 2019

Using an inquiry-based approach to address the challenge of improving schools provides opportunities for informed decision making and carries great promise for return on investment. Taking a collaborative approach toward improvement can be complex, yet also rewarding because of the opportunity to leverage the knowledge and capacity of multiple entities. The article presents an example of an education collaborative in Northern California that took an inquiry-based approach to their regional school improvement challenge of improving rates of college readiness and completion. The article provides insight into the structure, framework, and tools that were used to build and support the work of the collaborative, and reflects on the conditions that promote successful implementation of an inquiry-based approach to drive system change. Moreover, because each partner in the collaborative progressed through a unique process of inquiry and improvement, the article affords an opportunity to consider school improvement in multiple settings.
Untangling the cultural component behind the contextual placement of out-of-home advertising
Authors: Amirshahi Mirahmad , Jafari Dizicheh Samira , Wilson Rick T
Published: June 2019

Companies frequently place out-of-home advertisements in locations hoping their brand becomes associated with that environment’s favorable attributes. However, prior research using U.S. subjects suggested that these associative benefits do not actually transfer onto the advertised brand. We faithfully replicate this earlier research using a non-Western sample and find that culturally based communication and cognitive processing models may explain the lack of results in the earlier study and affirmative results in our study. Three experimental conditions are used: single exposure, multiple exposures, and high involvement. We find that a billboard’s external environment does influence brand evaluations but only in the single-exposure condition. A possible explanation for why results were not evident in the multiple exposure and high involvement conditions may be related to the amount of message elaboration across study conditions.